title: A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder.
abstract: Irritable bowel syndrome (IBS) and bipolar disorder (BD) are 2 distinct diseases but may share a similar pathophysiology. However, the comorbidity rate of these 2 diseases is unclear. Also, the current practice guidelines suggest prescribing antidepressants to IBS patients. However, this practice may increase the risk of phase-shift to manic episodes in IBS patients comorbid with BD.This study aimed to determine the relationship between IBS and BD through a meta-analysis.Electronic research through PubMed, Medline, ScienceDirect online, ClinicalTrials.gov, and additional resources.The inclusion criteria were studies investigating the prevalence rate of BD in subjects with IBS and control subjects; and articles on clinical trials on humans.Data from included studies were pooled by a random effects model, and possible confounding variables were examined by meta-regression and subgroup analysis.The current study consists of a total of 177,117 IBS patients and 192,092 control subjects extracted from 6 included studies. The prevalence rate of BD was significantly higher in the IBS patients than in the controls (odds ratio = 2.48, 95% confidence interval: 2.35-2.61, P < 0.001). However, the significance persists only in studies from database research, but not from primary studies. In addition, there was no significant association between the prevalence rate of BD in IBS and several clinical variables, including age, female proportion, prevalence of comorbid diabetes, or hypertension.The total number of included studies is small. Moreover, apparently different results from database research and primary research limit the generalization of our findings to a broad population. Also, we could only perform meta-regression on limited clinical variables.Our results support a significantly higher prevalence rate of BD in IBS patients than in controls. Clinicians should be cautious about the risk of phase-shift to manic episodes when prescribing antidepressants in IBS patients under current practice guidelines.
authors.affiliation: Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home Department of Internal Medicine Department of Neurology, E-Da Hospital Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ping-Tao
authors.initials: PT
authors.lastname: Tseng
authors.forename: Bing-Syuan
authors.initials: BS
authors.lastname: Zeng
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Chen
authors.forename: Ming-Kung
authors.initials: MK
authors.lastname: Wu
authors.forename: Ching-Kuan
authors.initials: CK
authors.lastname: Wu
authors.forename: Pao-Yen
authors.initials: PY
authors.lastname: Lin
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*