Drug consumption and the risk of microscopic colitis

BACKGROUND: Microscopic colitis is a rare disease of unknown etiology. It has been described that some drugs could cause or worsen the disease; however, the scientific evidence is limited. AIM: To investigate the possible association of chronic drug consumption with microscopic colitis. METHODS: This was a case-control study in which groups of cases were: Group 1-39 patients with collagenous colitis; Group 2-39 patients with lymphocytic colitis; and Group 3-52 patients with chronic watery diarrhea of functional characteristics. 103 subjects formed the control group. At diagnosis, a drug consumption history of at least 2-wk duration was registered. An age- and sex-adjusted logistic regression analysis was used, and the odds ratio (OR, 95% Cl) was calculated. RESULTS: Drug consumption was more frequent in lymphocytic colitis than in the control group (92.3% vs 76.3%, P < 0.05). The mean daily number of drugs by person was also higher in lymphocytic colitis (3.79 +/- 0.44 vs 2.13 +/- 0.22, P = 0.04). The following associations as compared with the control group were observed: Group I-Consumption of NSAIDs (46.2% vs 23%, OR 2.9, :1.3 - 6.4), selective serotonin reuptake inhibitors (SSRIs) (18% vs 1%, OR 21, 2.5 - 177), specifically, sertraline (15.4% vs 0%, P < 0.0005); Group 2-SSRIs (28% vs 1%, OR 37.7, 4.7-304), beta-blockers (13 vs 3%, OR 4.79, 1.04 - 20), statins (13% vs 3%, OR 4.6, 1.04 - 20), biphosphonates (8% vs 0%, P = 0.022); Group 3-SSRIs (15% vs 1%, OR 16.2, 2 - 135), statins (11.5% vs 3%, OR 5.4, 1.2 - 24). As compared with the chronic diarrhea group, a significant association with the usage of sertraline in LC (P = 0.005) and a trend for NSAIDs in CC (P = 0.057) were found. CONCLUSIONS: Drug consumption increases the risk of microscopic colitis. Some drugs might be trigger factors of colonic inflammation in predisposed hosts, and others might only worsen self-evolving microscopic colitis.