Drug Exposure and Risk of Microscopic Colitis: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background and Objectives:</i></b> Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhoea and a normal radiological and endoscopic appearance. Concern regarding a potential association between drug exposure and MC has recently emerged. We sought to systematically review and summarize the evidence for the potential association. <b><i>Methods:</i></b> A systematic review and meta-analysis were performed to evaluate the incidence of MC associated with exposure to drug. The PubMed and Embase databases were searched to identify potential studies for inclusion. <b><i>Results:</i></b> Twelve case-control studies were included in the meta-analysis. The results showed exposure to NSAID (OR, 1.64; 95% CI: 1.14–2.37; <i>p</i> &#x3c; 0.001), PPI (OR, 2.36; 95% CI: 1.59–3.52; <i>p</i> &#x3c; 0.001), SSRI (OR, 2.16; 95% CI: 1.5–3.13; <i>p</i> &#x3c; 0.001), or aspirin (OR, 2.84; 95% CI: 1.4–5.76; <i>p</i> &#x3c; 0.001) was related to the incidence of MC; however, such relationships in PPI and SSRI may be modulated by the selection of controls. Furthermore, we did not found a positive association with other drug exposure and MC. <b><i>Conclusion:</i></b> This meta-analysis indicated that NSAID, PPI, SSRI, or aspirin consumption may increase the risk for MC. Further studies exploring drug-induced microscopic colitis should include control groups with diarrhoea and not only healthy controls.