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Abstract
Introduction A number of eye diseases including uveitis and episcleritis/scleritis may occur in association with inflammatory bowel disease (IBD). We have examined the risk of later developing IBD in such eye conditions and the time to diagnosis.
Methods The Health Improvement Network, a large UK primary care database was examined. Cases of eye disorders associated with IBD were matched to controls on age, sex and GP registration. Subjects were followed until a diagnosis of ulcerative colitis (UC) or Crohn’s disease (CD), and the incident rate ratio (IRR) was modelled, adjusting for age, sex, body mass index, comorbidity, deprivation level and smoking status. Pre-existing IBD was excluded. The time to a later diagnosis of IBD in cases and controls was compared using the Mann-Whitney U test.
Results 36883 subjects (median age 50 (IQR 37–65), 58% female) with a new diagnosis of an eye disorder associated with IBD were matched to 102622 controls between 1995–2018. Uveitis made up 57% of eye disorder cases. 196 (0.53%) IBD cases were diagnosed in eye disorder subjects and 223 (0.02%) in controls. Median time to UC diagnosis was 952 days for subjects with eye disorders and 1351 for controls, p=0.170. Median time to CD diagnosis was 879 days and 1356 in controls, p = 0.013. Overall, median time to IBD diagnosis was 905 days compared to 1386 in controls, p<0.001.
Figure 1 is a boxplot of time to ulcerative colitis (UC) and Crohn’s disease (CD) diagnosis for eye disorder subjects compared to controls.
The rate of UC diagnoses in eye disorders was 70% higher than in controls, IRR 1.73 (95%CI 1.32–2.27). The rate of CD diagnoses was more than 3-fold higher in the eye disorder group, 3.55 (2.68–4.71). Overall, eye disorders had a greater than 2-fold rate of IBD diagnoses compared to controls, 2.44 (2.01–2.96). Eye disorder subjects had a 0.53% excess risk of IBD when compared to controls. When subjects coded for loperamide use, diarrhoea, anaemia, weight loss or lower gastrointestinal bleed within 6-months of study start were examined, eye disorder cases had a 1.6% excess IBD risk compared to controls.
Time to IBD diagnosis
Conclusions Eye disorders associated with IBD are commonly seen in isolation and health care professionals caring for those with these conditions may not consider IBD, leading to diagnostic delay. The relative risk of later IBD is high in such eye disorders and symptoms suggestive of IBD should be sought and screening investigations such as faecal calprotectin and gastroenterology referral considered.