Abstract
BackgroundGuidelines 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.MethodsIBS 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.ResultsFifteen 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.ConclusionSome 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.
Highlights
Irritable bowel syndrome (IBS) is a chronic functional condition affecting about 11% of the global population [1]
They did not compare this to diagnoses in the general population to assess any excess risk and there was no incident inflammatory bowel disease (IBD) or coeliac disease [13]
The most concerning differential diagnosis for physicians and patients is probably colorectal cancer (CRC) [7] and our study has reassuringly shown that incidence is no higher than the general population in young or elderly patients, and for those aged 30 to 74 years the excess incidence is very low after one year and disappears after 5 years following Irritable Bowel Syndrome (IBS) diagnosis
Summary
Irritable bowel syndrome (IBS) is a chronic functional condition affecting about 11% of the global population [1]. Changes in risk of diagnoses of IBD, coeliac disease and CRC over a long time period after a diagnosis of IBS in a general population has not been studied and variations in risk by age and sex are unknown. A community based study followed 112 patients with IBS for a median of 29 years after diagnosis to assess incidence of organic gastrointestinal disease and found 3.5% were subsequently diagnosed with gastrointestinal cancer between 13 and 30 years later They did not compare this to diagnoses in the general population to assess any excess risk and there was no incident IBD or coeliac disease [13]. 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
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