Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome?
Section snippets
Background
Approximately 10–20% of the general population suffer from irritable bowel syndrome (IBS) [1], [2]. IBS affects females more often than males with no ready available reasons [3], [4], [5]. Few studies can be found reporting incidence data of IBS. Agréus et al. reported a 3 month cumulative incidence rate of IBS of 2 per 1000 persons aged 20–79 years using a postal survey [6]. Kay et al., estimated an annual incidence of 31% among men and 36% among women in a population aged 30–65 years, with
Source population
The General Practice Research Database (GPRD) contains computerized information on about 3 million patients, entered by general practitioners (GPs) in the UK [10]. Data are systematically recorded and sent anonymously to the Medicine Control Agency that organizes this information in order to be used for research projects. The computerized information includes demographic data, diagnoses from GPs visits, specialist's referrals and hospital admissions, results of laboratory tests as well as a
Results
We originally identified 685 patients with a diagnosis of IBS among the HRT users cohort and 423 in the HRT never users. After the review of computerized information, 203 patients (18%) presented some exclusion condition and 28 (2.5%) had incomplete follow-up information. We sent a questionnaire to the GPs for the remaining 877 women. We obtained a 98% response rate. After review of all available information, we excluded 136 prevalent cases of IBS (16%), 12 cases were not confirmed as IBS by
Discussion
We found an association between HRT and a new diagnosis of IBS in women. The incidence rate was about twice as high among female ever users of HRT compared to non-users. The higher risk among HRT users was observed irrespective of the route of administration or whether the treatment was unopposed or opposed. We did not find any published study that examined the risk of developing IBS in women on HRT.
In a previous study using the GPRD, we reported that the incidence of IBS among males was fairly
Acknowledgements
We thank the staff at General Practice Research Database (GPRD), and the participating general practitioners for their collaboration. We also thank the Boston Collaborative Drug Surveillance Program (BCDSP) for providing access to the database. This study was supported by a research grant of AstraZeneca.
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