B0388 - Comparison of Surgical History and Reported Symptoms Between Patients With Concomitant IBD and IBS and Those With IBD Alone

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Yuhan Fu, DO

MetroHealth Medical Center/Case Western Reserve University
Cleveland, OH

Yuhan Fu, DO, Nisheet Waghray, MD, Ronnie Fass, MD, Gengqing Song, MD
MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH

Introduction: While symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can often overlap, IBD patients with documented remission may continue to experience IBS symptoms of abdominal pain, bloating and altered bowel function. The aim of this study was to determine the history of surgical interventions and gastrointestinal symptoms of patients with concomitant IBD and IBS and compare with patients with IBD alone.

Methods: We performed a population-based study using IBM Explorys database (1999-2022), a large deidentified healthcare database with information from over 300 hospitals across the United States. We identified patients with concomitant diagnosis of IBD and IBS (IBD+IBS). The control group consisted of patients with IBD without IBS. We collected surgical history and common gastrointestinal symptoms in both cohorts. The number of patients and respective percentages were tabulated. Odds ratios (OR) with 95% confidence intervals were used to compare the cohorts.

Results: We identified a total of 366,420 patients with IBD, of which 38,650 (10.5%) patients were reported to have coexisting IBD and IBS, and 327,770 (89.5%) patients had IBD without a concurrent diagnosis of IBS (Table 1). Patients with both IBD and IBS are more likely to have undergone surgical intervention when compared to patients with IBD alone, including cholecystectomy (24.3 vs 9.9%), appendectomy (15.9% vs 7.7%), small intestine excision (3.3 vs 1.9 %), colectomy (17.2% vs 9.8%), rectal resection (5.1 vs 3.2%), hernia repair (11.5 vs 7.0%) and exploratory laparotomy (2.2 vs 1.1%) (all p value < 0.0001) (Figure 1). Compared to the patients with IBD alone, patients with coexisting IBD and IBS are more likely to report gastrointestinal symptoms, including abdominal pain (23.1-38.8% vs 8.1-15.2%), diarrhea (66.9% vs 33.2%), constipation 36.2% vs 16.4), bloating (0.9% vs 0.2%), hematochezia (16.2 vs 8.0%) and abnormal weight loss (19.2 vs 8.6%) (all p value < 0.0001).

Discussion: Surgery and gastrointestinal symptoms appear to be more common in patients with coexisting IBD and IBS when compared to patients with IBD alone. Clearly, much work remains to improve the symptomatic management of functional GI disorders. Targeted therapies may help to reduce the need for surgical intervention and improve the quality of life of patients with overlapping IBD and IBS.

Figure: Figure 1 Comparison of Surgical Interventions in IBD+IBS and IBD alone

		IBD with IBS (N=38650)	%	IBD without IBS (N=327770)	%	OR	95% CI	P
Surgeries	Cholecystectomy	9390	24.3%	32380	9.9%	2.93	2.85-3.00	< 0.0001
	Appendectomy	6140	15.9%	25190	7.7%	2.27	2.20-2.34	< 0.0001
	Small intestine excision	1260	3.3%	6220	1.9%	1.74	1.64-1.85	< 0.0001
	Colectomy	6650	17.2%	32170	9.8%	1.91	1.86-1.97	< 0.0001
	Resection of rectum	1960	5.1%	10610	3.2%	1.60	1.52-1.68	< 0.0001
	Hernia repair	4460	11.5%	22810	7.0%	1.74	1.69-1.80	< 0.0001
	Exploratory laparotomy	860	2.2%	3460	1.1%	2.13	1.98-2.30	< 0.0001

Symptoms	Upper abdominal pain	14990	38.8%	49690	15.2%	3.55	3.47-3.63	< 0.0001
	Lower abdominal pain	12740	33.0%	43210	13.2%	3.24	3.16-3.32	< 0.0001
	Central abdominal pain	11610	30.0%	36460	11.1%	3.43	3.35-3.52	< 0.0001
	Generalized abdominal pain	10690	27.7%	34190	10.4%	3.28	3.20-3.37	< 0.0001
	Right sided abdominal pain	10600	27.4%	35020	10.7%	3.16	3.08-3.24	< 0.0001
	Left sided abdominal pain	8940	23.1%	26410	8.1%	3.43	3.34-3.53	< 0.0001
	Diarrhea	25860	66.9%	108690	33.2%	4.08	3.99-4.17	< 0.0001
	Constipation	13990	36.2%	53840	16.4%	2.89	2.82-2.95	< 0.0001
	Bloating	330	0.9%	500	0.2%	5.64	4.90-6.48	< 0.0001
	Hematochezia	6260	16.2%	26060	8.0%	2.24	2.17-2.31	< 0.0001
	Abnormal weight loss	7420	19.2%	28230	8.6%	2.52	2.45-2.59	< 0.0001

Table: Table 1 Comparison of Surgical History and Reported Symptoms Between Patients with Concomitant IBD and IBS and Those with IBD alone

Disclosures:

Yuhan Fu indicated no relevant financial relationships.

Nisheet Waghray indicated no relevant financial relationships.

Ronnie Fass indicated no relevant financial relationships.

Gengqing Song indicated no relevant financial relationships.

Yuhan Fu, DO, Nisheet Waghray, MD, Ronnie Fass, MD, Gengqing Song, MD. B0388 - Comparison of Surgical History and Reported Symptoms Between Patients With Concomitant IBD and IBS and Those With IBD Alone, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.