Association of Hidradenitis Suppurativa With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Key PointsQuestionIs hidradenitis suppurativa associated with inflammatory bowel disease? FindingsThis systematic review and meta-analysis included 5 case-control studies, 2 cross-sectional studies, and 1 cohort study with a total of 93601 unique participants with hidradenitis suppurativa who had 2.12-fold increased odds for Crohn disease and 1.51-fold increased odds for ulcerative colitis. One cohort study found a 5.6-fold increased risk of inflammatory bowel disease in patients with hidradenitis suppurativa. MeaningGastrointestinal tract symptoms, such as recurrent abdominal pain and chronic diarrhea, should not be overlooked in patients with hidradenitis suppurativa, and consultation with gastroenterologists should be sought. This systematic review and meta-analysis investigates the associated risk of inflammatory bowel disease in patients with hidradenitis suppurativa. ImportanceHidradenitis suppurativa (HS) and inflammatory bowel disease (IBD) are inflammatory diseases that share common genetic susceptibility and immunologic features. However, the link between HS and IBD has been largely unclear. ObjectiveTo conduct a meta-analysis to investigate the association between HS and IBD. Data SourcesA search of the MEDLINE, Cochrane Central Register of Controlled Trials, and Embase databases yielded 397 relevant studies from inception to June 10, 2018. Two additional studies were supplied by one of the investigators. Study SelectionCase-control, cross-sectional, or cohort studies that examined the odds or risk of IBD in patients with HS were included. No geographic or language limitations were imposed. Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The Newcastle-Ottawa Scale was used to assess the risk of bias of included studies. Crohn disease and ulcerative colitis were analyzed separately, and a random-effects model meta-analysis was conducted. Main Outcomes and MeasuresThe odds ratios (ORs) and hazard ratios (HRs) of IBD, Crohn disease, and ulcerative colitis in association with HS. ResultsFive case-control studies, 2 cross-sectional studies, and 1 cohort study with a total of 93601 unique participants were included. The meta-analysis of case-control and cross-sectional studies showed significant associations of HS with Crohn disease (pooled OR, 2.12; 95% CI, 1.46-3.08) and ulcerative colitis (pooled OR, 1.51; 95% CI, 1.25-1.82). Two case-control studies found significant association of HS with IBD (ORs, 2.16 [95% CI, 1.40-3.34] and 10.00 [95% CI, 1.94-51.50]). One cohort study found an increased risk of IBD in patients with HS (HR, 5.6; 95% CI not reported; P<.002). Conclusions and RelevanceThe evidence to date supports an association of HS with IBD. These results suggest that consultation with gastroenterologists should be sought when patients with HS present with recurrent abdominal pain, chronic diarrhea, bloody stool, and body weight loss.