Gülbahar ÜRÜN ÜNAL, Kamile MARAKOĞLU, Mehmet ÜNAL, Mehmet Ali ERYILMAZ, Orhan KÜLAHÇI

Skin and Gut: Psoriasis and irritable bowel syndrome. Is there an association?

Aim: The frequent occurrence of psoriasis with gastrointestinal system diseases indicates that psoriasis may also be associatedwith IBS. We aimed to evaluate the frequency of irritable bowel syndrome in patients with psoriasis and psoriatic arthritis.Material and Methods: Study included 111 patients with psoriasis, and 214 healthy volunteers. The presence of IBS in the psoriasisand control groups was evaluated according to the Rome III diagnostic criteria (Recurrent abdominal pain or discomfort at least 3days/month in the last 3 months associated with two or more of the following: Improvement with defecation, onset associated witha change in frequency of stool, onset associated with a change in form (appearance) of stool). The participants were also askedabout the presence of findings supporting the diagnosis of IBS. The participants were asked about the frequency of defecation, andthe stool type was evaluated according to the Bristol stool form scaleResults: 41 (36.9%) patients in the psoriasis group and 27 (12.6%) controls were detected to have IBS( p< 0.001). Passage of mucus,abdominal distension, and straining were found more frequently in the psoriasis group than in the control group (p = 0.023, 0.001,and 0.001, respectively). The mean defecation frequency per week was significantly higher in the psoriasis group than in the controlgroup (p = 0.000). The mean value for the Bristol stool scale was 4.12 ± 1.13 for the psoriasis group and 3.72 ± 1.16 for the controlgroup (p = 0.003).Conclusion: The increased frequency of IBS and the findings supporting the diagnosis of IBS in these patients suggest that theyhave a tendency to develop IBS. The indication of a higher frequency of IBS in patients with psoriatic arthritis is another importantoutcome of the present study

PDF

___

1. Braun-Falco O, Plewig G, Wolff HH, et al. Dermatology. 2nd edition, Berlin: Springer-Verlag 2000:585-607.
2. Gurer MA, Adisen E. Psoriasis, Introduction, General Information, Epidemiology. Turkderm 2008;42:15-7.
3. Thompson WG, Heaton KW, Smyth GT, et al. Irritable bowel syndrome in general practice: prevalance, characteristics, and referral. Gut 2000:46:78-82.
4. Patrick D, Drossman DA, Frederick IO. A Quality of life in persons with irritable bowel syndrome (IBS-QOL): Development and Validition of a Nem Measure. Dig Dis Sci 1998;43:400-11.
5. Zohar A, Cohen AD, Bitterman H, et al. Gastrointestinal comorbidities in patients with psoriatic arthritis. Clin Rheumatol 2016;35:2679-84.
6. Gisondi P, Del Giglio M, Cozzi A, et al. Psoriasis, the liver, and the gastrointestinal tract. Dermatol Ther 2010;23:155-9.
7. Yan D, Issa N, Afifi L, et al. The Role of the Skin and Gut Microbiome in Psoriatic Disease. Curr Dermatol Rep 2017;6:94-103.
8. Kewin WO, Marvin MS. Irritable Bowel Syndrome. In: Feldman M, Scharschmidt BF, Sleisenger MH. (Ed’s). Gastrointestinal and Liver Disease Pathophysiology / Diagnosis / Management. 6th Ed. Philadelphia:Saunders 1998;1536-48.
9. Kassinen A, Krogius-Kurikka L, Makivuokko H, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterologyb 2007;133:24-33.
10. Carroll IM, Ringel-Kulka T, Siddle JP, et al. Alterations in composition and diversity of the intestinal microbiota in patients with diarrhea predominant irritable bowel syndrome. Neurogastroenterol Motil 2012;24:248.
11. Yan D, Issa N, Afifi L, et al. The role of the skin and gut microbiome in psoriatic disease. Curr Dermatol Rep 2017;6:94-103.
12. Scher JU, Ubeda C, Artacho A, et al. Decreased bacterial diversity characterizes the altered gut microbiota in patients with psoriatic arthritis, resembling dysbiosis in inflammatory bowel disease. Arthritis & Rheumatology (Hoboken, NJ) 2015;67:128-39.
13. Masallat D, Moemen D, State AF. Gut bacterial microbiota in psoriasis: a case control study. Afr JMicrobiol Res 2016;10:1337-43.
14. Gulsen M. Irritable bowel syndrome. Current Gastroenterology 2007;11:98-121.
15. Unal HU, Irritable Bowel Syndrome, Current Gastroenterology 2012;16:213-7.
16. American Digestive Health Foundation: IBS; A Concise Guide for Medical Professionals. http://www.gastro. org/adhf/ibs-guide.html 2007.
17. American Gastroenterological Association Medical Position Statement; Irritable Bowel Syndrome. http:// www.wbsaunders.com/gastro/policy/ 2007.
18. Lubrano E, Iovino P, Tremolaterra F, et al. Fibromyalgia in patients with irritable bowel syndrome. An association with the severity of the intestinal disorder. Int J Color Dis 2001;16:211-5.
19. Salaffi F, De Angelis R, Carotti M, et al. Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatol Int 2014;34:1103-10.
20. De Giorgio R, Barbara G. Is irritable bowel syndrome an inflammatory disorder? Curr Gastroenterol Rep 2008;10:385-90.
21. Barbara G, Wang B, Stanghellini V, et al. Mast celldependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007;132:26-37.
22. Coruzzi G, Adami M, Pozzoli C. Role of histamine H4 receptors in the gastrointestinal tract. Front Biosci (Schol Ed) 2012;4:226-39.