Am J Gastroenterol. 2024 Jul 12. doi: 10.14309/ajg.0000000000002955. Online ahead of print.

David Bergman ¹, Bjorn Roelstraete ¹, Jiangwei Sun ¹, Fahim Ebrahimi ^1 2, Agnieszka Butwicka ¹, Darrell S Pardi ³, Jonas F Ludvigsson ¹

Author information

¹Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

²Department of Gastroenterology and Hepatology, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.

³Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Abstract

Introduction: Microscopic colitis (MC) is an inflammatory condition of the large intestine. Primarily diagnosed in middle-aged and older adults, the incidence of the disease has increased markedly during the past decades. While MC is associated with a reduced quality of life, large-scale studies on the association with future psychiatric disorders are lacking.

Methods: We conducted a nationwide matched cohort study in Sweden from 2006 to 2021. Through a nationwide histopathology database (the ESPRESSO study), we identified 5,816 patients with a colorectal biopsy consistent with MC. These patients were matched with 21,509 reference individuals from the general population, all of whom with no previous record of psychiatric disorders.

Results: From 2006-2021, 519 patients with MC (median age 64.4 years (interquartile range = 49.5-73.3)) and 1,313 reference individuals were diagnosed with psychiatric disorders (9.9 vs. 6.5 events per 1,000 person-years), corresponding to one extra case of psychiatric disorder in 29 patients with MC over 10 years. After adjustments, the hazard ratio (HR) for psychiatric disorders was 1.57 (95% confidence interval [CI]=1.42-1.74). We found significantly elevated estimates up to 10 years after MC diagnosis and a trend towards higher risk with increasing age. Specifically, we observed increased risks for unipolar depression, anxiety disorders, stress-related disorders, substance abuse, and suicide attempts.In sibling-controlled analysis the aHR was 1.76 (95%CI=1.44-2.15).

Conclusion: Patients with MC are at increased risk of incident psychiatric disorders compared to the general population.