Nonsteroidal Anti-Inflammatory Drug exposure associated with development of microscopic colitis

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) were independently associated with the development of microscopic colitis.

Evidence Rating Level: 2 (Good)

Microscopic colitis, a type of chronic inflammatory bowel disease, is a common cause of abdominal pain and chronic diarrhea. In recent years, the incidence of microscopic colitis has significantly increased to levels comparable to Crohn’s disease and ulcerative colitis. It has been suggested that medications such as non-steroidal anti-inflammatory drugs (NSAIDs), proton-pump inhibitors (PPIs), and selective serotonin reuptake inhibitors (SSRIs) can contribute to the onset of microscopic colitis; however, the evidence behind this remains unclear. In this prospective cohort study, 144 patients prospectively evaluated for chronic diarrhea underwent colonoscopic evaluation and were assessed for their medication use and evidence of microscopic colitis on colonoscopy, in attempt to investigate the potential association between drug exposure and microscopic colitis. From these included patients, microscopic colitis was identified in a total of 80 individuals. Of these patients diagnosed, the use of aspirin and other NSAIDs was higher compared to those that were not diagnosed with microscopic colitis (OR 3.04, 95%CI 1.65-5.69). In conclusion, this study confirms that the use of NSAIDs is likely associated with the onset of microscopic colitis. Strengths of this study include its prospective design and use of a control group who had a similar presentation. However, this study remains limited due to its single center patient enrollment reducing generalizability to the broader population. As well, medication use data was obtained from patients through surveys, which may be not entirely accurate. Despite this, further research investigating medication use and its effect on the development of microscopic colitis should be conducted, considering the findings of this study.

Click to read the study in BMC Gastroenterology

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