Digestive Diseases and Sciences

, Volume 54, Issue 5, pp 1079–1086

Irritable Bowel Syndrome and Gastroesophageal Reflux Disease in Primary Care: Is There a Link?

  • Ana Ruigómez
  • Mari-Ann Wallander
  • Saga Johansson
  • Luis Alberto García Rodríguez
ORIGINAL ARTICLE

Abstract

Population-based studies have shown that gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) coexist more commonly than expected by chance. We aimed to investigate the relationship between GERD and IBS in primary care. The General Practice Research Database was used to identify patients with a first diagnosis of GERD (n = 6,421) or IBS (n = 2,932). Patients were followed up for 12 months after diagnosis to investigate the incidence of IBS among GERD patients and GERD among IBS patients. The relative risk (RR) of developing IBS was 3.5 (95% CI: 2.3–5.4) in the GERD cohort compared with the comparison cohort. The RR of developing GERD was 2.8 (95% CI: 1.7–4.9) in the IBS cohort compared with the comparison cohort. A first diagnosis of either IBS or GERD significantly increases the risk of a subsequent diagnosis of the other condition.

Keywords

Database Epidemiology Gastroesophageal reflux Irritable bowel syndrome Primary health care 

References

  1. 1.
    Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–1491. doi:10.1053/j.gastro.2005.11.061.PubMedCrossRefGoogle Scholar
  2. 2.
    Vakil N, Veldhuyzen van Zanten S, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastro-esophageal reflux disease (GERD)—a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920. doi:10.1111/j.1572-0241.2006.00630.x.PubMedCrossRefGoogle Scholar
  3. 3.
    Dickman R, Feroze H, Fass R. Gastroesophageal reflux disease and irritable bowel syndrome: a common overlap syndrome. Curr Gastroenterol Rep. 2006;8:261–265. doi:10.1007/s11894-006-0045-1.PubMedCrossRefGoogle Scholar
  4. 4.
    Kennedy TM, Jones RH, Hungin AP, O’Flanagan H, Kelly P. Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population. Gut. 1998;43:770–774.PubMedGoogle Scholar
  5. 5.
    Wang JH, Luo JY, Dong L, Gong J, Tong M. Epidemiology of gastroesophageal reflux disease: a general population-based study in Xi’an of Northwest China. World J Gastroenterol. 2004;10:1647–1651.PubMedGoogle Scholar
  6. 6.
    Mohammed I, Nightingale P, Trudgill NJ. Risk factors for gastro-oesophageal reflux disease symptoms: a community study. Aliment Pharmacol Ther. 2005;21:821–827. doi:10.1111/j.1365-2036.2005.02426.x.PubMedCrossRefGoogle Scholar
  7. 7.
    Nastaskin I, Mehdikhani E, Conklin J, Park S, Pimentel M. Studying the overlap between IBS and GERD: a systematic review of the literature. Dig Dis Sci. 2006;51:2113–2120. doi:10.1007/s10620-006-9306-y.PubMedCrossRefGoogle Scholar
  8. 8.
    Zagari RM, Pozzato P, Damian S, et al. The epidemiology of irritable bowel syndrome and its relationship with gastroesophageal reflux disease in the general population: results from the Loiano–Monghidoro study. Gastroenterology. 2006;130:S1132.Google Scholar
  9. 9.
    Jung HK, Halder S, McNally M, et al. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther. 2007;26:453–461.PubMedGoogle Scholar
  10. 10.
    Smart HL, Nicholson DA, Atkinson M. Gastro-oesophageal reflux in the irritable bowel syndrome. Gut. 1986;27:1127–1131. doi:10.1136/gut.27.10.1127.PubMedCrossRefGoogle Scholar
  11. 11.
    Pimentel M, Rossi F, Chow EJ, et al. Increased prevalence of irritable bowel syndrome in patients with gastroesophageal reflux. J Clin Gastroenterol. 2002;34:221–224. doi:10.1097/00004836-200203000-00004.PubMedCrossRefGoogle Scholar
  12. 12.
    Guillemot F, Ducrotte P, Bueno L. Prevalence of functional gastrointestinal disorders in a population of subjects consulting for gastroesophageal reflux disease in general practice. Gastroenterol Clin Biol. 2005;29:243–246. doi:10.1016/S0399-8320(05)80756-0.PubMedGoogle Scholar
  13. 13.
