6 Comorbidities in IBD Patients Should Know

Patients with inflammatory bowel disease (IBD) may experience significant pain and discomfort if their condition is not properly treated and managed. The pain and symptom burden IBD can cause your patients is reason enough to discuss preventative measures with them – there may be more risks associated with the condition than they realize.

IBD, an umbrella term for conditions that include ulcerative colitis (UC) and Crohn’s disease, can vary in severity depending on the patient and how effectively they manage it. To complicate matters, IBD also has a number of comorbidity risks that can exacerbate a patient’s condition and worsen their quality of life. With this in mind, it is important to discuss what patients who have or are at risk of IBD should be looking for. What are some notable IBD comorbidities to discuss with your patients?

1. Hypertension

Could there be an association between IBD and hypertension, two conditions that both involve some sort of systemic inflammation? A 2022 study published in the United European Gastroenterology Journal examined data from 281,064 participants to see if a correlation could be found.¹ Of the subjects, 20,129 (7.2%) developed hypertension with a median follow-up time of 8.1 years.

When breaking the data down to compare participants with and without IBD, those with IBD had a higher incidence of hypertension; while 7.1% of those without IBD developed the condition, hypertension developed in 10.9% of participants with UC, 7.7% of participants with Crohn’s disease, and 9.3% of participants with unclassified IBD. From this data, the researchers concluded that UC should be considered an independent risk factor for hypertension. Health care professionals may consider warning patients with UC of the risk for hypertension to and working with them to develop early preventative measures.

2. Arthritis

A study published in Pediatric Research in 2019 found that among adolescents with IBD, patients with both Crohn’s disease and UC were at an increased risk and incidence for arthritis.²

Though arthritis can be a common comorbid condition with IBD, patients may not be aware of the risk. It may manifest as rheumatoid arthritis, another chronic inflammatory condition. There is also the potential for IBD-associated spondyloarthritis, considered the most common extraintestinal manifestation in those with IBD.³

3. Thyroid disease

In addition to arthritis, the participants in the Pediatric Research study also had an increased risk of thyroid disease for both UC and Crohn’s disease.² Though research has not determined a definitive cause, it has been speculated that genetic abnormalities and overactive immune systems in people with UC could play a role.⁴ Patients with congenital hypothyroidism have been seen as more likely to develop IBD, though more research is needed.

4. Autoimmune hepatitis

Patients with inflammatory bowel diseases need to be particularly vigilant about their liver, as it has been estimated that nearly one-third of those with IBD have liver test abnormalities.⁵ As a result, they can be particularly at risk for autoimmune hepatitis, an inflammation of the liver. This condition can be ably managed if found in time, but can be dangerous if untreated.

5. Depression and anxiety

An April 2022 study in Psychosomatic Medicine examined data from 18 studies and found that patients with depression were at an increased risk of developing gastrointestinal disorders including IBD.⁶ In addition to patients with depression having an observed higher likelihood of a comorbid gastrointestinal disorder, patients with IBD often had higher rates of depression as far as 5 years prior to IBD diagnosis.

6. Eating disorders

While mood disorders may be a more well-known psychiatric comorbidity, there is emerging evidence that eating disorders may be one as well. Researchers of a study published in the Journal of Clinical Medicine concluded that eating disorders may be considered a comorbidity due to IBD and eating disorders both affecting gut microbiome and the increased risk of psychiatric disorders.⁷ The researchers also found that psychiatric disorders were underdiagnosed in patients with IBD. Health care professionals may consider prioritizing mental health care in their IBD management and treatment.

References

1. He J, Zhang S, Qiu Y, et al. Ulcerative colitis increases risk of hypertension in a UK Biobank Cohort Study. United Eur. Gastroenterol. J. 2022;11(1):19-30. doi:10.1002/ueg2.12351
2. Ghersin, I., Khateeb, N., Katz, LH, et al. Comorbidities in adolescents with inflammatory bowel disease: findings from a population-based cohort study. Pediatr Res 87, 1256–1262 (2020). doi: 10.1038/s41390-019-0702-3
3. Gionchetti P, Calabrese C, Rizzello F. Inflammatory bowel diseases and spondyloarthropathies. J Rheumatol Suppl. 2015;93:21-23. doi:10.3899/jrheum.150628
4. Marie S. Ulcerative colitis and thyroid disease: What’s the link? Healthline. Updated July 20, 2021. Accessed February 14, 2023.
5. DeFilippis EM, Kumar S. Clinical presentation and outcomes of autoimmune hepatitis in inflammatory bowel disease. Dig Dis Sci. 2015 Oct;60(10):2873-80. doi: 10.1007/s10620-015-3699-4. Epub 2015 May 22. PMID: 25999245.
6. Nikolova VL, Pelton Lucy, Moulton CD,; Zorzato Daniele, Cleare AJ, Young AH, Stone JM. The prevalence and incidence of irritable bowel syndrome and inflammatory bowel disease in depression and bipolar disorder: A systematic review and meta-analysis. Psychosom Med. 84(3):p 313-324, April 2022. | DOI: 10.1097/PSY.0000000000001046
7. Kuźnicki P, Neubauer K. Emerging comorbidities in inflammatory bowel disease: Eating disorders, alcohol and narcotics misuse. J Clin Med. 2021 Oct 8;10(19):4623. doi: 10.3390/jcm10194623. PMID: 34640641; PMCID: PMC8509435.

This article originally appeared on Gastroenterology Advisor