The disease course in microscopic colitis may be influenced by hormonal factors

Abstract Background Microscopic colitis (MC) is characterized by non-bloody, watery diarrhea predominantly in elderly women. Known risk factors are smoking, medication with NSAIDs, PPIs or SSRIs, while data on hormonal factors is sparse. The aim of the present study was to investigate whether hormon...

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Main Authors: Klas Sjöberg, Lina Vigren, Marie-Rose Mellander, Izabella Janczewska, Hans Strid, Elisabeth Hultgren Hörnquist, Andreas Münch
Format: Article
Language:English
Published: BMC 2025-06-01
Series:BMC Gastroenterology
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Online Access:https://doi.org/10.1186/s12876-025-04083-8
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author Klas Sjöberg
Lina Vigren
Marie-Rose Mellander
Izabella Janczewska
Hans Strid
Elisabeth Hultgren Hörnquist
Andreas Münch
author_facet Klas Sjöberg
Lina Vigren
Marie-Rose Mellander
Izabella Janczewska
Hans Strid
Elisabeth Hultgren Hörnquist
Andreas Münch
author_sort Klas Sjöberg
collection DOAJ
description Abstract Background Microscopic colitis (MC) is characterized by non-bloody, watery diarrhea predominantly in elderly women. Known risk factors are smoking, medication with NSAIDs, PPIs or SSRIs, while data on hormonal factors is sparse. The aim of the present study was to investigate whether hormonal factors that disrupt the sex hormonal balance could have an impact on the disease course in MC. Methods A questionnaire was distributed to 384 women with microscopic colitis (MC) (mean age 64 years, range 35–90) from five centers in Sweden about demographic aspects including age at diagnosis, disease duration, treatment, and polycystic ovary syndrome, endometriosis, bilateral oophorectomy, previous or ongoing medication with hormones or in vitro fertilization (IVF) in relation to the disease course. Results The association with smoking could be verified. In relation to the disease course the odds ratio (OR) was higher for celiac disease and oral contraceptives but lower for hormone replacement therapy but for the two latter non-significant. However, bilateral oophorectomy had a significantly lower OR (0.41, CI 0.19–0.86, p = 0.019). No other factors had any substantial impact on the disease course. Conclusion An association was verified with smoking. Celiac disease may be associated with more active disease. The observed lower OR for more active disease after bilateral oophorectomy is in line with a previously suggested association between the risk of MC and the hormonal balance. The exact mechanisms behind the hormonal effect on the disease course found in the present study are although still obscure.
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spelling doaj-art-8a156404170441e691267eb0b5e64c9d2025-08-20T03:47:14ZengBMCBMC Gastroenterology1471-230X2025-06-012511610.1186/s12876-025-04083-8The disease course in microscopic colitis may be influenced by hormonal factorsKlas Sjöberg0Lina Vigren1Marie-Rose Mellander2Izabella Janczewska3Hans Strid4Elisabeth Hultgren Hörnquist5Andreas Münch6Department of Clinical Sciences, Lund UniversityDepartment of Clinical Sciences, Lund UniversityCentre for Digestive Health, IBD Unit, Stockholm University HospitalDepartment of Gastroenterology, Ersta HospitalGastroenterology unit, Centre for Digestive health, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University HospitalSchool of Medical Sciences, Örebro UniversityDepartment of Gastroenterology and Hepatology, Linköping UniversityAbstract Background Microscopic colitis (MC) is characterized by non-bloody, watery diarrhea predominantly in elderly women. Known risk factors are smoking, medication with NSAIDs, PPIs or SSRIs, while data on hormonal factors is sparse. The aim of the present study was to investigate whether hormonal factors that disrupt the sex hormonal balance could have an impact on the disease course in MC. Methods A questionnaire was distributed to 384 women with microscopic colitis (MC) (mean age 64 years, range 35–90) from five centers in Sweden about demographic aspects including age at diagnosis, disease duration, treatment, and polycystic ovary syndrome, endometriosis, bilateral oophorectomy, previous or ongoing medication with hormones or in vitro fertilization (IVF) in relation to the disease course. Results The association with smoking could be verified. In relation to the disease course the odds ratio (OR) was higher for celiac disease and oral contraceptives but lower for hormone replacement therapy but for the two latter non-significant. However, bilateral oophorectomy had a significantly lower OR (0.41, CI 0.19–0.86, p = 0.019). No other factors had any substantial impact on the disease course. Conclusion An association was verified with smoking. Celiac disease may be associated with more active disease. The observed lower OR for more active disease after bilateral oophorectomy is in line with a previously suggested association between the risk of MC and the hormonal balance. The exact mechanisms behind the hormonal effect on the disease course found in the present study are although still obscure.https://doi.org/10.1186/s12876-025-04083-8ContraceptivesEstrogenMHTMicroscopic colitisOophorectomySex hormones
spellingShingle Klas Sjöberg
Lina Vigren
Marie-Rose Mellander
Izabella Janczewska
Hans Strid
Elisabeth Hultgren Hörnquist
Andreas Münch
The disease course in microscopic colitis may be influenced by hormonal factors
BMC Gastroenterology
Contraceptives
Estrogen
MHT
Microscopic colitis
Oophorectomy
Sex hormones
title The disease course in microscopic colitis may be influenced by hormonal factors
title_full The disease course in microscopic colitis may be influenced by hormonal factors
title_fullStr The disease course in microscopic colitis may be influenced by hormonal factors
title_full_unstemmed The disease course in microscopic colitis may be influenced by hormonal factors
title_short The disease course in microscopic colitis may be influenced by hormonal factors
title_sort disease course in microscopic colitis may be influenced by hormonal factors
topic Contraceptives
Estrogen
MHT
Microscopic colitis
Oophorectomy
Sex hormones
url https://doi.org/10.1186/s12876-025-04083-8
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