Hidradenitis Suppurativa Tied to Inflammatory Bowel Disease Risk

By Marilynn Larkin

July 18, 2019

NEW YORK (Reuters Health) - Patients with hidradenitis suppurativa (HS) are at relatively high risk for inflammatory bowel disease (IBD), according to a recent meta-analysis.

"For HS patients presenting with sterile abscesses, scarring, and sinus tract formation in the perineal and inguinal area, especially in perianal areas, dermatologists should (ask about) gastrointestinal symptoms," Drs. Ching-Chi Chi and We-Ti-Chen of Chang Gung Memorial Hospital in Taoyuan, Taiwan told Reuters Health in a joint email.

"If patients have recurrent abdominal pain, chronic diarrhea, bloody stool, and body weight loss," they added, "dermatologists should refer (them) to gastroenterologists for further investigations, such as colonoscopy."

As reported online July 10 in JAMA Dermatology, Drs. Chi and Chen searched Medline from inception through 2018 and identified five relevant case-control studies, two cross-sectional studies, and one cohort study; a total of 93,601 participants were included.

The meta-analysis of case-control and cross-sectional studies showed significant associations between HS and Crohn's disease (pooled odds ratio, 2.12) and ulcerative colitis (pooled OR, 1.51).

Two of the case-control studies revealed a significant association between HS with IBD (ORs, 2.16 and 10.00, respectively).

The cohort study reported an increased risk of IBD in HS patients (hazard ratio, 5.6).

Drs. Chi and Chen said several challenges might stand in the way of appropriate patient referrals. "First, dermatologists might not (be familiar with) the association between HS and IBD. Secondly, dermatologists in our country sometimes don't have enough time to approach HS patients (and) ask whether (they) have gastrointestinal symptoms. To some extent, we would likely miss HS patients coincidently having IBD unless the patients tell their GI problems to us."

The third challenge is that relatively few IBD experts are available for consultation, they noted. "Fortunately, our hospital referral system is efficient, and the waiting time for examination is not long."

They also cite several limitations of their analysis, including lack of studies examining associations between different levels of disease severity. Further, most of the studies were from the U.S. and Europe. More research is needed, they say, to determine whether the results hold true for Asians and other ethnic groups.

Dr. Haley Naik of the University of California, San Francisco, coauthor of a related editorial, commented in an email to Reuters Health, "HS is a prevalent chronic disease that disproportionately affects women and minorities, and is alarmingly understudied and underfunded. As a result, there are no uniformly effective treatments for this devastating condition."

"New studies like (this one) highlight the tremendous burden of HS and the urgent need for more research that deepens our understanding of this condition so we can develop better treatments and improve care," she said.

Two US government-funded research opportunities - PA-18-718 (http://bit.ly/2YWx2V1) and PA-18-719 (http://bit.ly/2YUWhqX)- highlight the "critical need" for more research, she noted.

Further, she added, HS PROGRESS, a multi-institutional longitudinal observational registry and biorepository led by UCSF (http://bit.ly/2YVNpkz), provides resources and infrastructure to facilitate research collaborations among investigators and between investigators and patients.

SOURCE: http://bit.ly/2YW1z5c and http://bit.ly/2YRnP0k

JAMA Dermatol 2019.