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Reged: 12/09/02
Posts: 7389
Loc: Seattle, WA
Surgery and IBS
      01/26/04 03:21 PM

Surgery and IBS

Lin Chang, MD

An increased number of abdominal surgeries have been reported in a random population of patients with IBS compared with individuals without IBS.[9,10] Two studies presented during these meeting proceedings evaluated the prevalence of surgery in patients with IBS compared with control subjects in 2 different patient populations.

In one study,[11] the prevalence of potentially unnecessary surgeries was investigated using computerized patient questionnaire data in HMO health examinees. An analysis of health data on 89,008 examinees was performed. IBS was reported in 5.2% of subjects (3.0% of men and 7.2% of women). Of the different types of surgeries, cholecystectomy, appendectomy, hysterectomy, and back surgery were significantly more common in patients with IBS than in patients without IBS. Patients with IBS reported these surgeries 2-3 times more than individuals without IBS, except for back surgery (reported 1.5 times more often). Various medical history parameters were evaluated as predictive factors for the types of surgeries. An IBS diagnosis yielded the highest odds ratio (OR) for cholecystectomy and appendectomy. The diagnoses of IBS and fibromyalgia tied for the highest OR for hysterectomy, and fibromyalgia had the highest OR for back surgery.

The second study[12] retrospectively determined the prevalence of gastrointestinal-related surgeries in a 2-state Medicaid IBS patient population compared with a non-IBS control group matched for age, sex, race, and months of eligibility (both, n = 2546). Patients with IBS had a corresponding ICD (International Classification of Diseases) code as a primary or secondary diagnosis. The gastrointestinal-related procedures included cholecystectomy, appendectomy, colectomy, obesity procedures, and abdominal and vaginal hysterectomy. The 1-year prevalence of gastrointestinal-related procedures in the IBS group was significantly higher than that of the control group (n = 42 [1.65%] vs n = 23 [0.9%]; P = .01). The prevalence of vaginal hysterectomy was higher in the IBS group than in the control group (0.5% vs 0.2%; P = .02).

Summary. These studies confirm that factors that contribute to the increased healthcare and economic burden associated with IBS include physician visits, surgical procedures, medication (prescription and OTC), and alternative treatments (that are frequently used by patients with IBS). The lack of satisfaction and effectiveness of current IBS treatments and decreased QOL and work productivity also contribute to the burden of illness.

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