S781 Comparison of Surgical History and Reported Symptoms Between Patients With Concomitant IBD and IBS and Those With IBD Alone

Abstract

Introduction: While symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can often overlap, IBD patients with documented remission may continue to experience IBS symptoms of abdominal pain, bloating and altered bowel function. The aim of this study was to determine the history of surgical interventions and gastrointestinal symptoms of patients with concomitant IBD and IBS and compare with patients with IBD alone. Methods: We performed a population-based study using IBM Explorys database (1999-2022), a large deidentified healthcare database with information from over 300 hospitals across the United States. We identified patients with concomitant diagnosis of IBD and IBS (IBD+IBS). The control group consisted of patients with IBD without IBS. We collected surgical history and common gastrointestinal symptoms in both cohorts. The number of patients and respective percentages were tabulated. Odds ratios (OR) with 95% confidence intervals were used to compare the cohorts. Results: We identified a total of 366,420 patients with IBD, of which 38,650 (10.5%) patients were reported to have coexisting IBD and IBS, and 327,770 (89.5%) patients had IBD without a concurrent diagnosis of IBS (Table). Patients with both IBD and IBS are more likely to have undergone surgical intervention when compared to patients with IBD alone, including cholecystectomy (24.3 vs 9.9%), appendectomy (15.9% vs 7.7%), small intestine excision (3.3 vs 1.9 %), colectomy (17.2% vs 9.8%), rectal resection (5.1 vs 3.2%), hernia repair (11.5 vs 7.0%) and exploratory laparotomy (2.2 vs 1.1%) (all p value < 0.0001) (Figure). Compared to the patients with IBD alone, patients with coexisting IBD and IBS are more likely to report gastrointestinal symptoms, including abdominal pain (23.1-38.8% vs 8.1-15.2%), diarrhea (66.9% vs 33.2%), constipation 36.2% vs 16.4), bloating (0.9% vs 0.2%), hematochezia (16.2 vs 8.0%) and abnormal weight loss (19.2 vs 8.6%) (all p value < 0.0001). Conclusion: Surgery and gastrointestinal symptoms appear to be more common in patients with coexisting IBD and IBS when compared to patients with IBD alone. Clearly, much work remains to improve the symptomatic management of functional GI disorders. Targeted therapies may help to reduce the need for surgical intervention and improve the quality of life of patients with overlapping IBD and IBS.Figure 1.: Comparison of Surgical Interventions in IBD+IBS and IBD alone Table 1. - Comparison of Surgical History and Reported Symptoms Between Patients with Concomitant IBD and IBS and Those with IBD alone IBD with IBS (N=38650) % IBD without IBS (N=327770) % OR 95% CI P Surgeries Cholecystectomy 9390 24.3% 32380 9.9% 2.93 2.85-3.00 < 0.0001 Appendectomy 6140 15.9% 25190 7.7% 2.27 2.20-2.34 < 0.0001 Small intestine excision 1260 3.3% 6220 1.9% 1.74 1.64-1.85 < 0.0001 Colectomy 6650 17.2% 32170 9.8% 1.91 1.86-1.97 < 0.0001 Resection of rectum 1960 5.1% 10610 3.2% 1.60 1.52-1.68 < 0.0001 Hernia repair 4460 11.5% 22810 7.0% 1.74 1.69-1.80 < 0.0001 Exploratory laparotomy 860 2.2% 3460 1.1% 2.13 1.98-2.30 < 0.0001 Symptoms Upper abdominal pain 14990 38.8% 49690 15.2% 3.55 3.47-3.63 < 0.0001 Lower abdominal pain 12740 33.0% 43210 13.2% 3.24 3.16-3.32 < 0.0001 Central abdominal pain 11610 30.0% 36460 11.1% 3.43 3.35-3.52 < 0.0001 Generalized abdominal pain 10690 27.7% 34190 10.4% 3.28 3.20-3.37 < 0.0001 Right sided abdominal pain 10600 27.4% 35020 10.7% 3.16 3.08-3.24 < 0.0001 Left sided abdominal pain 8940 23.1% 26410 8.1% 3.43 3.34-3.53 < 0.0001 Diarrhea 25860 66.9% 108690 33.2% 4.08 3.99-4.17 < 0.0001 Constipation 13990 36.2% 53840 16.4% 2.89 2.82-2.95 < 0.0001 Bloating 330 0.9% 500 0.2% 5.64 4.90-6.48 < 0.0001 Hematochezia 6260 16.2% 26060 8.0% 2.24 2.17-2.31 < 0.0001 Abnormal weight loss 7420 19.2% 28230 8.6% 2.52 2.45-2.59 < 0.0001