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The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study

Canavan, Caroline; Card, Timothy R.; West, Joe

Authors

Caroline Canavan

Dr TIM CARD tim.card@nottingham.ac.uk
Clinical Associate Professor

JOE WEST JOE.WEST@NOTTINGHAM.AC.UK
Professor of Epidemiology



Abstract

BACKGROUND: Guidelines recommend Irritable Bowel Syndrome (IBS) diagnosis and management in primary care with minimal investigations; however little evidence exists regarding risk of organic gastrointestinal conditions following diagnosis of IBS and how such risks vary over the long term. This study assesses excess incidence of coeliac disease, inflammatory bowel disease (IBD) and colorectal cancer (CRC) and variation with age and time after IBS diagnosis.

METHODS: IBS patients and controls were identified within the UK Clinical Practice Research Dataset. Incidence rates were calculated and stratified by age and time since IBS diagnosis with incident rate ratios generated.

RESULTS: Fifteen years after IBS diagnosis there is a significant cumulative excess incidence of coeliac disease, IBD and CRC in IBS of 3.7% compared to 1.7% in controls. For every 10000 patient years, IBS patients experienced an additional 4 diagnoses of coeliac disease, 13 of IBD and 4 CRCs. In each condition peak excess incidence was in the 6 months following diagnosis. After one year, increased incidence of coeliac disease remained consistent without variation by age. IBD incidence fell slowly, with higher rates in those under 30. CRC incidence was increased only in patients aged 30 to 74 during the first 5 years.

CONCLUSION: Some IBS patients later receive organic gastrointestinal diagnoses, with the early excess incidence likely detected during diagnostic investigation at the time of IBS diagnosis. More than 5 years after IBS diagnosis there is no increased risk of CRC compared to the general population, but a small excess risk of coeliac disease and IBD persists. Overall, though our findings provide reassurance that non-specialists, especially those in primary care, are unlikely to be missing an organic condition in the majority of their patients. This suggests that current guidelines suggesting avoidance of universal referral for these patients are appropriate.

Journal Article Type Article
Publication Date Sep 19, 2014
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 9
Issue 9
Article Number e106478
APA6 Citation Canavan, C., Card, T. R., & West, J. (2014). The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study. PLoS ONE, 9(9), doi:10.1371/journal.pone.0106478
DOI https://doi.org/10.1371/journal.pone.0106478
Publisher URL http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106478
Related Public URLs http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169512/
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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