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Original research
High risk of microscopic colitis after Campylobacter concisus infection: population-based cohort study
  1. Hans Linde Nielsen1,2,
  2. Michael Dalager-Pedersen2,3,
  3. Henrik Nielsen2,3
  1. 1 Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
  2. 2 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  3. 3 Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
  1. Correspondence to Hans Linde Nielsen, Department of Clinical Microbiology, Aalborg University Hospital, Aalborg 9000, Denmark; halin{at}


Objective Microscopic colitis (MC) encompasses the two histopathological distinct entities of collagenous colitis (CC) and lymphocytic colitis (LC). In this Danish population-based cohort study, we examined the risk of MC following stool culture with Campylobacter concisus, C. jejuni, non-typhoidal Salmonella or a culture-negative stool test.

Design We identified patients with a first-time positive stool culture with C. concisus, C. jejuni, non-typhoidal Salmonella or negative stool test, from 2009 through 2013 in North Denmark Region, Denmark, and matched each with 10 population comparisons. All subjects were followed up until 1 March 2018 using Systematised Nomenclature of Medicine codes from The Danish Pathology Register for incident diagnoses of CC and LC. We computed risk and adjusted HRs with 95% CIs for MC among patients and comparisons.

Results We identified 962 patients with C. concisus, 1725 with C. jejuni, 446 with Salmonella and 11 825 patients with culture-negative stools. The MC risk and HR versus comparisons were high for patients with C. concisus (risk 6.2%, HR 32.4 (95% CI 18.9 to 55.6)), less for C. jejuni (risk 0.6%, HR 3.7 (95% CI 1.8 to 7.7)), low for Salmonella (risk 0.4%, HR 2.2 (95% CI 0.5 to 10.8)) and for patients with negative stool testing (risk 3.3%, HR 19.6 (95% CI 16.4 to 23.4)). After exclusion of the first year of follow-up, the HRs were 9.3 (95% CI 4.1 to 20.1), 2.2 (95% CI 0.9 to 5.4), 1.3 (95% CI 0.2 to 11.1) and 5.6 (95% CI 4.6 to 7.2), respectively.

Conclusion A high risk of MC was observed following C. concisus in stools. Further studies are needed to elucidate any underlying biological mechanisms.

  • Campylobacter concisus
  • Campylobacter jejuni
  • Salmonella
  • microscopic colitis
  • collagenous colitis
  • lymphocytic colitis

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  • Contributors HLN, MD-P and HN initiated the study. MD-P and HLN applied for permissions from the Danish Data Protection Agency and the Danish Patient Safety Authority. HLN performed the data collection, and MD-P performed the statistical analysis. HLN drafted the manuscript, which was critically revised by all authors. All authors contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency (reference number 2008-58-0028) and by the Danish Patient Safety Authority (reference number 3-3013-2314/1). According to Danish law, individual consent is not required for registry-based studies and approval by the ethics committee is not applicable.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary material.