Fu Yuhan, Waghray Nisheet, Fass Ronnie, Song Gengqing
Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
Department of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
Diagnostics (Basel). 2023 May 29;13(11):1901. doi: 10.3390/diagnostics13111901.
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can present with overlapping symptoms, making diagnosis and management challenging. Patients with IBD in remission may continue to experience IBS symptoms. Patients with IBS were found to have a disproportionately higher prevalence of abdominal and pelvic surgeries than the general population.
The aim of this study was to determine whether IBS is a risk factor for undergoing surgical interventions in patients with IBD and explore the diagnostic implications of these findings.
A population-based cohort analysis was performed using TriNetX. Patients with Crohn's disease + IBS (CD + IBS) and ulcerative colitis + IBS (UC + IBS) were identified. The control groups consisted of patients with CD or UC alone without IBS. The main outcome was to compare the risks of undergoing surgical interventions between the cohorts. The secondary outcomes were to compare the risks of developing gastrointestinal symptoms and IBD-related complications between the cohorts.
Patients with IBD who subsequently developed IBS were more likely to experience gastrointestinal symptoms than those without IBS ( < 0.0001). Patients with concomitant IBD and IBS were more likely to develop IBD-related complications, including perforation of the intestine, gastrointestinal bleeding, colon cancer, and abdominal abscess ( < 0.05). Patients with concomitant IBD and IBS were more likely to undergo surgical interventions than patients without IBS, including colectomy, appendectomy, cholecystectomy, exploratory laparotomy, and hysterectomy ( < 0.05).
IBS appears to be an independent risk factor for patients with IBD to develop IBD-related complications and undergo surgical interventions. Patients with concomitant IBD and IBS could represent a unique subgroup of IBD patients with more severe symptoms, highlighting the importance of accurate diagnosis and management in this population.
炎症性肠病（IBD）和肠易激综合征（IBS）可能表现出重叠症状，这使得诊断和管理具有挑战性。处于缓解期的IBD患者可能会持续出现IBS症状。研究发现，IBS患者腹部和盆腔手术的患病率比普通人群高得多。
本研究的目的是确定IBS是否是IBD患者接受手术干预的危险因素，并探讨这些发现的诊断意义。
使用TriNetX进行基于人群的队列分析。确定患有克罗恩病+IBS（CD+IBS）和溃疡性结肠炎+IBS（UC+IBS）的患者。对照组由仅患有CD或UC而无IBS的患者组成。主要结果是比较队列之间接受手术干预的风险。次要结果是比较队列之间出现胃肠道症状和IBD相关并发症的风险。
随后出现IBS的IBD患者比没有IBS的患者更有可能出现胃肠道症状（<0.0001）。合并IBD和IBS的患者更有可能发生IBD相关并发症，包括肠穿孔、胃肠道出血、结肠癌和腹腔脓肿（<0.05）。合并IBD和IBS的患者比没有IBS的患者更有可能接受手术干预，包括结肠切除术、阑尾切除术、胆囊切除术、剖腹探查术和子宫切除术（<0.05）。
IBS似乎是IBD患者发生IBD相关并发症和接受手术干预的独立危险因素。合并IBD和IBS的患者可能代表症状更严重的IBD患者的一个独特亚组，突出了在这一人群中准确诊断和管理的重要性。
