Highlights
- •Symptoms of irritable bowel syndrome (IBS) are common reasons for endoscopic procedures.
- •We examined the yield of colonoscopy and upper endoscopy in IBS in a large cohort.
- •Inflammatory bowel disease, precancerous polyps, colorectal cancer, and celiac disease were all less common in IBS compared to controls.
- •Microscopic colitis was more common in IBS patients.
- •The yield of upper endoscopy and colonoscopy for organic disease is low in patients with a first-time diagnosis of IBS.
Abstract
Introduction
: Symptoms of irritable bowel syndrome (IBS) are common reasons for endoscopic procedures.
We examined the yield of colonoscopy and upper endoscopy in IBS for several organic
diseases.
Methods
: Matched population-based prevalence study in Sweden. We identified 21,944 participants
diagnosed with IBS from 1987 to 2016 undergoing colonoscopy with a biopsy from all
of Sweden's 28 pathology departments within 6 months of diagnosis. We compared prevalence
of histopathology-proven diagnoses of inflammatory bowel disease (IBD), colorectal
cancer, precancerous polyps, and microscopic colitis between patients recently diagnosed
with IBS and matched controls without IBS (n = 81,101) undergoing colonoscopy. We also compared prevalence of celiac disease between
patients diagnosed with IBS (n = 9,965) and matched controls (n = 45,584) undergoing upper endoscopy with biopsy. IBS patients were also compared
to their siblings. Conditioned logistic regression estimated adjusted odds ratios
(aORs).
Results
: Biopsy-proven IBD was seen in 1.6% of IBS and in 5.9% of controls (aOR=0.21; 95%CI=0.19–0.24).
The prevalence of precancerous polyps was 4.1% vs. 13.0% (aOR=0.28; 95%CI=0.26–0.30),
colorectal cancer 0.8% vs. 6.3% (aOR=0.17; 95%CI=0.14–0.20) and celiac disease 1.9%
vs. 3.4% (aOR=0.54; 95%CI=0.47–0.63). Conversely, the prevalence of microscopic colitis
was 2.9% vs. 1.7% (aOR=1.77; 95%CI=1.61–1.95), with higher prevalence in older patients
and patients with IBS with diarrhea. Yield of colonoscopy for precancerous polyps,
colorectal cancer, and microscopic colitis increased by age. Our findings were consistent
using unaffected siblings as the comparator group.
Discussion
: The diagnostic yield of upper endoscopy and colonoscopy for organic disease is low
in patients with a first-time diagnosis of IBS, though increases with age.
Keywords
Abbreviations:
CI (confidence interval), OR (Odds ratio), IBD (inflammatory bowel disease), IBS (irritable bowel syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 19, 2021
Accepted:
August 4,
2021
Received in revised form:
July 31,
2021
Received:
April 11,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
