Abstract

Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987-2016

Eur J Intern Med. 2021 Aug 19;S0953-6205(21)00267-3. doi: 10.1016/j.ejim.2021.08.001.

Kyle Staller 1, Ola Olén 2, Jonas Söderling 3, Bjorn Roelstraete 4, Hans Törnblom 5, Hamed Khalili 6, Mingyang Song 7, Jonas F Ludvigsson 8

 
     

Author information

  • 1Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States.
  • 2Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
  • 3Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Broad Institute, Cambridge, MA, United States.
  • 4Broad Institute, Cambridge, MA, United States.
  • 5Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
  • 6Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Broad Institute, Cambridge, MA, United States.
  • 7Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States; Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
  • 8Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States; Department of Paediatrics, Örebro University Hospital, Sweden.

Abstract

Introduction: Symptoms of irritable bowel syndrome (IBS) are common reasons for endoscopic procedures. We examined the yield of colonoscopy and upper endoscopy in IBS for several organic diseases.

Methods: Matched population-based prevalence study in Sweden. We identified 21,944 participants diagnosed with IBS from 1987 to 2016 undergoing colonoscopy with a biopsy from all of Sweden's 28 pathology departments within 6 months of diagnosis. We compared prevalence of histopathology-proven diagnoses of inflammatory bowel disease (IBD), colorectal cancer, precancerous polyps, and microscopic colitis between patients recently diagnosed with IBS and matched controls without IBS (n = 81,101) undergoing colonoscopy. We also compared prevalence of celiac disease between patients diagnosed with IBS (n = 9,965) and matched controls (n = 45,584) undergoing upper endoscopy with biopsy. IBS patients were also compared to their siblings. Conditioned logistic regression estimated adjusted odds ratios (aORs).

Results: Biopsy-proven IBD was seen in 1.6% of IBS and in 5.9% of controls (aOR=0.21; 95%CI=0.19-0.24). The prevalence of precancerous polyps was 4.1% vs. 13.0% (aOR=0.28; 95%CI=0.26-0.30), colorectal cancer 0.8% vs. 6.3% (aOR=0.17; 95%CI=0.14-0.20) and celiac disease 1.9% vs. 3.4% (aOR=0.54; 95%CI=0.47-0.63). Conversely, the prevalence of microscopic colitis was 2.9% vs. 1.7% (aOR=1.77; 95%CI=1.61-1.95), with higher prevalence in older patients and patients with IBS with diarrhea. Yield of colonoscopy for precancerous polyps, colorectal cancer, and microscopic colitis increased by age. Our findings were consistent using unaffected siblings as the comparator group.

Discussion: The diagnostic yield of upper endoscopy and colonoscopy for organic disease is low in patients with a first-time diagnosis of IBS, though increases with age.

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