Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec:94:85-92.
doi: 10.1016/j.ejim.2021.08.001. Epub 2021 Aug 20.

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

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
Affiliations

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

Kyle Staller et al. Eur J Intern Med. 2021 Dec.

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.

Keywords: Colonoscopy; Esophagogastroduodenoscopy; Functional GI disease; Healthcare utilization; Histopathology.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow chart of identified IBS patients undergoing colonoscopy and their matched controls IBS, irritable bowel syndrome; IBD, inflammatory bowel disease
Figure 2.
Figure 2.
Flow chart of identified IBS patients undergoing upper endoscopy and their matched controls IBS, irritable bowel syndrome; IBD, inflammatory bowel disease
Figure 3.
Figure 3.
Spline regressions showing estimated yield of organic disease diagnosis by colonoscopy (for inflammatory bowel disease, colorectal cancer, microscopic colitis, and precancerous polyps) or upper endoscopy (for celiac disease) by age IBS, irritable bowel syndrome; IBD, inflammatory bowel disease
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–21 e4. - PubMed
    1. Staller K, Olen O, Soderling J, Roelstraete B, Tornblom H, Khalili H, et al. Mortality Risk in Irritable Bowel Syndrome: Results From a Nationwide Prospective Cohort Study. Am J Gastroenterol. 2020. - PMC - PubMed
    1. Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:1019–30. - PubMed
    1. Levy RL, Von Korff M, Whitehead WE, Stang P, Saunders K, Jhingran P, et al. Costs of care for irritable bowel syndrome patients in a health maintenance organization. Am J Gastroenterol. 2001;96:3122–9. - PubMed
    1. Lieberman DA, Williams JL, Holub JL, Morris CD, Logan JR, Eisen GM, et al. Colonoscopy utilization and outcomes 2000 to 2011. Gastrointest Endosc. 2014;80:133–43. - PubMed