Risk for Irritable Bowel Syndrome in Patients with Helicobacter Pylori Infection: A Nationwide Population-Based Study Cohort Study in Taiwan.

Chia-Ming Liang,Chi-Hsiang Chung,Wu-Chien Chien,Sheng-Der Hsu,Zhi-Jie Hong,Je-Ming Hu,Pi-Kai Chang,Lin-Yin Wang,Chao-Yang Chen,Chih-Hsiung Hsu

doi:10.3390/ijerph17103737

Abstract

Background: The association between Helicobacter pylori (H. pylori) infection and the risk of developing irritable bowel syndrome (IBS) has yet to be investigated; thus, we conducted this nationwide cohort study to examine the association in patients from Taiwan. Methods: A total of approximately 2669 individuals with newly diagnosed H. pylori infection and 10,676 age- and sex-matched patients without a diagnosis of H. pylori infection from 2000 to 2013 were identified from Taiwan’s National Health Insurance Research Database. The Kaplan–Meier method was used to determine the cumulative incidence of H. pylori infection in each cohort. Whether the patient underwent H. pylori eradication therapy was also determined. Results: The cumulative incidence of IBS was higher in the H. pylori-infected cohort than in the comparison cohort (log-rank test, p < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of IBS (adjusted hazard ratio (aHR) 3.108, p < 0.001). In addition, the H. pylori-infected cohort who did not receive eradication therapy had a higher risk of IBS than the non-H. pylori-infected cohort (adjusted HR 4.16, p < 0.001). The H. pylori-infected cohort who received eradication therapy had a lower risk of IBS than the comparison cohort (adjusted HR 0.464, p = 0.037). Conclusions: Based on a retrospective follow-up, nationwide study in Taiwan, H. pylori infection was associated with an increased risk of IBS; however, aggressive H. pylori infection eradication therapy can also reduce the risk of IBS. Further underlying biological mechanistic research is needed.

Highlights

Irritable bowel syndrome (IBS), a functional disorder of the gastrointestinal tract, is formalized in the Rome criteria, which include chronic abdominal pain and altered bowel habits [1]
After adjusting for H. pylori infection, sex, age group, insurance premium and pre-existing comorbidities, including sleep apnea, HTN, and only H. pylori infection (aHR = 3.108, 95% confidence interval (CI) = 1.934–4.995, p < 0.001), patients in the study cohort showed an increased risk of irritable bowel syndrome (IBS) diagnosis compared with the control cohort
The Kaplan–Meier analysis revealed that the study subjects had a significantly higher 14-year IBS rate than the controls after adjusting for potential confounders; this is further strong evidence for a potential association between IBS and H. pylori infection

Summary

Introduction

Irritable bowel syndrome (IBS), a functional disorder of the gastrointestinal tract, is formalized in the Rome criteria, which include chronic abdominal pain and altered bowel habits [1]. The association between Helicobacter pylori (H. pylori) infection and the risk of developing irritable bowel syndrome (IBS) has yet to be investigated; we conducted this nationwide cohort study to examine the association in patients from Taiwan. The H. pylori-infected cohort who did not receive eradication therapy had a higher risk of IBS than the non-H. pylori-infected cohort (adjusted HR 4.16, p < 0.001). The H. pylori-infected cohort who received eradication therapy had a lower risk of IBS than the comparison cohort (adjusted HR 0.464, p = 0.037). Conclusions: Based on a retrospective follow-up, nationwide study in Taiwan, H. pylori infection was associated with an increased risk of IBS; aggressive H. pylori infection eradication therapy can reduce the risk of IBS.

Methods

Results

Discussion

Conclusion