Enteric Diseases Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, USA.
BMC Gastroenterol. 2012 May 28;12:55. doi: 10.1186/1471-230X-12-55.
Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) symptoms often overlap. In some IBS cases there are subtle inflammatory changes similar to the immune-mediated pathophysiology of IBD, and the risk of both increases after infectious gastroenteritis (IGE).
To evaluate the effect of IBS and IGE on IBD risk utilizing US Department of Defense medical encounter data, active duty personnel with IBS were matched to subjects without IBS. Medical encounter history was analyzed to assess for incident IBD. IGE was identified from documented medical encounters and by self-report. Relative risks were calculated using Poisson regression models.
We identified 9,341 incident IBS cases and 18,678 matched non-IBS subjects and found an 8.6-fold higher incidence (p < 0.0001) of IBD among those with IBS (238.1 per 100,000 person-years) compared to our referent population (27.8 per 100,000 person-years). In a subset (n = 2,205) of well-defined IBS cases, IBD risk was 15 times that of subjects without IBS. The median time between IBS and IBD diagnoses was 2.1 years. IGE also increased IBD risk approximately 2-fold ( p < 0.05) after controlling for IBS.
These data reflect a complex interaction between illness presentation and diagnosis of IBS and IBD and suggest intercurrent IGE may increase IBD risk in IBS patients. Additional studies are needed to determine whether IBS lies on the causal pathway for IBD or whether the two are on a pathophysiological spectrum of the same clinical illness. These data suggest consideration of risk reduction interventions for IGE among IBS patients at high disease risk.
肠易激综合征（IBS）和炎症性肠病（IBD）的症状经常重叠。在某些 IBS 病例中，存在类似于 IBD 的免疫介导病理生理学的细微炎症变化，并且在感染性胃肠炎（IGE）后，两者的风险都会增加。
利用美国国防部医疗遭遇数据评估 IBS 和 IGE 对 IBD 风险的影响，将 IBS 患者与无 IBS 的患者进行匹配。分析医疗遭遇史以评估是否有 IBD 事件发生。通过记录的医疗遭遇和自我报告来确定 IGE。使用泊松回归模型计算相对风险。
我们确定了 9341 例新发 IBS 病例和 18678 例匹配的非 IBS 患者，发现 IBS 患者的 IBD 发病率高 8.6 倍（p<0.0001）（238.1/100000 人年），而我们的参照人群为 27.8/100000 人年。在一个（n=2205）定义明确的 IBS 病例亚组中，IBD 风险是无 IBS 患者的 15 倍。IBS 和 IBD 诊断之间的中位时间为 2.1 年。在控制 IBS 后，IGE 也使 IBD 风险增加了近 2 倍（p<0.05）。
这些数据反映了 IBS 和 IBD 的疾病表现和诊断之间的复杂相互作用，并表明并发 IGE 可能会增加 IBS 患者的 IBD 风险。需要进一步的研究来确定 IBS 是否处于 IBD 的因果途径上，或者两者是否处于同一临床疾病的病理生理谱上。这些数据表明，对于高疾病风险的 IBS 患者，应考虑针对 IGE 的风险降低干预措施。
