Detection of Colorectal Tumor and Inflammatory Bowel Disease during Follow-up of Patients with Initial Diagnosis of Irritable Bowel Syndrome

Rodriguez, Alexis

doi:10.1080/003655200750024191

Cited by 110 publications

(55 citation statements)

References 8 publications

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“…During this period they also saw initially high rates of IBD and CRC fall in the first year. They reported a crude incidence of 26.2 CRCs diagnosed per 10000 patient years [12], (considerably higher than we report over the complete follow-up now available, but similar to the incidence we found in the early follow-up period), and no overall excess compared to controls. They found an overall crude incidence of IBD of 17.8 cases per 10000 person years, 16 times the rate in controls [12] which is similar to our finding.…”

Section: Discussionsupporting

confidence: 84%

“…Shorter studies are likely to be biased by the higher rates we have shown in the first 12 months, probably related to the diagnostic work-up for IBS. Our study adds 12 years of follow-up to the findings of Garcia-Rodriguez et al [12], allowing assessment of how incidence of organic disease changes over time since IBS diagnosis. Since most IBS diagnoses are made among those under 50 years such prolonged follow up is of particular importance.…”

Section: Discussionmentioning

confidence: 98%

“…Also we have measured the cumulative incidence over time rather than prevalence. A study using an earlier version of CPRD in 2000 looked at the rate of diagnosis of IBD and CRC [12]. Then they had just under 3000 IBS cases and included only 5 years following IBS diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…A small meta-analysis suggests prevalence of coeliac disease in patients diagnosed with IBS is around 4 times the population rate [10], but there are no large cohort studies considering this. Incidence rates of IBD and CRC in patients with IBS have previously been calculated, with estimates of IBD incidence between 8 [11] and 16 [12] times that in the general population and no increased incidence of CRC [12]. These studies, however, have short follow up periods and in one the study population were service personnel, unlikely to be a representative sample.…”

Section: Introductionmentioning

confidence: 99%

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The Incidence of Other Gastroenterological Disease following Diagnosis of Irritable Bowel Syndrome in the UK: A Cohort Study

2014

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BackgroundGuidelines recommend Irritable Bowel Syndrome (IBS) diagnosis and management in primary care with minimal investigations; however little evidence exists regarding risk of organic gastrointestinal conditions following diagnosis of IBS and how such risks vary over the long term. This study assesses excess incidence of coeliac disease, inflammatory bowel disease (IBD) and colorectal cancer (CRC) and variation with age and time after IBS diagnosis.MethodsIBS patients and controls were identified within the UK Clinical Practice Research Dataset. Incidence rates were calculated and stratified by age and time since IBS diagnosis with incident rate ratios generated.ResultsFifteen years after IBS diagnosis there is a significant cumulative excess incidence of coeliac disease, IBD and CRC in IBS of 3.7% compared to 1.7% in controls. For every 10000 patient years, IBS patients experienced an additional 4 diagnoses of coeliac disease, 13 of IBD and 4 CRCs. In each condition peak excess incidence was in the 6 months following diagnosis. After one year, increased incidence of coeliac disease remained consistent without variation by age. IBD incidence fell slowly, with higher rates in those under 30. CRC incidence was increased only in patients aged 30 to 74 during the first 5 years.ConclusionSome IBS patients later receive organic gastrointestinal diagnoses, with the early excess incidence likely detected during diagnostic investigation at the time of IBS diagnosis. More than 5 years after IBS diagnosis there is no increased risk of CRC compared to the general population, but a small excess risk of coeliac disease and IBD persists. Overall, though our findings provide reassurance that non-specialists, especially those in primary care, are unlikely to be missing an organic condition in the majority of their patients. This suggests that current guidelines suggesting avoidance of universal referral for these patients are appropriate.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Incidence of Other Gastroenterological Disease following Diagnosis of Irritable Bowel Syndrome in the UK: A Cohort Study

2014

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“…The correlation between intestinal infection and IBS was well documented [2]. Through a cohort study, Rodríguez found that, after an episode of gastroenteritis, patients were ten times more likely to have IBS than were subjects in the general population [3]. Although the pathophysiology of post-infection irritable bowel syndrome (PI-IBS) is heterogeneous and not fully elucidated, some results have suggested that there are abnormalities of motility [4] and visceral sensitivity [5] in patients with PI-IBS.…”

Section: Introductionmentioning

confidence: 97%