{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T16:48:45Z","timestamp":1761324525307,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T00:00:00Z","timestamp":1685318400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can present with overlapping symptoms, making diagnosis and management challenging. Patients with IBD in remission may continue to experience IBS symptoms. Patients with IBS were found to have a disproportionately higher prevalence of abdominal and pelvic surgeries than the general population. Aims: The aim of this study was to determine whether IBS is a risk factor for undergoing surgical interventions in patients with IBD and explore the diagnostic implications of these findings. Methods: A population-based cohort analysis was performed using TriNetX. Patients with Crohn\u2019s disease + IBS (CD + IBS) and ulcerative colitis + IBS (UC + IBS) were identified. The control groups consisted of patients with CD or UC alone without IBS. The main outcome was to compare the risks of undergoing surgical interventions between the cohorts. The secondary outcomes were to compare the risks of developing gastrointestinal symptoms and IBD-related complications between the cohorts. Results: Patients with IBD who subsequently developed IBS were more likely to experience gastrointestinal symptoms than those without IBS (p &lt; 0.0001). Patients with concomitant IBD and IBS were more likely to develop IBD-related complications, including perforation of the intestine, gastrointestinal bleeding, colon cancer, and abdominal abscess (p &lt; 0.05). Patients with concomitant IBD and IBS were more likely to undergo surgical interventions than patients without IBS, including colectomy, appendectomy, cholecystectomy, exploratory laparotomy, and hysterectomy (p &lt; 0.05). Conclusions: IBS appears to be an independent risk factor for patients with IBD to develop IBD-related complications and undergo surgical interventions. Patients with concomitant IBD and IBS could represent a unique subgroup of IBD patients with more severe symptoms, highlighting the importance of accurate diagnosis and management in this population.<\/jats:p>","DOI":"10.3390\/diagnostics13111901","type":"journal-article","created":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T07:49:23Z","timestamp":1685346563000},"page":"1901","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Implications of Irritable Bowel Syndrome Is an Independent Risk Factor for Undergoing Surgical Interventions in Patients with Inflammatory Bowel Disease"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2071-2868","authenticated-orcid":false,"given":"Yuhan","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisheet","family":"Waghray","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronnie","family":"Fass","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gengqing","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sza\u0142wi\u0144ska, P., W\u0142odarczyk, J., Spinelli, A., Fichna, J., and W\u0142odarczyk, M. (2020). IBS-Symptoms in IBD Patients-Manifestation of Concomitant or Different Entities. J. Clin. Med., 10.","DOI":"10.3390\/jcm10010031"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1038\/nrgastro.2016.141","article-title":"IBS and IBD\u2014Separate entities or on a spectrum?","volume":"13","author":"Spiller","year":"2016","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.cgh.2008.08.032","article-title":"The functional-organic dichotomy: Postinfectious irritable bowel syndrome and inflammatory bowel disease-irritable bowel syndrome","volume":"7","author":"Grover","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/S2468-1253(20)30300-9","article-title":"Prevalence of irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease in remission: A systematic review and meta-analysis","volume":"5","author":"Fairbrass","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.dld.2020.11.026","article-title":"The gut-brain axis in irritable bowel syndrome and inflammatory bowel disease","volume":"53","author":"Ancona","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S2468-1253(19)30089-5","article-title":"The influence of the brain-gut axis in inflammatory bowel disease and possible implications for treatment","volume":"4","author":"Gracie","year":"2019","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"628157","DOI":"10.1155\/2015\/628157","article-title":"Intestinal Permeability in Inflammatory Bowel Disease: Pathogenesis, Clinical Evaluation, and Therapy of Leaky Gut","volume":"2015","author":"Michielan","year":"2015","journal-title":"Mediat. Inflamm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1111\/j.1572-0241.2006.00672.x","article-title":"Abnormal intestinal permeability in subgroups of diarrhea-predominant irritable bowel syndromes","volume":"101","author":"Dunlop","year":"2006","journal-title":"Am. J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1038\/ajg.2011.86","article-title":"Intestinal serotonin release, sensory neuron activation, and abdominal pain in irritable bowel syndrome","volume":"106","author":"Cremon","year":"2011","journal-title":"Am. J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1002\/jcp.25518","article-title":"Neurotransmitters: The Critical Modulators Regulating Gut-Brain Axis","volume":"232","author":"Mittal","year":"2017","journal-title":"J. Cell. Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/cns.12490","article-title":"Stress and the Microbiota-Gut-Brain Axis in Visceral Pain: Relevance to Irritable Bowel Syndrome","volume":"22","author":"Moloney","year":"2016","journal-title":"CNS Neurosci. