Could Chronic Rhinosinusitis Increase the Risk of Ulcerative Colitis? A Nationwide Cohort Study

Abstract

Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease of the sinonasal mucosa with an inflammatory or infectious etiology. Inflammatory bowel disease (IBD) causes chronic intestinal inflammation. Thus, both diseases share innate immune and epithelial barrier dysfunctions of the mucosa. However, the association between sinusitis and IBD is not well-known. We aimed to determine the association between CRS and the risk for IBDs, such as Crohn’s disease (CD) and ulcerative colitis (UC). In this long-term retrospective cohort study, 15,175 patients with CRS and 30,350 patients without CRS (comparison group) were enrolled after 1:2 propensity score matching. The incidence rates of CD and UC were 0.22 and 0.51 (1000 person-years), respectively. The adjusted hazard ratio (HR) for developing CD and UC in CRS patients was 1.01 (95% confidence interval (CI), 0.66–1.54) and 1.72 (95% CI, 1.26–2.36), respectively. Additionally, in the subgroup analysis using the CRS phenotype, the adjusted HRs of UC were significantly increased in patients with CRS without nasal polyps (adjusted HR = 1.71; 95% CI, 1.24–2.35), but not in those with CRS with nasal polyps. CRS without nasal polyps is associated with an increased incidence of UC but not CD. Therefore, clinicians should pay attention to the early detection of UC when treating patients with CRS without nasal polyps.

The causality between chronic rhinosinusitis and inflammatory bowel disease: a bi-directional two-sample Mendelian randomization analysis

“…Besides, Lin et al found that patients with IBD history, especially UC, had an increased risk of subsequent development of CRS [16] . A 10-year-long retrospective cohort study by Lee et al including 15,175 CRS patients and 30,350 controls to assess the subsequent incidence of IBD, shown that CRS was signi cantly related to the risk of UC(adjusted HR = 1.72, 95% CI = 1.26-2.36) after adjusting for sex, age, residence, income level, and comorbidities, but not CD, and more precisely, the subgroup analysis shown that CRS without nasal polyps was related to an increased incidence of UC(adjusted HR = 1.71, 95% CI = 1.24-2.35) [15] . However, not all observational studies have found a correlation between CRS and IBD [17,28] .…”

“…Therefore, it is worthy of further studying the relationship between CRS and IBD. Actually, there are several studies having already evaluated the relationship between CRS and IBD [14][15][16][17] , but the results are inconsistent. However, it is noteworthy that these evidence come only from observational studies, which are hard to infer causality and avoid the impact of confounding factors [18] .…”

Incidence Rates and Risk Ratios of Normal Tension Glaucoma in Patients with Chronic Rhinosinusitis: A Population-Based Longitudinal Follow-Up Study

“…Third, depending on the design of this study, it is unknown whether our findings indicate a causal relationship between the two diseases or a simple temporal association between them. However, despite these limitations, several previous studies examining the relative association between the two diseases have used the same cohort dataset as ours [49][50][51][52]. Further clinical and experimental studies are required to confirm the possible link between these two diseases.…”

Relationship of Depression, Anxiety, and Bipolar Disease with Burning Mouth Syndrome: A Nationwide Cohort Study

“…However, this nationwide population-based dataset allowed us to identify the total medical service history; hence, we could assess the association between psychological comorbidities and the risk of BMS while adjusting for clinical and demographic factors. Numerous retrospective cohort studies have already published similar study designs using this database [ 28 , 29 , 30 , 31 , 32 , 33 ]. Moreover, we selected patients with BMS diagnosed by otorhinolaryngologists to improve diagnostic accuracy.…”