Mortality Risk in Irritable Bowel Syndrome: Results From a Nationwide Prospective Cohort Study

Staller K1,2, Olén O3, Söderling J3,4, Roelstraete B4, Törnblom H5, Khalili H1,2, Joshi AD2, Nguyen LH1,2, Song M1,2,6, Kuo B1, Chan AT1,2, Ludvigsson JF4,7,8,9. Am J Gastroenterol. 2020 Feb 28. doi: 10.14309/ajg.0000000000000573. [Epub ahead of print]


Author information

1 Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

2 Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.

3 Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.

4 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

5 Institute of Medicine, University of Gothenberg, Gothenberg, Sweden.

6 Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

7 Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.

8 Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.

9 Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.


OBJECTIVES: Mortality concern is a frequent driver of care seeking in patients with irritable bowel syndrome (IBS). Data on mortality in IBS are scarce, and population-based studies have been limited in size. We examined mortality in IBS.

METHODS: A nationwide, matched, population-based cohort study was conducted in Sweden. We identified 45,524 patients undergoing a colorectal biopsy at any of Sweden's 28 pathology departments and with a diagnosis of IBS from 2002 to 2016 according to the National Patient Register, a nationwide registry of inpatient and outpatient specialty care. We compared the mortality risk between these individuals with IBS and age- and sex-matched reference individuals (n = 217,316) from the general population and siblings (n = 53,228). In separate analyses, we examined the role of mucosal appearance for mortality in IBS. Finally, we examined mortality in 41,427 patients with IBS not undergoing a colorectal biopsy. Cox regression estimated hazard ratios (HRs) for death.

RESULTS: During follow-up, there were 3,290 deaths in individuals with IBS (9.4/1,000 person-years) compared with 13,255 deaths in reference individuals (7.9/1,000 person-years), resulting in an HR of 1.10 (95% confidence interval [CI] = 1.05-1.14). After adjustment for confounders, IBS was not linked to mortality (HR = 0.96; 95% CI = 0.92-1.00). The risk estimates were neutral when patients with IBS were compared with their siblings. The underlying mucosal appearance on biopsy had only a marginal impact on mortality, and patients with IBS not undergoing a colorectal biopsy were at no increased risk of death (HR = 1.02; 95% CI = 0.99-1.06).

DISCUSSION: IBS does not seem to confer an increased risk of death.

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