Irritable bowel syndrome is more frequent in patients hospitalized for ischaemic colitis: results of a case–control study

Abstract

It has been suspected that there is an epidemiological link between irritable bowel syndrome (IBS) and ischaemic colitis (IC). We performed a retrospective case-control study to compare the frequency of IBS in patients hospitalized for IC compared with that of patients with peptic ulcer bleeding. Cases were patients with a first episode of IC and controls were patients with a first episode of peptic ulcer bleeding, matched to cases for sex and 10-year age-class. Diagnosis of IBS was based on medical information extracted from hospital medical files and a standard self-questionnaire. The association between IBS and IC was tested using Mc Nemar's paired odds ratio (OR); confidence interval at 95% (CI 95%) was calculated; Mantel-Haenzel's Chi(2) was applied. A total of 113 cases and 113 matched controls were studied. There were 37 males and 76 females and the mean age was 69 +/- 15 years in each group. The prevalence of IBS in cases was 16.9%vs 1.8% in controls. The risk of IBS was 11.05 times higher among cases than in controls (P < 0.001); CI 95%: (2.45-49.74). A total of 87 pairs with complete data were used for OR calculation. The risk of IBS was 7.5 times higher in cases than in controls (P = 0.002); CI 95%: (1.72-32.80). This case-control study shows that IBS is more frequent in IC patients than in controls.

A Population-based Study of Incidence, Risk Factors, Clinical Spectrum, and Outcomes of Ischemic Colitis

“…Previous studies have found that the incidence of IC was at least three time higher in IBS patients as compared to a matched control population[15-20]. With the exception of the report by Herve and colleagues[19], these studies used ICD-9 codes, with limited or no review of patient medical records for validation of case finding, potentially resulting in misclassification bias as highlighted above. On the other hand, the study by Herve et al included only hospitalized IC patients, and noted a lower prevalence of 1.6% of IBS in controls, compared to an expected rate of 4.7% in the general French population as reported by the authors, and may be indicative of inadequate matching[19].…”

“…With the exception of the report by Herve and colleagues[19], these studies used ICD-9 codes, with limited or no review of patient medical records for validation of case finding, potentially resulting in misclassification bias as highlighted above. On the other hand, the study by Herve et al included only hospitalized IC patients, and noted a lower prevalence of 1.6% of IBS in controls, compared to an expected rate of 4.7% in the general French population as reported by the authors, and may be indicative of inadequate matching[19]. Our study did show a higher odds for IC in subjects with atherosclerotic diseases as highlighted in hospital-based manual record review studies [2,3].…”

A 9-year evaluation of temporal trends in alosetron postmarketing safety under the risk management program

“…The adjudicated incidence rate of IC has been stable at approximately 1.0 cases/1000 patient-years, which is similar to the inherent background rate of IC in IBS patients that ranges from 0.40 cases/1000 patient-years to 1.79 cases/1000 patient-years [Cole et al 2004;Walker et al 2004; et al 2004]. Epidemiological studies have consistently demonstrated that IBS itself is an independent risk factor for IC, and have shown that patients with IBS have a two-to four-fold greater risk of developing IC than those without IBS Hervé et al 2009;Chang et al 2008]. Given the apparent increased background rate of IC among patients with IBS, the frequency of IC attributable to alosetron in the real-world, clinical practice setting remains difficult to determine.…”

9-Year Evaluation of Temporal Trends in Alosetron Postmarketing Safety Under the Risk Management Program

“…Singh et al 2004]. Epidemiological studies have consistently demonstrated that IBS itself is an independent risk factor for IC, and have shown that patients with IBS have a two-to four-fold greater risk of developing IC than those without IBS [Walker et al 2004;Hervé et al 2009;Chang et al 2008]. Given the apparent increased background rate of IC among patients with IBS, the frequency of IC attributable to alosetron in the real-world, clinical practice setting remains difficult to determine.…”