Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Open. 2022 May 11;12(5):e052833. doi: 10.1136/bmjopen-2021-052833.
Ophthalmic conditions including anterior uveitis (AU), episcleritis and scleritis may occur in association with the inflammatory bowel diseases (IBD) as ophthalmic extraintestinal manifestations. The aim of this study was to assess the risk of a later IBD diagnosis in those presenting with IBD associated ocular inflammation (IAOI).
Retrospective cohort study.
Primary care UK database.
38 805 subjects with an IAOI were identified (median age 51 (38-65), 57% women) and matched to 153 018 subjects without IAOI.
The risk of a subsequent diagnosis of IBD in subjects with IAOIs compared with age/sex matched subjects without IAOI. HRs were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, baseline axial arthropathy, diarrhoea, loperamide prescription, anaemia, lower gastrointestinal bleeding and abdominal pain.Logistic regression was used to produce a prediction model for a diagnosis of IBD within 3 years of an AU diagnosis.
213 (0.6%) subsequent IBD diagnoses (102 ulcerative colitis (UC) and 111 Crohn's disease (CD)) were recorded in those with IAOIs and 329 (0.2%) (215 UC and 114 CD) in those without. Median time to IBD diagnosis was 882 (IQR 365-2043) days in those with IAOI and 1403 (IQR 623-2516) in those without. The adjusted HR for a subsequent diagnosis of IBD was 2.25 (95% CI 1.89 to 2.68), p<0.001; for UC 1.65 (95% CI 1.30 to 2.09), p<0.001; and for CD 3.37 (95% CI 2.59 to 4.40), p<0.001 in subjects with IAOI compared with those without.Within 3 years of an AU diagnosis, 84 (0.5%) subjects had a recorded diagnosis of IBD. The prediction model performed well with a C-statistic of 0.75 (95% CI 0.69 to 0.80).
Subjects with IAOI have a twofold increased risk of a subsequent IBD diagnosis. Healthcare professionals should be alert for potential signs and symptoms of IBD in those presenting with ophthalmic conditions associated with IBD.
眼部疾病包括前葡萄膜炎（AU）、表层巩膜炎和巩膜炎可能与炎症性肠病（IBD）同时发生，作为眼部肠外表现。本研究旨在评估那些伴有 IBD 相关眼部炎症（IAOI）的患者发生 IBD 后诊断的风险。
回顾性队列研究。
英国初级保健数据库。
确定了 38805 例 IAOI 患者（中位年龄 51（38-65）岁，57%为女性），并与 153018 例无 IAOI 的患者相匹配。
与无 IAOI 的年龄/性别匹配患者相比，IAOI 患者发生 IBD 后诊断的风险。使用 HR 调整了年龄、性别、体重指数、贫困程度、合并症、吸烟、基线轴向关节炎、腹泻、洛哌丁胺处方、贫血、下消化道出血和腹痛。使用逻辑回归为 AU 诊断后 3 年内的 IBD 诊断生成预测模型。
在 IAOI 患者中记录了 213 例（0.6%）后续 IBD 诊断（102 例溃疡性结肠炎（UC）和 111 例克罗恩病（CD）），在无 IAOI 患者中记录了 329 例（0.2%）（215 例 UC 和 114 例 CD）。IAOI 患者的中位 IBD 诊断时间为 882（IQR 365-2043）天，无 IAOI 患者为 1403（IQR 623-2516）天。IAOI 患者后续诊断为 IBD 的调整 HR 为 2.25（95%CI 1.89-2.68），p<0.001；UC 为 1.65（95%CI 1.30-2.09），p<0.001；CD 为 3.37（95%CI 2.59-4.40），p<0.001。与无 IAOI 的患者相比，IAOI 患者的风险更高。在 AU 诊断后 3 年内，84（0.5%）例患者有记录的 IBD 诊断。预测模型的 C 统计量为 0.75（95%CI 0.69-0.80），表现良好。
IAOI 患者发生 IBD 的风险增加一倍。医疗保健专业人员应警惕那些患有与 IBD 相关的眼部疾病的患者出现潜在的 IBD 症状和体征。
