Patients with celiac disease (CD) have an increased risk for irritable bowel syndrome (IBS) long before and after CD diagnosis, according to a study in Clinical Gastroenterology and Hepatology.
Researchers assessed the risk for IBS in patients with CD compared with a matched general population using data from the ESPRESSO cohort in Sweden.
Participants had an incident CD diagnosis from 2002 to 2017. Each patient with CD was matched based on age, sex, calendar year, and county of residence with as many as 5 comparators.
IBS was defined as having at least 1 International Classification of Diseases code in the Swedish National Patient Register. In sensitivity analyses, at least 2 diagnostic records of IBS or IBS listed as the main diagnosis were required.
IBS data were obtained through December 31, 2021. The main analysis was limited to a diagnosis of IBS at least 1 year before CD diagnosis.
Patients with CD (N=27,262) had a mean age at CD diagnosis of 31.8 years, and 63% were women. The matched comparators (n=132,922) had a mean age of 31.2 years, and 63% were women. The average follow-up was 11.1 years in the patients with CD vs 11.2 years in the matched comparators.
IBS was frequently diagnosed near CD diagnosis, although excluding the initial year after CD diagnosis and the same period for the comparators, 732 (2.7%) patients with CD were diagnosed with IBS during follow-up (incidence rate, 24.3; 95% CI, 22.5-26.0; per 10,000 person-years) vs 1131 (0.9%) matched comparators (7.6; 95% CI, 7.2-8.0; per 10,000 person-years). The finding resulted in more than a 3-fold increased risk for IBS (HR, 3.23; 95% CI, 2.94-3.55).
The results were comparable after adjustment for participants’ education level, country of birth, Charlson Comorbidity Index, and number of inpatient admissions between 1 and 2 years before the index date (adjusted HR [aHR], 3.11; 95% CI, 2.83-3.42).
A 2-fold increased risk for IBS was observed beyond 10 years of follow-up (aHR, 2.00; 95% CI, 1.63-2.45). The cumulative incidence of IBS diagnosis after 15 years was 3.2% (95% CI, 3.0%-3.4%) in patients with CD vs 1.1.% (95% CI, 1.0%-1.1%) in matched comparators, for an absolute risk difference of 2.1% (95% CI, 2.0%-2.2%).
In a comparison of 19,211 patients with CD with their 32,010 siblings, a significantly increased risk for IBS was observed beyond 1 year (aHR, 2.42; 95% CI, 2.08-2.82) and 10 years (aHR, 1.67; 95% CI, 1.20-2.32) after CD diagnosis.
Among 1398 patients with persistent villus atrophy, 38 (2.7%) had a later diagnosis of IBS vs 177 of 3812 (4.6%) patients with mucosal healing, for an aHR of 0.66 (95% CI, 0.46-0.95).
After exclusion of individuals with CD in the year before IBS diagnosis, patients had an average time from IBS diagnosis to CD diagnosis of 3.8 years (SD 4.5). More than a 3-fold increased risk for an IBS diagnosis before CD was observed (≥1 year before CD diagnosis; odds ratio 3.62; 95% CI, 3.03-4.34).
Among several limitations, no data were available for IBS-like symptoms, and the findings were based on inpatient and hospital-based outpatient diagnoses of IBS. Also, whether IBS risk varied according to adherence to a gluten-free diet was not analyzed, and data were lacking on what symptoms prompted the IBS diagnosis in patients with pre-existing CD and vice versa.
“Clinicians should be aware of these long-term associations and their implications on patient management,” the researchers noted.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
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