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. 2021;11(2):641-651.
doi: 10.3233/JPD-202330.

Irritable Bowel Syndrome and Risk of Parkinson's Disease in Finland: A Nationwide Registry-Based Cohort Study

Tuomas H Mertsalmi  1 , Anna But  2 , Eero Pekkonen  1 , Filip Scheperjans  1
Affiliations

Irritable Bowel Syndrome and Risk of Parkinson's Disease in Finland: A Nationwide Registry-Based Cohort Study

Tuomas H Mertsalmi et al. J Parkinsons Dis. 2021.

Abstract

Background: The gastrointestinal tract is considered as a potential origin of Parkinson's disease (PD) pathology. Besides constipation, appendectomy and inflammatory bowel disease have also been associated with a higher PD-risk, but findings have been inconsistent. To date, there is only one previous study suggesting that irritable bowel syndrome (IBS) is associated with an increased risk of PD.

Objective: To evaluate whether IBS is associated with a higher risk of PD.

Methods: In this retrospective registry-based cohort study, we identified 28,150 patients that were diagnosed with IBS (IBS+) during the years 1998-2014, using data from the Finnish Care Register for Health Care. In addition, 98,789 IBS-free reference subjects (IBS-) of same age and gender and living in the same municipality were included. The study subjects were followed until the end of the year 2014 to analyze the incidence of PD. The association between IBS and PD was assessed by a Cox proportional hazards model.

Results: Diagnosis of IBS was associated with a higher hazard of PD with an adjusted hazard ratio (aHR) of 1.70 (95% CI 1.27-2.26). However, the ratio of hazard rates for PD between IBS+ and IBS- subjects was not constant over time. The Cox model with time-varying coefficient for IBS status showed that the hazard of PD was significantly higher in IBS patients only during the first two years of follow-up (aHR 2.96, 95% CI 1.78-4.92).

Conclusion: Our findings indicate that the association between IBS and PD is likely explained by reverse causation and detection bias. It remains open whether IBS is an actual risk factor or a prodromal symptom of PD.

Keywords: Parkinson’s disease; epidemiology; gastrointestinal tract; irritable bowel syndrome.

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Conflict of interest statement

T.H.M., A.B, and F.S. reports no conflict of interest relative to the research covered in this manuscript. E.P. is a Member of the MDS Non-Motor Parkinson’s Disease Study Group.

Figures

Fig. 1
Fig. 1
Study flowchart representing data collection and exclusion criteria of the study
Fig. 2
Fig. 2
Cumulative hazard of Parkinson’s disease in patients diagnosed with irritable bowel syndrome (IBS+) compared to an IBS-free reference population (IBS–) matched by gender, age, and place of living.
Fig. 3
Fig. 3
Incidence of PD (spikes) in IBS+ and IBS–subjects during the follow-up and the corresponding hazard rate, including 95% confidence intervals.
See this image and copyright information in PMC

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