Identification of Risk Factors for Coexisting Sinusitis and Inflammatory Bowel Disease

Abstract

BACKGROUND This study aimed to analyze the association of coexisting sinusitis and IBD, establish significant factors involved in their development, and enable further biological correlation between these two diseases. METHODS The IBD and Sinusitis Study at __________ (TISSUe) is a retrospective, single-center study. We reviewed patients to confirm IBD and chronic sinusitis diagnoses. Case-control propensity score matching was performed using matched controls with IBD only or sinusitis only. Statistical methods included Chi-squared test and Wilcoxon rank sum test. Logistic regression analysis was performed, and factors were considered significant if p<0.05. RESULTS Stratifying 214 patients with coexisting IBD and sinusitis, 176 patients had IBD first and 38 patients had sinusitis first. Multivariable analysis of factors associated with subsequent disease with matched controls determined that duration of disease, UC, steroid exposure ever, and younger age of IBD diagnosis were associated with subsequent sinusitis in patients with IBD; steroid exposure ever and duration of sinusitis were significantly associated with subsequent IBD in patients with sinusitis. CONCLUSIONS This study suggests that IBD maintenance therapies are not associated with increased risk of sinusitis, as proposed by adverse events in clinical trial data; rather, UC diagnosis and duration of disease may be more influential in sinusitis development. While further studies are necessary, this study also demonstrates that sinusitis precedes IBD in some patients, probing its biological association with IBD and possible classification as an extraintestinal manifestation.

The causality between chronic rhinosinusitis and inflammatory bowel disease: a bi-directional two-sample Mendelian randomization analysis

“…Several studies have explored the link between CRS and IBD previously. A small single-center retrospective study from UChicago Medicine suggested that the diagnosis and duration of UC may be more associated with development of CRS, while CRS may be considered as an extraintestinal manifestation of IBD due to CRS precedes IBD in some patients [14] . Besides, Lin et al found that patients with IBD history, especially UC, had an increased risk of subsequent development of CRS [16] .…”

“…Therefore, it is worthy of further studying the relationship between CRS and IBD. Actually, there are several studies having already evaluated the relationship between CRS and IBD [14][15][16][17] , but the results are inconsistent. However, it is noteworthy that these evidence come only from observational studies, which are hard to infer causality and avoid the impact of confounding factors [18] .…”

Could Chronic Rhinosinusitis Increase the Risk of Ulcerative Colitis? A Nationwide Cohort Study

“…In real-world studies, patients with IBD often showed more nasal and sinus symptoms than the control group [ 12 , 17 , 18 ]. However, some large-scale, retrospective studies showed that there was no significant evidence for the association between IBD and the subsequent development of CRS [ 15 , 25 ].…”

“…Similar to this study, we found an increased risk of subsequent UC development in patients with CRSsNP, but not in patients with CRSwNP. Additionally, another recent study investigating the bidirectional development between sinusitis and IBD reported that the duration of IBD, UC, steroid exposure, and younger age of IBD diagnosis were associated with subsequent sinusitis in patients with UC, whereas steroid exposure and duration of sinusitis were significantly associated with subsequent IBD in patients with sinusitis [ 25 ]. For these reasons, we hypothesize that UC and CRSsNP have been intrinsically associated with a network of deregulated inflammatory mediators, such as the interleukin (IL)-33/ST2 pathway [ 26 , 27 , 28 , 29 ].…”