    Agreus L, Svardsudd K, Talley NJ, Jones MP, Tibblin G. Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study. Am J Gastroenterol. 2001;96:2905–2914.PubMedGoogle Scholar
  14. 14.
    Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S, Graffner H, Dent J. Natural history of gastro-oesophageal reflux disease diagnosed in general practice. Aliment Pharmacol Ther. 2004;20:751–760. doi:10.1111/j.1365-2036.2004.02169.x.PubMedCrossRefGoogle Scholar
  15. 15.
    García Rodríguez LA, Pérez Gutthann S. Use of the UK General Practice Research Database for pharmacoepidemiology. Br J Clin Pharmacol. 1998;45:419–425. doi:10.1046/j.1365-2125.1998.00701.x.PubMedCrossRefGoogle Scholar
  16. 16.
    Lawson D, Sherman V, Hollowell J. The general practice research database. Q J Med. 1998;91:445–452.Google Scholar
  17. 17.
    Jick SS, Kaye JA, Vasilakis-Scaramozza C, et al. Validity of the general practice research database. Pharmacotherapy. 2003;23:686–689. doi:10.1592/phco.23.5.686.32205.PubMedCrossRefGoogle Scholar
  18. 18.
    Jick H, Jick SS, Derby LE. Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. BMJ. 1991;302:766–768.PubMedCrossRefGoogle Scholar
  19. 19.
    Ruigomez A, Wallander MA, Johansson S, Garcia Rodriguez LA. One-year follow-up of newly diagnosed irritable bowel syndrome patients. Aliment Pharmacol Ther. 1999;13:1097–1102. doi:10.1046/j.1365-2036.1999.00576.x.PubMedCrossRefGoogle Scholar
  20. 20.
    Talley NJ. Overlapping abdominal symptoms: why do GERD and IBS often coexist? Drugs Today (Barc). 2006;42:3–8. doi:10.1358/dot.2006.42.1.893611.CrossRefGoogle Scholar
  21. 21.
    Nasseri-Moghaddam S, Razjouyan H, Mamarabadi M, et al. Factors contributing in response of patients with gastroesophageal reflux disease to PPI therapy. Gastroenterology. 2008;134:A323.Google Scholar
  22. 22.
    Neumann H, Monkemuller K, Kandulski A, Malfertheiner P. Dyspepsia and IBS symptoms in patients with NERD, ERD and Barrett’s esophagus. Dig Dis. 2008;26:243–247. doi:10.1159/000121354.PubMedCrossRefGoogle Scholar
  23. 23.
    Saito YA, Schoenfeld P, Locke GR 3rd. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol. 2002;97:1910–1915.PubMedGoogle Scholar
  24. 24.
    Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2004;20:31–39. doi:10.1111/j.1365-2036.2004.02183.x.PubMedCrossRefGoogle Scholar
  25. 25.
    Payne S. Sex, gender and irritable bowel syndrome: making the connections. Gend Med. 2004;1:18–28. doi:10.1016/S1550-8579(04)80007-X.PubMedCrossRefGoogle Scholar
  26. 26.
    Jones R, Latinovic R, Charlton J, Gulliford M. Physical and psychological co-morbidity in irritable bowel syndrome: a matched cohort study using the General Practice Research Database. Aliment Pharmacol Ther. 2006;24:879–886. doi:10.1111/j.1365-2036.2006.03044.x.PubMedCrossRefGoogle Scholar
  27. 27.
    Locke GR 3rd, Weaver AL, Melton LJ 3rd, Talley NJ. Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study. Am J Gastroenterol. 2004;99:350–357. doi:10.1111/j.1572-0241.2004.04043.x.PubMedCrossRefGoogle Scholar
  28. 28.
    Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am. 1991;20:249–267.PubMedGoogle Scholar
  29. 29.
    El-Serag HB. Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord. 2003;3:S3–S11.PubMedGoogle Scholar
  30. 30.
    Torii A, Toda G. Management of irritable bowel syndrome. Intern Med. 2004;43:353–359. doi:10.2169/internalmedicine.43.353.PubMedCrossRefGoogle Scholar
  31. 31.
    Chang L, Heitkemper MM. Gender differences in irritable bowel syndrome. Gastroenterology. 2002;123:1686–1701. doi:10.1053/gast.2002.36603.PubMedCrossRefGoogle Scholar
  32. 32.
    Naliboff BD, Berman S, Chang L, et al. Sex-related differences in IBS patients: central processing of visceral stimuli. Gastroenterology. 2003;124:1738–1747. doi:10.1016/S0016-5085(03)00400-1.PubMedCrossRefGoogle Scholar
  33. 33.
    Talley NJ, Boyce PM, Jones M. Predictors of health care seeking for irritable bowel syndrome: a population based study. Gut. 1997;41:394–398.PubMedGoogle Scholar
