A pilot prospective prevalence study of chronic rhinosinusitis associated with inflammatory bowel disease

Abstract

Background: Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract. Extra-intestinal manifestations such as pulmonary diseases have been reported. Chronic rhinosinusitis (CRS), an inflammatory condition of the sinonasal mucosa, has been associated with several lung diseases. Given the relationship between lung and intestinal pathologies, and lung and sinus pathologies, we aimed to determine the prevalence of IBD among CRS patients.

Methods: Pilot prevalence study. Ninety-two CRS patients were screened for IBD symptoms from October 2018 to January 2020. Patient-reported disease symptoms and overall quality of life were evaluated using the Sino-Nasal Outcome Test 22 (SNOT-22), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and EuroQol 5 Dimension 5 Level (EQ-5D-5L) questionnaires. The Modified Lund-Kennedy (MLK) endoscopic and Lund-Mackay (LM) grading systems were used to confirm CRS diagnoses. Individuals who reported subjective symptoms of IBD were referred to a gastroenterologist clinic for further diagnostics.

Results: Twenty of the 92 (20.2%, 95% CI: 12.6%-29.8%) CRS patients reported symptoms of IBD and four individuals (4.26%, 95% CI: 1.17%-10.50%) were subsequently diagnosed with IBD. Compared to patients without IBD symptoms (n = 72), those with symptoms (n = 20) reported significantly worse SNOT-22 (P = 0.002), SIBDQ (P < 0.05), and EQ-5D-3L (P = 0.0063) scores. However, these patients did not exhibit significantly different MLK (P = 0.81) or LM (P = 0.04) scores.

Conclusion: The prevalence of IBD may be elevated among individuals with CRS relative to the general Canadian population. This pilot study suggests that CRS with IBD is associated with lower quality of life. Further cross-sectional studies with larger sample sizes are required.

Keywords: Modified Lund–Kennedy; Sino‐Nasal Outcome Test 22 (SNOT‐22); chronic rhinosinusitis; microbiome; quality of life.

Figure 1

Comparisons of scores between chronic rhinosinusitis (CRS) patients without and with inflammatory bowel disease (IBD) symptoms. (A) Comparison of total median Modified Lund–Kennedy (MLK) between CRS patients without (n = 71) and with (n = 18) IBD symptoms (P > 0.05). (B) Comparison of total median Lund–MacKay (LM) between CRS patients without (n = 61) and with (n = 17) IBD symptoms (P < 0.05). (C) Comparison of total mean Sino‐Nasal Outcome Test 22 (SNOT‐22) between CRS patients without (n = 72) and with (n = 20) IBD symptoms. (D) Comparison of total median EuroQol 5 Dimension 5 Level (EQ‐5D‐5L) score between CRS patients without (n = 69) and with (n = 20) IBD symptoms (P < 0.05). (E) Comparison of total median Short Inflammatory Bowel Disease Questionnaire (SIBDQ) score between CRS patients without (n = 58) and with (n = 19) IBD symptoms (P < 0.05). Error bars represent standard deviation