Risk of irritable bowel syndrome in patients with hidradenitis suppurativa: a global-federated, multicenter cohort study

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease increasingly viewed as systemic. Irritable bowel syndrome (IBS) has been proposed as a comorbidity, yet longitudinal data remain limited. A retrospective cohort study was conducted using the U.S. Collaborative Network of the TriNetX platform, including adults diagnosed with HS from 2005-2023 and matched controls without HS. Patients with prior IBS or cancer were excluded. Propensity score matching (1:1) accounted for demographic, socioeconomic, and clinical variables. Incident IBS, defined by ICD-10-CM codes, was assessed over 15 years. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Sensitivity analyses varied washout periods, follow-up times, and HS definitions; subgroups were stratified by age and sex. The matched cohort comprised 119,848 HS patients and equal controls. HS was associated with greater IBS risk (HR 1.422, 95% CI 1.308-1.547), consistent across sensitivity analyses. Compared with psoriasis, HS conferred higher IBS risk (HR 1.268, 95% CI 1.157-1.390). Age-stratified analyses showed increased risk in both 18-64 years (HR 1.538, 95% CI 1.397-1.694) and ≥ 65 years (HR 2.443, 95% CI 1.619-3.686). Risk was also elevated in males (HR 1.556, 95% CI 1.221-1.983) and females (HR 1.489, 95% CI 1.354-1.638). HS independently predicts higher long-term IBS risk, supporting shared inflammatory and barrier dysfunction pathways.