  34. 34.
    Ruigomez A, Garcia-Rodriguez LA, Johansson S, Wallander MA. Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome? Maturitas. 2003;44:133–140. doi:10.1016/S0378-5122(02)00321-3.PubMedCrossRefGoogle Scholar
  35. 35.
    Case AM, Reid RL. Effects of the menstrual cycle on medical disorders. Arch Intern Med. 1998;158:1405–1412. doi:10.1001/archinte.158.13.1405.PubMedCrossRefGoogle Scholar
  36. 36.
    Heitkemper MM, Jarrett M, Caudell KA, Bond E. Women with gastrointestinal symptoms: implications for nursing research and practise. Gastroenterol Nurs. 1998;21:52–58. doi:10.1097/00001610-199803000-00005.PubMedCrossRefGoogle Scholar
  37. 37.
    Eliakim R, Abulafia O, Sherer DM. Estrogen, progesterone and the gastrointestinal tract. J Reprod Med. 2000;45:781–788.PubMedGoogle Scholar
  38. 38.
    Bond EF, Heitkemper MM, Bailey SL. Estrogen suppresses gastric motility response to thyrotropin-releasing hormone and stress in awake rats. Res Nurs Health. 1998;21:221–228. doi :10.1002/(SICI)1098-240X(199806)21:3<221::AID-NUR5>3.0.CO;2-J.PubMedCrossRefGoogle Scholar
  39. 39.
    Bradesi S, Eutamene H, Fioramonti J, Bueno L. Acute restraint stress activates functional NK1 receptor in the colon of female rats: involvement of steroids. Gut. 2002;50:349–354. doi:10.1136/gut.50.3.349.PubMedCrossRefGoogle Scholar
  40. 40.
    Li TJ, Yu BP, Dong WG, Luo HS, Xu L, Li MQ. Ovarian hormone modulates 5-hydroxytryptamine 3 receptors mRNA expression in rat colon with restraint stress-induced bowel dysfunction. World J Gastroenterol. 2004;10:2723–2726.PubMedGoogle Scholar
  41. 41.
    Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–717. doi:10.1136/gut.2004.051821.PubMedCrossRefGoogle Scholar
  42. 42.
    Amouretti M, Le Pen C, Gaudin AF, et al. Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol. 2006;30:241–246. doi:10.1016/S0399-8320(06)73160-8.PubMedCrossRefGoogle Scholar
  43. 43.
    Talley NJ, Dennis EH, Schettler-Duncan VA, Lacy BE, Olden KW, Crowell MD. Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea. Am J Gastroenterol. 2003;98:2454–2459. doi:10.1111/j.1572-0241.2003.07699.x.PubMedCrossRefGoogle Scholar
  44. 44.
    Ford AC, Forman D, Moayyedi P, Morice AH. Cough in the community: a cross sectional survey and the relationship to gastrointestinal symptoms. Thorax. 2006;61:975–979. doi:10.1136/thx.2006.060087.PubMedCrossRefGoogle Scholar
  45. 45.
    Camilleri M, Choi MG. Review article: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:3–15. doi:10.1046/j.1365-2036.1997.84256000.x.PubMedCrossRefGoogle Scholar
  46. 46.
    Kennedy T, Jones R. The prevalence of gastro-oesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms. Aliment Pharmacol Ther. 2000;14:1589–1594. doi:10.1046/j.1365-2036.2000.00884.x.PubMedCrossRefGoogle Scholar
  47. 47.
    Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut. 2000;46:78–82. doi:10.1136/gut.46.1.78.PubMedCrossRefGoogle Scholar
  48. 48.
    Vandvik PO, Aabakken L, Farup PG. Diagnosing irritable bowel syndrome: poor agreement between general practitioners and the Rome II criteria. Scand J Gastroenterol. 2004;39:448–453. doi:10.1080/00365520310008782.PubMedCrossRefGoogle Scholar
  49. 49.
    Bijkerk CJ, de Wit NJ, Stalman WA, Knottnerus JA, Hoes AW, Muris JW. Irritable bowel syndrome in primary care: the patients’ and doctors’ views on symptoms, etiology and management. Can J Gastroenterol. 2003;17:363–368. quiz 405–406.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Ana Ruigómez
    • 1
  • Mari-Ann Wallander
    • 2
    • 3
  • Saga Johansson
    • 2
    • 4
  • Luis Alberto García Rodríguez
    • 1
  1. 1.Spanish Centre for Pharmacoepidemiological Research (CEIFE)MadridSpain
  2. 2.AstraZeneca R&DMölndalSweden
  3. 3.Department of Public Health and Caring ScienceUppsala UniversityUppsalaSweden
  4. 4.Institute of Medicine, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden

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