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/s41575-022-00634-6","article-title":"Depression and anxiety in inflammatory bowel disease: Epidemiology, mechanisms and treatment","volume":"19","author":"Bisgaard","year":"2022","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_13","first-page":"75","article-title":"The central role of psychopathology and its association with disease severity in inflammatory bowel disease and irritable bowel syndrome","volume":"54","author":"Piacentino","year":"2019","journal-title":"Riv. Psichiatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-031-05843-1_1","article-title":"Contribution of the Enteric Nervous System to Autoimmune Diseases and Irritable Bowel Syndrome","volume":"1383","author":"Schemann","year":"2022","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/nrgastro.2017.88","article-title":"Gut microbiota and IBD: Causation or correlation?","volume":"14","author":"Ni","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1007\/s10620-019-05488-8","article-title":"Presence of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease Is Associated with High Rate of Anxiety and Depression","volume":"64","author":"Perera","year":"2019","journal-title":"Dig. Dis. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3356","DOI":"10.3748\/wjg.v23.i18.3356","article-title":"Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease","volume":"23","author":"Pedersen","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1093\/ecco-jcc\/jjaa241","article-title":"Hypnotherapy for Irritable Bowel Syndrome-Type Symptoms in Patients with Quiescent Inflammatory Bowel Disease: A Randomized, Controlled Trial","volume":"15","author":"Hoekman","year":"2021","journal-title":"J. Crohns Colitis"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/S2468-1253(20)30217-X","article-title":"Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: A systematic review and meta-analysis","volume":"5","author":"Oka","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1001\/jama.2020.22532","article-title":"Diagnosis and Treatment of Irritable Bowel Syndrome: A Review","volume":"325","author":"Camilleri","year":"2021","journal-title":"Jama"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1053\/j.gastro.2015.07.003","article-title":"Biomarkers of Inflammation in Inflammatory Bowel Disease","volume":"149","author":"Sands","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.cgh.2018.08.001","article-title":"AGA Clinical Practice Update on Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: Expert Review","volume":"17","author":"Colombel","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.bpg.2018.05.017","article-title":"Surgery in ulcerative colitis: When? How?","volume":"32\u201333","author":"Gallo","year":"2018","journal-title":"Best. Pract. Res. Clin. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1007\/s00384-021-03857-2","article-title":"Surgical management of Crohn\u2019s disease: A state of the art review","volume":"36","author":"Buskens","year":"2021","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1046\/j.1365-2036.2003.01499.x","article-title":"Systematic review: Abdominal and pelvic surgery in patients with irritable bowel syndrome","volume":"17","author":"Hasler","year":"2003","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1053\/j.gastro.2004.02.020","article-title":"Irritable bowel syndrome and surgery: A multivariable analysis","volume":"126","author":"Longstreth","year":"2004","journal-title":"Gastroenterology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1080\/15548627.2019.1635384","article-title":"New insights into the interplay between autophagy, gut microbiota and inflammatory responses in IBD","volume":"16","author":"Larabi","year":"2020","journal-title":"Autophagy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3748\/wjg.v28.i4.412","article-title":"Gut bless you: The microbiota-gut-brain axis in irritable bowel syndrome","volume":"28","author":"Hillestad","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"eaap8914","DOI":"10.1126\/scitranslmed.aap8914","article-title":"Gut microbiota composition and functional changes in inflammatory bowel disease and irritable bowel syndrome","volume":"10","author":"Imhann","year":"2018","journal-title":"Sci. Transl. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/j.1365-2982.2012.01921.x","article-title":"Intestinal barrier function in health and gastrointestinal disease","volume":"24","author":"Camilleri","year":"2012","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"345","DOI":"10.2147\/JIR.S174982","article-title":"The role of inflammation in irritable bowel syndrome (IBS)","volume":"11","author":"Ng","year":"2018","journal-title":"J. Inflamm. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1038\/s41577-022-00700-9","article-title":"Immune activation in irritable bowel syndrome: What is the evidence?","volume":"22","author":"Hussein","year":"2022","journal-title":"Nat. Rev. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1136\/gut.2006.115006","article-title":"Avoiding unnecessary surgery in irritable bowel syndrome","volume":"56","author":"Longstreth","year":"2007","journal-title":"Gut"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1046\/j.1365-2168.2000.01596.x","article-title":"Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population","volume":"87","author":"Kennedy","year":"2000","journal-title":"Br. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.dld.2008.02.013","article-title":"Gallstones, cholecystectomy and irritable bowel syndrome (IBS) MICOL population-based study","volume":"40","author":"Corazziari","year":"2008","journal-title":"Dig. Liver Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/j.1742-1241.2000.tb10949.x","article-title":"The epidemiology of hysterectomy and irritable bowel syndrome in a UK population","volume":"54","author":"Kennedy","year":"2000","journal-title":"Int. J. Clin. Pract."},{"key":"ref_37","first-page":"307","article-title":"The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases","volume":"31","author":"Chaudhary","year":"1962","journal-title":"QJM Int. J. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/11\/1901\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:44:26Z","timestamp":1760125466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/11\/1901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,29]]},"references-count":37,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["diagnostics13111901"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13111901","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2023,5,29]]}}}