Elsevier

Maturitas

Volume 44, Issue 2, 25 February 2003, Pages 133-140
Maturitas

Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome?

https://doi.org/10.1016/S0378-5122(02)00321-3Get rights and content

Abstract

Objective: Hormonal status could be involved in the occurrence of irritable bowel syndrome (IBS). The authors examined the risk of developing IBS in women using hormone replacement therapy (HRT). Methods: Women 50–69 years old with at least one prescription for HRT during 1994–1999 were identified from the General Practice Research Database in the UK (n=40, 119). An aged-matched cohort of 50 000 women who never used HRT was sampled from the source population where the HRT cohort was ascertained. Women in the two cohorts were followed to assess the risk of development of IBS. Authors performed a nested case-control analysis to assess the role of duration, route and regimen of HRT use and other risk factors for IBS. The IBS diagnosis was validated by means of a questionnaire sent to the general practitioners (n=660). Results: The incidence rate of IBS per 1000 person-years was 1.7 in the cohort of never HRT users and 3.8 among HRT users, respectively. Both current and past users of HRT presented an increased risk of IBS compared to non-users, after adjusting for co-morbidity and consultation patterns. This increased risk was observed irrespective of treatment duration, regimen or route of administration of HRT. Conclusion: The result suggests that HRT use is associated with an increased risk of IBS similar to the one observed among younger premenopausal women with endogenous oestrogenic activity.

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.

References (28)

  • L. Kay et al.

    The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors

    J. Int. Med.

    (1994)
  • L.A. Garcı́a Rodrı́guez et al.

    Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome

    Scand. J. Gastroenterol.

    (2000)
  • L.A. Garcı́a Rodrı́guez et al.

    Use of the UK General Practice Research Database for pharmacoepidemiology

    Br. J. Clin. Pharmacol.

    (1998)
  • H. Jick et al.

    Validation of information recorded on general practitioner based computerised data resource in the United Kingdom

    BMJ

    (1991)
  • Cited by (0)

    View full text