Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3513-3521
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3513
Relationship between use of selective serotonin reuptake inhibitors and irritable bowel syndrome: A population-based cohort study
Wan-Tzu Lin, Yi-Jun Liao, Yen-Chun Peng, Chung-Hsin Chang, Ching-Heng Lin, Hong-Zen Yeh, Chi-Sen Chang
Wan-Tzu Lin, Yen-Chun Peng, Chung-Hsin Chang, Hong-Zen Yeh, Chi-Sen Chang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Yi-Jun Liao, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou 54552, Taiwan
Ching-Heng Lin, Taichung Veteran General Hospital, Taichung 40705, Taiwan
Yen-Chun Peng, Hong-Zen Yeh, Faculty of Medicine, College of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
Author contributions: Lin WT and Liao YJ contributed equally to this work; Lin WT and Chang CS designed the study; Peng YC and Lin CH collected the clinical data; Chang CH and Lin CH analyzed and interpreted the data; Peng YC, Yeh HZ and Chang CS provided executive support for this study; Lin WZ and Liao YJ wrote the manuscript; and Chang CS provided critical revision of the manuscript for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board (IRB) of Taichung Veterans General Hospital (IRB number: CE13152B-3).
Informed consent statement: The Institutional Review Board specifically waived the consent requirement, because the presented data are anonymized in Taiwan’s National Health Insurance Research Database, with no risk of identification.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chi-Sen Chang, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan. changcs@vhgtc.gov.tw
Telephone: +886-4-23592525-2001 Fax: +886-4-23741331
Received: December 14, 2016
Peer-review started: December 16, 2016
First decision: January 10, 2017
Revised: February 12, 2017
Accepted: March 31, 2017
Article in press: March 31, 2017
Published online: May 21, 2017

To investigate the relationship between selective serotonin reuptake inhibitor (SSRI) use and the subsequent development of irritable bowel syndrome (IBS).


This retrospective, observational, population-based cohort study collected data from Taiwan’s National Health Insurance Research Database. A total of 19653 patients newly using SSRIs and 78612 patients not using SSRIs, matched by age and sex at a ratio of 1:4, were enrolled in the study from January 1, 2000 to December 31, 2010. The patients were followed until IBS diagnosis, withdrawal from the National Health Insurance system, or the end of 2011. We analyzed the effects of SSRIs on the risk of subsequent IBS using Cox proportional hazards regression models.


A total of 236 patients in the SSRI cohort (incidence, 2.17/1000 person-years) and 478 patients in the comparison cohort (incidence, 1.04/1000 person-years) received a new diagnosis of IBS. The mean follow-up period from SSRI exposure to IBS diagnosis was 2.05 years. The incidence of IBS increased with advancing age. Patients with anxiety disorders had a significantly increased adjusted hazard ratio (aHR) of IBS (aHR = 1.33, 95%CI: 1.11-1.59, P = 0.002). After adjusting for sex, age, urbanization, family income, area of residence, occupation, the use of anti-psychotics and other comorbidities, the overall aHR in the SSRI cohort compared with that in the comparison cohort was 1.74 (95%CI: 1.44-2.10; P < 0.001). The cumulative incidence of IBS was higher in the SSRI cohort than in the non-SSRI cohort (log-rank test, P < 0.001).


SSRI users show an increased risk of subsequent diagnosis of IBS in Taiwan.

Keywords: Brain-gut axis, Irritable bowel syndrome, Selective serotonin reuptake inhibitor

Core tip: Selective serotonin reuptake inhibitor (SSRI) users were associated with a risk of subsequently diagnosed irritable bowel syndrome. The brain-gut axis may play a key role in this relationship. In clinical practice, physicians should pay attention to the gastrointestinal symptoms of patients with psychiatric disorders and SSRI use.