Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors.
OBJECTIVE
Quality of life is reduced in inflammatory bowel disease (IBD). Whether or not this is true in IBD patients in long-standing remission is unclear. Symptoms compatible with irritable bowel syndrome (IBS) are common in IBD patients in remission. The importance of psychological factors in this process is a matter of controversy.


METHODS
Forty-three patients with ulcerative colitis (UC) and 40 with Crohn's disease (CD), who had been in remission for at least 1 yr according to laboratory parameters and clinical and endoscopical appearance, were included. These patients completed four different self-administered questionnaires, evaluating GI symptoms, anxiety, depression, and psychological general well-being. The two patient groups were compared with the general population, and within-group comparisons in psychometric scores were made between patients with and without IBS-like symptoms.


RESULTS
The psychological well-being in IBD patients in long-standing remission was similar to that of the general population, despite the presence of more severe GI symptoms. CD patients reported more psychosocial dysfunction, reduced well-being, and GI symptoms than UC patients. Thirty-three percent of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety and depression and more reduced well-being than those without. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients.


CONCLUSIONS
The prevalence of IBS-like symptoms in IBD patients in long-standing remission is two to three times higher than that in the normal population. Psychological factors seem to be of importance in this process. However, as a group IBD patients in remission demonstrate psychological well-being comparable to that of the general population.
Simrén
Magnus
M
Department of Internal Medicine and Section of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg, Sweden.
Axelsson
Jenny
J
Gillberg
Rolf
R
Abrahamsson
Hasse
H
Svedlund
Jan
J
Björnsson
Einar S
ES
D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011788:Quality of Life; D012075:Remission, Spontaneous; D018570:Risk Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D018709:Statistics, Nonparametric; D013548:Sweden