S2003 Coexisting IBS in IBD Is Associated With Greater Healthcare Utilization, Surgery and Advanced Therapies

Introduction: Many patients with inflammatory bowel disease (IBD) achieve clinical remission but continue to experience gastrointestinal symptoms driven by overlapping irritable bowel syndrome (IBS). We aimed to assess whether patients with both IBD and IBS experience worse outcomes compared to those with IBD alone. Methods: Using the TriNetX multi-institutional database, we identified adult patients with IBD (Crohn’s disease or ulcerative colitis) from 2010 to 2024. Patients were stratified into 2 cohorts: IBD with IBS and IBD without IBS. Propensity score matching (PSM) was performed to balance cohorts based on demographics, comorbidities, and IBD-related medications. Outcomes were assessed over a 5-year period following the index date (i.e., IBD and IBS diagnosis in cases, and IBD only in controls). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Results: After PSM, each cohort included 43,044 patients. Compared to those with IBD alone, patients with IBD + IBS had significantly higher rates of ED visits (aHR 1.19, 95% CI 1.17–1.22), surgical resections (aHR 1.10, 95% CI 1.05–1.16), imaging (CT/MRI) (aHR 1.27, 95% CI 1.24–1.30), and colonoscopies (aHR 1.33, 95% CI 1.30–1.37). Use of corticosteroids (aHR 1.10, 95% CI 1.08–1.13), biologics (aHR 1.13, 95% CI 1.10–1.17), and JAK inhibitors (aHR 1.30, 95% CI 1.16–1.46) was also more common in the IBD + IBS group. Immunomodulator use was similar between groups (aHR 0.97, 95% CI 0.93–1.01). Hospitalizations were slightly more common in the IBD-only group (34.8% vs 34.3%). Conclusion: Patients with coexisting IBS and IBD demonstrated consistently higher healthcare utilization, including increased diagnostic and therapeutic interventions. These findings highlight the clinical impact of IBS in IBD. Further study is needed to develop management strategies for IBD patients who have symptoms of IBS.