Celiac Disease Increases Mortality Among Patients With Microscopic Colitis, Study Says

Celiac disease (CD) is a potential independent risk factor for increased mortality among patients with microscopic colitis (MC), according to a study published in The Saudi Journal of Gastroenterology.¹

MC is a persistent inflammatory bowel disease characterized by various symptoms, including chronic watery diarrhea, cramps, and nausea. The authors noted that diagnosing MC involves a thorough examination through a colonoscopy with biopsies to ensure that other conditions presenting with similar symptoms are excluded, namely CD; CD, an autoimmune disorder where gluten consumption leads to small intestine damage, has previously exhibited an association with MC in several past studies.²

Consequently, the researchers conducted a study to better understand this possible association and investigate its impact on patient mortality and hospitalizations.¹ To conduct their study, the researchers used the National Inpatient Sample (NIS) database, the largest publicly available all-payer inpatient health care database designed to produce both regional and national estimates of inpatient access, quality, cost, utilization, and outcomes.³

Celiac disease | Image Credit: tolikoffphotography - stock.adobe.com

“By examining prevalence, risk factors, potential connections, impact on mortality, and hospitalization length, this research contributes to a deeper understanding of the underlying mechanisms,” the authors wrote.¹ “Ultimately, these findings aid in the development of more targeted treatments for both diseases.”

Using NIS data from 2016 to 2019, the researchers identified patients with MC and/or CD based on the International Classification of Diseases, Tenth Revision codes. They then extracted the eligible patients’ baseline characteristics from the NIS database, including race, age, income, admission year, and hospital characteristics.

Of the 26,836,118 patients analyzed, 26,829,282 patients did not have MC; however, 31,756 of this population had CD. Conversely, the researchers found that 6836 patients had MC, 179 of whom also had CD. They determined that the rate of death was significantly higher (2.79% vs 0.99%; P = .019) among patients with both MC and CD than in those with MC and no CD.

Also, the mean (standard deviation [SD]) hospital stay was longer among patients with both MC and CD (5.42 [5.44] days; P = .202) than in those with MC and no CD (4.95 [4.66] days; P = .202); however, this was not statistically significant. Additionally, the researchers found that the coexisting presence of CD in patients with MC emerged as a significant, independent prognostic variable of in-hospital mortality in both the univariate (OR, 2.87; 95% CI, 1.14-7.21; P = .025) and multivariate analyses (OR, 3.37; 95% CI, 1.32-8.60; P .011).

The univariate analysis also revealed a significant association between CD and MC (OR, 22.69; 95% CI, 19.55, 26.33). The association remained significant in the multivariate analysis, which adjusted for potential confounders like age, race, and smoking status (OR, 15.71; 95% CI, 13.52-18.25; P < .0001). Overall, although the presence of CD in patients with MC did not significantly impact the mean hospital stay, the researchers determined that the results demonstrated a likely association between MC and CD as the presence of CD among patients with MC was linked to higher mortality.

The researchers acknowledged their limitations, one being that the study focuses solely on hospitalized patients; this may restrict the generalizability of their findings as it excludes those in outpatient settings. Also, the study’s retrospective design required them to rely on potentially inaccurately coded information. Despite these limitations, the researchers expressed confidence in their findings.

“Despite constraints, the study significantly contributes to understanding the link between MC and CD interactions, prompting future research to address limitations and provide further validation,” the authors wrote.

References

1. Altawili A, Albalawi MA, Albalawi SA, et al. Exploring the association between microscopic colitis and celiac disease: A comprehensive analysis using the national in-patient data (2016-2019). Saudi J Gastroenterol. doi:10.4103/sjg.sjg_92_24

2. Nimri FM, Muhanna A, Almomani Z, Khazaaleh S, Alomari M, Almomani L, et al. The association between microscopic colitis and celiac disease: A systematic review and meta‑analysis. Ann Gastroenterol 2022;35:281‑9. doi:10.20524/aog.2022.0714.

3. HCUP-US NIS Overview. hcup-us.ahrq.gov. Accessed May 8, 2024. https://hcup-us.ahrq.gov/nisoverview.jsp

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