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Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987–2016

  • Kyle Staller
    Affiliations
    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States
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  • Ola Olén
    Affiliations
    Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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  • Jonas Söderling
    Affiliations
    Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden

    Broad Institute, Cambridge, MA, United States
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  • Bjorn Roelstraete
    Affiliations
    Broad Institute, Cambridge, MA, United States
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  • Hans Törnblom
    Affiliations
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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  • Hamed Khalili
    Affiliations
    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States

    Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden

    Broad Institute, Cambridge, MA, United States
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  • Mingyang Song
    Affiliations
    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States

    Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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  • Jonas F Ludvigsson
    Correspondence
    Corresponding author at: Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Affiliations
    Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom

    Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States

    Department of Paediatrics, Örebro University Hospital, Sweden
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Published:August 19, 2021DOI:https://doi.org/10.1016/j.ejim.2021.08.001

      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)
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      References

        • Lovell R.M.
        • Ford A.C.
        Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.
        Clin Gastroenterol Hepatol. 2012; 10 (e4): 712-721
        • Staller K.
        • Olen O.
        • Soderling J.
        • Roelstraete B.
        • Tornblom H.
        • Khalili H.
        • et al.
        Mortality risk in irritable bowel syndrome: results from a nationwide prospective cohort study.
        Am J Gastroenterol. 2020;
        • Wells N.E.
        • Hahn B.A.
        • Whorwell P.J.
        Clinical economics review: irritable bowel syndrome.
        Aliment Pharmacol Ther. 1997; 11: 1019-1030
        • Levy R.L.
        • Von Korff M.
        • Whitehead W.E.
        • Stang P.
        • Saunders K.
        • Jhingran P.
        • et al.
        Costs of care for irritable bowel syndrome patients in a health maintenance organization.
        Am J Gastroenterol. 2001; 96: 3122-3129
        • Lieberman D.A.
        • Williams J.L.
        • Holub J.L.
        • Morris C.D.
        • Logan J.R.
        • Eisen G.M.
        • et al.
        Colonoscopy utilization and outcomes 2000 to 2011.
        Gastrointest Endosc. 2014; 80: 133-143
        • Canavan C.
        • West J.
        • Card T.
        Review article: the economic impact of the irritable bowel syndrome.
        Aliment Pharmacol Ther. 2014; 40: 1023-1034
        • Chey W.D.
        • Nojkov B.
        • Rubenstein J.H.
        • Dobhan R.R.
        • Greenson J.K.
        • Cash B.D.
        The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial.
        Am J Gastroenterol. 2010; 105: 859-865
        • Patel P.
        • Bercik P.
        • Morgan D.G.
        • Bolino C.
        • Pintos-Sanchez M.I.
        • Moayyedi P.
        • et al.
        Prevalence of organic disease at colonoscopy in patients with symptoms compatible with irritable bowel syndrome: cross-sectional survey.
        Scand J Gastroenterol. 2015; 50: 816-823
        • Gu H.X.
        • Zhang Y.L.
        • Zhi F.C.
        • Jiang B.
        • Huang Y.
        Organic colonic lesions in 3,332 patients with suspected irritable bowel syndrome and lacking warning signs, a retrospective case–control study.
        Int J Colorectal Dis. 2011; 26: 935-940
        • Chang H.C.
        • Yen A.M.
        • Fann J.C.
        • Chiu S.Y.
        • Liao C.S.
        • Chen H.H.
        • et al.
        Irritable bowel syndrome and the incidence of colorectal neoplasia: a prospective cohort study with community-based screened population in Taiwan.
        Br J Cancer. 2015; 112: 171-176
        • Guagnozzi D.
        • Arias A.
        • Lucendo A.J.
        Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders.
        Aliment Pharmacol Ther. 2016; 43: 851-862
        • Hilpusch F.
        • Johnsen P.H.
        • Goll R.
        • Valle P.C.
        • Sorbye S.W.
        • Abelsen B.
        Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome.
        Scand J Gastroenterol. 2017; 52: 173-177
        • Kamp E.J.
        • Kane J.S.
        • Ford A.C.
        Irritable bowel syndrome and microscopic colitis: a systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2016; 14 (e1quiz e54-5): 659-668
        • Irvine A.J.
        • Chey W.D.
        • Ford A.C.
        Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis.
        Am J Gastroenterol. 2017; 112: 65-76
        • Sanders D.S.
        • Patel D.
        • Stephenson T.J.
        • Ward A.M.
        • McCloskey E.V.
        • Hadjivassiliou M.
        • et al.
        A primary care cross-sectional study of undiagnosed adult coeliac disease.
        Eur J Gastroenterol Hepatol. 2003; 15: 407-413
        • Ludvigsson J.F.
        • Lashkariani M.
        Cohort profile: ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden).
        Clin Epidemiol. 2019; 11: 101-114
        • Svensson M.
        • Bergman D.
        • Olen O.
        • Myrelid P.
        • Bohr J.
        • Wickbom A.
        • et al.
        Validating microscopic colitis (MC) in Swedish pathology registers.
        Scand J Gastroenterol. 2018; 53: 1469-1475
        • Ludvigsson J.F.
        • Brandt L.
        • Montgomery S.M.
        • Granath F.
        • Ekbom A.
        Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers.
        BMC Gastroenterol. 2009; 9: 19
        • Nguyen L.H.
        • Ö A.K.
        • Y. C.
        • Simon T.G.
        • Roelstraete B.
        • Song M.
        • et al.
        Antibiotic use and the development of inflammatory bowel disease: a national case/control study in Sweden.
        Lancet Gastroenterol Hepatol. 2020;
        • Bozorg S.R.
        • Song M.
        • Emilsson L.
        • Ludvigsson J.F.
        Validation of serrated polyps (SPs) in Swedish pathology registers.
        BMC Gastroenterol. 2019; 20: 3
        • Ludvigsson J.F.
        • Almqvist C.
        • Bonamy A.K.
        • Ljung R.
        • Michaelsson K.
        • Neovius M.
        • et al.
        Registers of the Swedish total population and their use in medical research.
        Eur J Epidemiol. 2016; 31: 125-136
        • Ludvigsson J.F.
        • Svedberg P.
        • Olen O.
        • Bruze G.
        Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research.
        Eur J Epidemiol. 2019; 34: 423-437
        • Ludvigsson J.F.
        • Andersson E.
        • Ekbom A.
        • Feychting M.
        • Kim J.L.
        • Reuterwall C.
        • et al.
        External review and validation of the Swedish national inpatient register.
        BMC Public Health. 2011; 11: 450
        • Jossan N.
        • Backman A.S.
        • Linder M.
        • Altman M.
        • Simren M.
        • O. O.
        • et al.
        Validation of the Use of the ICD-10 Diagnostic Code for Irritable Bowel Syndrome in the Swedish National Patient Register.
        Gastroenterology. 2014; 146: S543
        • Siegel R.L.
        • Fedewa S.A.
        • Anderson W.F.
        • Miller K.D.
        • Ma J.
        • Rosenberg P.S.
        • et al.
        Colorectal Cancer Incidence Patterns in the United States, 1974-2013.
        J Natl Cancer Inst. 2017; 109
        • Ludvigsson J.F.
        • Haberg S.E.
        • Knudsen G.P.
        • Lafolie P.
        • Zoega H.
        • Sarkkola C.
        • et al.
        Ethical aspects of registry-based research in the Nordic countries.
        Clin Epidemiol. 2015; 7: 491-508
        • Pare P.
        • Gray J.
        • Lam S.
        • Balshaw R.
        • Khorasheh S.
        • Barbeau M.
        • et al.
        Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study.
        Clin Ther. 2006; 28 (discussion 10-1): 1726-1735
        • Hsiao C.W.
        • Huang W.Y.
        • Ke T.W.
        • Muo C.H.
        • Chen W.T.
        • Sung F.C.
        • et al.
        Association between irritable bowel syndrome and colorectal cancer: a nationwide population-based study.
        Eur J Intern Med. 2014; 25: 82-86
        • Hu L.Y.
        • Ku F.C.
        • Lu T.
        • Shen C.C.
        • Hu Y.W.
        • Yeh C.M.
        • et al.
        Risk of cancer in patients with irritable bowel syndrome: a nationwide population-based study.
        Ann Epidemiol. 2015; 25: 924-928
        • Norgaard M.
        • Farkas D.K.
        • Pedersen L.
        • Erichsen R.
        • de la Cour Z.D.
        • Gregersen H.
        • et al.
        Irritable bowel syndrome and risk of colorectal cancer: a Danish nationwide cohort study.
        Br J Cancer. 2011; 104: 1202-1206
        • Kjellstrom L.
        • Molinder H.
        • Agreus L.
        • Nyhlin H.
        • Talley N.J.
        • Andreasson A
        A randomly selected population sample undergoing colonoscopy: prevalence of the irritable bowel syndrome and the impact of selection factors.
        Eur J Gastroenterol Hepatol. 2014; 26: 268-275
        • Cash B.D.
        • Rubenstein J.H.
        • Young P.E.
        • Gentry A.
        • Nojkov B.
        • Lee D.
        • et al.
        The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls.
        Gastroenterology. 2011; 141: 1187-1193
        • Ludvigsson J.F.
        • Otterblad-Olausson P.
        • Pettersson B.U.
        • Ekbom A
        The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research.
        Eur J Epidemiol. 2009; 24: 659-667
        • Canavan C.
        • West J.
        • Card T.
        The epidemiology of irritable bowel syndrome.
        Clin Epidemiol. 2014; 6: 71-80