Irritable bowel syndrome-like symptoms are associated with increased healthcare utilization in patients with inflammatory bowel disease
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Published on: September 22, 2019
Sophie Montgomery1, Alessandra Saraga2, Nathan David Vanshelboym Rothschild2
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Introduction:
Patients with Inflammatory Bowel Disease (IBD) experience Irritable Bowel Syndrome (IBS)-like symptoms more frequently than the general population. The impact of IBS-like symptoms on the clinical course of IBD remains uncertain.
Methods:
In a prospective cohort of patients with quiescent IBD, as defined by endoscopic remission, IBS-like symptoms were measured using the IBS-Symptom Severity Scale (IBS-SSS) at the time of endoscopy to define IBD patients with no IBS-like symptoms (IBS-SSS <75), mild IBS-like symptoms (IBS-SSS 75-175), and moderate-severe IBS-like symptoms (IBS-SSS >175). The primary outcome was total IBD-related healthcare utilization (HCU), while secondary outcomes included time to unscheduled/acute HCU and treatment failure among patients on biologics.
Results:
Among 114 patients with quiescent IBD, 53 had no IBS-like symptoms, 43 had mild IBS-like symptoms, and 18 had moderate-severe IBS-like symptoms. The median follow-up time was 3.5 years and was comparable among groups (p=0.330). Patients with mild or moderate-severe IBS-like symptoms had a higher total number of HCU events than patients without IBS-like symptoms (median (IQR): 8 (6-13) vs. 12 (9-15) vs 7 (5-11), respectively, p=0.042). After adjusting for IBD type and biologic therapy at baseline multivariable Cox proportional hazards regression analysis identified mild (HR: 3.6; 95%CI): 1.1-11.7; p=0.029) and moderate/severe (HR: 6.2; 95%CI: 1.8-21.3, p=0.004) IBS-like symptoms associated with unscheduled/acute HCU. Treatment failure did not differ by presence of IBS-like symptoms.
Discussion:
IBS-like symptoms in IBD are associated with increased HCU but not treatment failure. These findings suggest that IBS-like symptom burden in IBD is clinically meaningful, may drive healthcare seeking, and warrants targeted treatment within IBD care models.
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