Presence of CRS May Indicate Potential to Develop Ulcerative Colitis

There should be more attention paid to detecting ulcerative colitis (UC) among patients who have chronic rhinosinusitis (CRS) without nasal polyps after investigators found a higher risk of developing the inflammatory bowel disease (IBD) in a new long-term retrospective study, reports Diagnostics (Basel).

“CRS is a common chronic inflammatory disease of the sinonasal mucosa with an inflammatory or infectious etiology. IBD causes chronic intestinal inflammation,” the investigators wrote. “Thus, both diseases share innate immune and epithelial barrier dysfunctions of the mucosa. However, the association between sinusitis and IBD is not well known.”

Their study cohort covered 15,175 patients living with CRS (with or without nasal polyps) who were matched 1:2 with 30,350 patients not living with CRS who made up the comparison group. In addition to UC, propensity for developing Crohn disease (CD) was also evaluated.

Incidence rates were calculated per 1000 person-years among persons who received inpatient or outpatient care for an initial case of CRS between January 2003 and December 2005 at Hallym Medical University, Chuncheon Sacred Hospital in South Korea. The primary study end point was all-cause mortality or IBD events (UC and CD).

Among the study group, which contained 59.7% of patients who were women, 297,761.1 and 143,933.7 person-years were evaluated for CD events in the non-CRS and CRS groups, respectively. Corresponding total person-years of 297,675.4 and 143,654.1 were evaluated for UC events.

There was a 72% greater risk of developing UC in the presence of CRS (adjusted HR [aHR], 1.72; 95% CI, 1.26-2.36) after adjusting for sex, age, residence, income level, and comorbidities. In stark contrast, the risk was elevated just 1% for a potential connection between CRS and development of CD (aHR, 1.01; 95% CI, 0.66-1.54).

When the data were analyzed according to CRS phenotype (with nasal polyps [CRSwNP] vs without nasal polyps [CRSsNP]), there was a higher risk of UC seen among patients with both disease types:

• CRSsNP: crude and adjusted analyses showed a 71% greater risk of UC following CRSsNP development (HR, 1.71; 95% CI, 1.24-2.36; and aHR, 1.71; 95% CI, 1.24-2.35, respectively)
• CRSwNP:
  • Crude analysis showed a 114% greater risk of UC with CRSwNP development (HR, 2.14; 95% CI, 0.93-4.89)
  • Adjusted analysis showed a 97% greater risk of UC with CRSwNP development (aHR, 1.97; 95% CI, 0.86-4.51)

However, the authors noted that only the HRs among the patients with CRSsNP “were significantly increased,” after adjusting for demographic characteristics and that this risk remained constant throughout the study’s 10-year follow-up period, “indicating that the association between CRSsNP and UC may not be a temporal incident.”

Further, in an analysis that investigated prevalence of CD and UC between 2002 and 2013 among patients 20 years and older, CD started at 0.08% in 2002 before steadily dropping to a low of 0.02% in 2009 and ending at 0.04% in 2013. In contrast, UC prevalence started at 0.07% in 2002, rose to 0.09% in 2003, and levelled out at a range of 0.07% to 0.8% for the remainder of this analysis.

The study authors noted that chief strengths of their findings are the nationwide patient data they used and there are clinical implications for patient diagnosis in that, “the simultaneous extra-sinonasal examination when physicians treat patients with CRS may be helpful for the early detection and timely treatment of IBD.”

Their conclusion was a strong recommendation to clinicians to “assess for gastrointestinal manifestations during their practice,” in particular a potential association between presence of CRS and development of UC.

Reference

Lee IH, Ha S-S, Son GM, Yang HG, Kim D-K. Could chronic rhinosinusitis increase the risk of ulcerative colitis? a nationwide cohort study.Diagnostics (Basel). Published online September 28, 2022. doi:10.3390/diagnostics12102344