Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2024;22(7):1404–15.e20
Association between celiac disease and irritable bowel syndrome: A nationwide cohort study
Background and aims: The aim of this study was to determine the risk of irritable bowel syndrome (IBS) diagnosis in patients with celiac disease compared with general population comparators.
Methods: Using Swedish histopathology and register-based data, the authors identified 27,262 patients with celiac disease diagnosed in 2002–2017 and 132,922 age- and sex-matched general population comparators. Diagnoses of IBS were obtained from nationwide inpatient and non-primary outpatient records. Cox regression estimated hazard ratios (aHRs) for IBS adjusted for education level and Charlson Comorbidity Index. To reduce potential surveillance bias their analyses considered incident IBS diagnosis ≥ 1 year after celiac disease diagnosis. Using conditional logistic regression, secondary analyses were calculated to estimate odds ratios (ORs) for IBS diagnosis ≥ 1 year before celiac disease diagnosis.
Results: During an average of 11.1 years of follow-up, 732 celiac patients (2.7%) were diagnosed with IBS versus 1131 matched general population comparators (0.9%). Overall (≥ 1 year of follow-up), the aHR for IBS was 3.11 (95% confidence interval [CI]: 2.83–3.42), with aHR of 2.00 (95% CI: 1.63–2.45) after ≥ 10 years of follow-up. Compared with siblings (n = 32,010), celiac patients (n = 19,211) had ≥ 2-fold risk of later IBS (aHR = 2.42; 95% CI: 2.08–2.82). Compared with celiac patients with mucosal healing, those with persistent villus atrophy on follow-up biopsy were less likely to be diagnosed with IBS (aHR = 0.66; 95% CI: 0.46–0.95). Celiac disease was also associated with having an earlier IBS diagnosis (OR = 3.62; 95% CI: 3.03–4.34).
Conclusions: In patients with celiac disease, the risk of irritable bowel syndrome is increased long before and after diagnosis. Clinicians should be aware of these long-term associations and their implications on patient management.