Laith Al Momani, MD1, Mohammad Alomari, MD2, Zain Almomani, MBBCh3, Shrouq Khazaaleh, MD4, Fredy Nehme, MD1, Alisa Likhitsup, MD5; 1University of Missouri, Kansas City, MO; 2Cleveland Clinic Florida, Weston, FL; 3Jordan University of Science and Technology, Irbid, Irbid, Jordan; 4Cleveland Clinic Foundation, Johnson City, TN; 5St. Luke's Health System, Kansas City, MO
Introduction: Multiple studies have suggested that Celiac disease (CD) may be associated with microscopic colitis (MC); however, most of these studies were limited by their small sample size or the main scope of interest. Hence, we aimed to analyze the previously published literature on this association to determine the extent and significance of this relationship. Methods: A systemic review was conducted in PUBMED, Embase, PubMed Central and ScienceDirect databases from inception through May 2020. Effect estimates from the individual studies were extracted and combined using the random effect, generic inverse variance method of DerSimonian and Laird and a pooled odds ratio (OR) and event rates were calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques. Results: Fifteen studies with a total of 4640 patients with MC were included in this Analysis. CD was significantly associated with MC (OR 6.221, 95% CI, 3.828-10.108,P< 0.005). The pooled event rate for MC in patients with CD was 6.7% (4.4%-10.0%,P< 0.005), while the pooled event rate for celiac disease in patients with MC was 7.7% (4.6%-12.6%,P< 0.005). CD was prevalent in both types of MC; 5.4% (1.3%-20%,P< 0.005) in collagenous colitis and 9.1% (4.5%-17.3%,P< 005) in lymphocytic colitis. We found no publication bias as assessed by the funnel plots and Egger’s regression asymmetry test. Discussion: Our meta-analysis confirms a statistically significant association between CD and MC, with a high prevalence of CD in both types of MC. Gastroenterologists should be wary of this association when evaluating patients with either disease, particularly in patients with a sub-optimal response to first line therapy.
Forrest plot, pooled OR for the association between celiac disease and microscopic colitis
Disclosures: Laith Al Momani indicated no relevant financial relationships. Mohammad Alomari indicated no relevant financial relationships. Zain Almomani indicated no relevant financial relationships. Shrouq Khazaaleh indicated no relevant financial relationships. Fredy Nehme indicated no relevant financial relationships. Alisa Likhitsup indicated no relevant financial relationships.