Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Clin Gastroenterol Hepatol. 2009 Nov;7(11):1210-6. doi: 10.1016/j.cgh.2009.07.011. Epub 2009 Jul 22.
BACKGROUND & AIMS: Microscopic colitis has been associated with celiac disease. We aimed to determine the extent and significance of this relationship.
A prospectively maintained database of celiac disease patients, seen between 1981 and 2006, was analyzed. Standardized morbidity ratios (SMR) were calculated using a general population study of microscopic colitis as the reference group. Statistical analysis was conducted using the Student t test, Pearson chi(2) test, or Fisher exact test.
Microscopic colitis was found in 44 of 1009 patients (4.3%); this represented a 70-fold increased risk for individuals with celiac disease to have microscopic colitis, compared with the general population (SMR, 72.39; 95% confidence interval [CI], 52.52-95.36). The celiac disease patients with microscopic colitis were older (P = .0001) and had more severe villous atrophy (P = .002) than the celiac disease patients without microscopic colitis. Microscopic colitis was diagnosed after celiac disease in 64% of the patients, simultaneously in 25%, and before celiac disease in 11% (P = .0001). Pancolitis predominated, though 16% had colitis limited to the right colon. Steroid or immunosuppressant therapies were required in 66% of the celiac disease patients with microscopic colitis and given as maintenance therapy to 50% of these patients. Follow-up biopsies revealed that the colitis persisted in 57% of the patients with celiac disease and microscopic colitis, despite improved diarrhea symptoms; the diarrhea resolved in most of the patients.
Microscopic colitis is more common in patients with celiac disease than in the general population. Patients with celiac disease and microscopic colitis have more severe villous atrophy and frequently require steroids or immunosuppressant therapies to control diarrhea.
显微镜下结肠炎与乳糜泻有关。我们旨在确定这种关系的程度和意义。
分析了 1981 年至 2006 年间观察到的乳糜泻患者的前瞻性维护数据库。使用显微镜下结肠炎的一般人群研究作为参考组计算标准化发病比（SMR）。使用学生 t 检验、Pearson χ²检验或 Fisher 确切检验进行统计分析。
在 1009 例患者中发现 44 例（4.3％）显微镜下结肠炎；与普通人群相比，乳糜泻患者发生显微镜下结肠炎的风险增加了 70 倍（SMR，72.39；95％置信区间[CI]，52.52-95.36）。患有显微镜下结肠炎的乳糜泻患者年龄较大（P =.0001），并且绒毛萎缩更为严重（P =.002）。在 64％的患者中，显微镜下结肠炎在乳糜泻后诊断，25％的患者同时诊断，11％的患者在乳糜泻前诊断（P =.0001）。虽然 16％的结肠炎局限于右结肠，但结肠炎以全结肠炎为主。66％的乳糜泻合并显微镜下结肠炎患者需要类固醇或免疫抑制剂治疗，其中 50％的患者给予维持治疗。随访活检显示，尽管腹泻症状改善，但 57％的乳糜泻合并显微镜下结肠炎患者的结肠炎仍持续存在；大多数患者的腹泻缓解。
显微镜下结肠炎在乳糜泻患者中比在普通人群中更为常见。患有乳糜泻和显微镜下结肠炎的患者绒毛萎缩更为严重，常需要类固醇或免疫抑制剂治疗来控制腹泻。
