Rancz Anett, Teutsch Brigitta, Obeidat Mahmoud, Walter Anna, Weidinger Gergő, Erőss Bálint, Hegyi Péter, Mihály Emese
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Department of Internal Medicine and Haematology, Semmelweis University, Medical School, Budapest, Hungary.
J Gastroenterol Hepatol. 2025 Sep;40(9):2148-2162. doi: 10.1111/jgh.70007. Epub 2025 Jul 17.
Microscopic colitis (MC) is still an underdiagnosed disease due to its primarily histological appearance. We aimed to address the scarcity and inconsistency of data on MC risk factors.
Our protocol was prospectively registered in PROSPERO (CRD42022286624). We systematically searched PubMed, Embase, and Cochrane from inception to January 6, 2025. Cohort, case-control, and cross-sectional studies were included. Controls were distinguished with or without a histopathological examination. We used the random-effect model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs).
The systematic search yielded 6493 articles, of which 45 were meta-analyzed. We found increased odds for MC in the case of nonsteroidal anti-inflammatory drug (NSAID) and statin use compared to histological (OR = 2.57, CI: 1.45-4.53; OR = 2.15, CI: 1.14-4.05) and random (OR = 2.56, CI: 1.13-5.79; OR = 1.84, CI: 0.58-5.80) controls. Our results did not show an association between proton pump inhibitors (PPIs) and MC, compared to histological controls (OR = 1.81, CI: 0.75-4.35), except in the case of random controls (OR = 4.31, CI: 1.66-11.20). Neither current (OR = 1.35, CI: 0.88-2.06) nor previous smoking (OR = 1.26, CI: 0.67-2.39) increased the odds of MC compared to histological controls. In contrast, the odds doubled for current smoking and slightly changed for past smoking when MC patients were compared to random controls (OR = 2.40, CI: 1.64-3.50; OR = 1.11, CI: 0.93-1.31).
NSAID and statin treatment were associated with an increased risk for MC compared to histological controls. PPIs and smoking showed only an association with MC when random controls were used.
显微镜下结肠炎（MC）因其主要的组织学表现，至今仍诊断不足。我们旨在解决MC危险因素数据的稀缺性和不一致性问题。
我们的方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42022286624）中进行了前瞻性注册。我们系统检索了从数据库建库至2025年1月6日的PubMed、Embase和Cochrane数据库。纳入队列研究、病例对照研究和横断面研究。对照组分为有或无组织病理学检查的两类。我们使用随机效应模型计算合并比值比（OR）及95%置信区间（CI）。
系统检索共获得6493篇文章，其中45篇进行了荟萃分析。我们发现，与组织学对照（OR = 2.57，CI：1.45 - 4.53；OR = 2.15，CI：1.14 - 4.05）和随机对照（OR = 2.56，CI：1.13 - 5.79；OR = 1.84，CI：0.58 - 5.80）相比，使用非甾体抗炎药（NSAID）和他汀类药物会增加患MC的几率。与组织学对照相比（OR = 1.81，CI：0.75 - 4.35），我们的结果未显示质子泵抑制剂（PPI）与MC之间存在关联，不过在随机对照中除外（OR = 4.31，CI：1.66 - 11.20）。与组织学对照相比，目前吸烟（OR = 1.35，CI：0.88 - 2.06）和既往吸烟（OR = 1.26，CI：0.67 - 2.39）均未增加患MC的几率。相比之下，与随机对照相比，MC患者目前吸烟的几率翻倍，既往吸烟的几率略有变化（OR = 2.40，CI：1.64 - 3.50；OR = 1.11，CI：0.93 - 1.31）。
与组织学对照相比，NSAID和他汀类药物治疗与MC风险增加相关。仅在使用随机对照时，PPI和吸烟才显示与MC有关联。
