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INSIGHTS FROM THE POLISH REGISTRY OF MICROSCOPIC COLITIS: ANALYSIS OF THE FIRST 165 PATIENTS ACROSS NINE ACADEMIC GASTROENTEROLOGY REFERENCE CENTERS IN POLAND

Arkadiusz Bielski 1, Wojciech Marlicz 2, Ewa Malecka-Wojciesko 3, Jaroslaw Regula 4,5, Andrzej Mroz 6, Malgorzata Maria Zwolinska-Wcislo 7, Dorota Wasko-Czopnik 8, Piotr Eder 9, Jaroslaw Daniluk 10, Mariusz Rosolowski 11, Grazyna Rydzewska Wyszkowska 1,12

Affiliations

1 Department of Internal Medicine and Gastroenterology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland

2 Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland

3 Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland

4 Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland

5 Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

6 Department of Pathology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland

7 Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Krakow, Poland

8 Department of Gastroenterology and Hepatology, Medical University of Wroclaw, Wroclaw, Poland

9 Department of Gastroenterology, Dietetics, and Internal Medicine, Poznan University of Medical Sciences, Heliodor Swiecicki University Hospital, Poznan, Poland

10 Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland

11 Department of Hypertension, Gastroenterology, and Internal Medicine, Medical University of Bialystok Clinical Hospital, Bialystok, Poland

12 Collegium Medicum of Jan Kochanowski University, Kielce, Poland

Summary

AI Generated

The Polish Registry of Microscopic Colitis reports clinical characteristics and treatment outcomes in 165 patients across nine academic centers, finding budesonide MMX achieved 92.4% improvement rates and lymphocytic colitis was the most common subtype.

Among 165 patients, lymphocytic colitis was most common (66.7%), followed by collagenous colitis (24.1%) and incomplete colitis (9.3%), with median age at diagnosis of 57 years and 3.5-fold female predominance.
Budesonide MMX showed highest treatment efficacy with 92.4% of 92 patients reporting improvement, while budesonide achieved 91.3% improvement in 23 patients; loperamide, rifaximine, mesalazine, and probiotics showed lower response rates ranging from 27.8% to 50.0%.
Predominant symptoms included watery diarrhea (86.1%), fecal urgency (66.1%), bloating (62.4%), and abdominal pain (58.8%), with one-third reporting abdominal pain meeting Rome IV criteria for irritable bowel syndrome.
Normal colonoscopy findings occurred in 71.5% of patients, average diagnostic delay was approximately 3 years from symptom onset, and three patients with severe disease were successfully treated with adalimumab.
This multicenter registry addresses a gap in Polish epidemiological data on microscopic colitis and may inform clinicians managing chronic watery diarrhea and gastroenterologists considering treatment options for microscopic colitis.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Microscopic colitis (MC) represents a spectrum of chronic inflammatory bowel diseases (IBD) characterized by chronic watery diarrhea and distinctive histologic features. The data concerning the epidemiology of microscopic colitis in Poland are non-existing or scarce.

Aims & Methods

The Polish Registry of Microscopic Colitis was established to better understand the clinical characteristics, treatment patterns, and outcomes of MC patients in Poland.
We present retrospective and prospective data findings from the initial cohort of 165 patients enrolled in the registry, spanning nine academic gastroenterology centers across Poland. Data collection included demographics, clinical presentation, histopathological features, treatment modalities, and clinical outcomes.

Results

The median age at diagnosis was 57 years, with 36% of patients diagnosed before age 45. The majority (80%) had a prior MC diagnosis, with an average delay of approximately 3 years from symptom onset to diagnosis. MC occurred 3.5 times more frequently in women. Lymphocytic colitis (LC) was the most common subtype (66.7%), followed by collagenous colitis (CC) (24.1%) and incomplete colitis (IC) (9.3%). Women were more predisposed to CC. Normal colonoscopy results were observed in 71.5% of patients. Approximately 48% were active or former smokers, with smokers more likely to have CC. Predominant symptoms included watery diarrhea (86.1%), fecal urgency (66.1%), abdominal pain (58.8%), and bloating (62.4%). Weight loss during exacerbation of symptoms was reported in nearly one-fifth of patients. One-third of MC patients reported abdominal pain consistent with Rome IV criteria for irritable bowel syndrome (IBS) during medical interviews. Additionally, nearly half of the patients had a confirmed Covid-19 infection based on authorized testing. Budesonide MMX demonstrated the highest efficacy (92.4% reported improvement), with other treatment modalities showing varied effectiveness. Three patients with severe MC were successfully treated with adalimumab.

	Number of patients using treatment	Number of patients reporting improvement after treatment	Number of patients reporting no improvement after treatment	Improvement after treatment (in percentage)
Budesonide MMX	92	85	7	92.4%
Budesonide	23	21	2	91.3%
Loperamide	34	15	19	44.1%
Mesalazine	18	5	13	27.8%
Rifaximine	40	20	20	50.0%
Probiotics	45	15	30	33.3%

Table 1. Polish Microscopic Colitis Registry. The effectiveness of treatment following therapies.

Conclusion

The Polish Registry of Microscopic Colitis provides comprehensive insights into the clinical features and treatment outcomes of MC in Poland. Budesonide MMX emerged as an effective treatment option, while biologic therapy showed promise in refractory cases. Our findings suggest a potential overlap of symptoms between MC and IBS, highlighting the importance of thorough clinical assessment. Our findings inform evidence-based practice and highlight the importance of multidisciplinary collaboration in MC management. The multicenter nature of the Polish MC Registry provides a comprehensive overview of real-world practices and outcomes, facilitating future research and the development of standardized management strategies for this understudied condition.

References

Miehlke S., Guagnozzi D., Zabana Y. et al.: European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol. J., 2021; 9: 13–37.
Larsson JK, Clarkson S, Sjoberg K: Regional differences in the incidence of lymphocytic and collagenous colitis over time. Scand J Gastroenterol. 2023; 58(12):1445-1452.
Weimers P, Vedel Ankersen D, Lophaven SN et al. Microscopic Colitis in Denmark: Regional Variations in Risk Factors and Frequency of Endoscopic Procedures. J Crohns Colitis. 2022; 16(1):49-5

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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