Atopic dermatitis linked to subsequent IBD

Children and adults with atopic dermatitis (AD) are at risk of inflammatory bowel disease (IBD), with the risk varying by age, AD severity, and IBD subtype, according to a study.

Researchers used data from a UK electronic medical record database, The Health Improvement Network, to examine the risk of developing IBD in paediatric and adult patients with AD.

The analysis included 409,431 children with AD (93.2 percent mild, 5.5 percent moderate, and 1.3 percent severe) and 1,809,029 paediatric controls. Their median age ranged from 4 to 5 years, and most were boys (51.8 percent in the control group, 51.6 percent in the mild AD group, 50.7 percent in the moderate AD group, and 56.1 percent in the severe AD group).

In the adult cohort, a total of 625,083 patients with AD (65.7 percent mild, 31.4 percent moderate, and 2.9 percent severe) and 2,678,888 matched controls were included. Their median age ranged from 45 to 50 years, and the majority were women (54.0 percent in the control group, 62.3 percent in the mild AD group, 55.8 percent in the moderate AD group, and 59.3 percent in the severe AD group).

Multivariable analysis showed that AD was associated with an elevated risk of IBD in the paediatric cohort (hazard ratio [HR], 1.44, 95 percent CI, 1.31–1.58). This association was observed for Crohn’s disease (CD; HR, 1.74, 95 percent CI, 1.54–1.97), with the risk increasing with worsening AD. Meanwhile, only children with severe AD were at increased risk of ulcerative colitis (UC; HR, 1.65, 95 percent CI, 1.02–2.67).

In the adult cohort, on the other hand, AD was associated with a heightened risk of IBD (HR, 1.34, 95 percent CI, 1.27–1.40) and its subtypes (CD: HR, 1.36, 95 percent CI, 1.26–1.47; UC: HR, 1.32, 95 percent CI, 1.24–1.41).

In light of the findings, clinicians should consider the risk of IBD in AD, particularly when selecting systemic treatments in patients who may have coincident gastrointestinal symptoms.