Irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease: a real association or reflection of occult inflammation?
OBJECTIVE
Do gastrointestinal symptoms in patients with inflammatory bowel disease (IBD) in apparent remission reflect the coexistence of irritable bowel syndrome (IBS) or subclinical inflammation? The aims of this study were as follows: (i) to prospectively determine the prevalence of IBS symptoms in IBD patients in remission; and (ii) to determine whether IBS symptoms correlate with levels of fecal calprotectin.


METHODS
Remission was defined by physician assessment: Crohn's disease (CD) activity index <or=150 and ulcerative colitis disease activity index <or=3, and serum C-reactive protein <10, while off corticosteroids or biologics. Quality of life (QOL) (by inflammatory bowel disease questionnaire), the hospital anxiety and depression scale (HAD), and fecal calprotectin were measured.


RESULTS
Rome II criteria for IBS were fulfilled in 37/62 (59.7%) of CD patients and by 17/44 (38.6%) of those with ulcerative colitis (UC). However, fecal calprotectin was significantly elevated above the upper limit of normal in both IBD patient groups, indicating the presence of occult inflammation. Furthermore, calprotectin levels were significantly higher in CD and UC patients with criteria for IBS than in those without IBS-type symptoms. QOL scores were lower and HAD scores higher among UC patients with IBS symptoms in comparison to those who did not have IBS symptoms.


CONCLUSIONS
IBS-like symptoms are common in patients with IBD who are thought to be in clinical remission, but abnormal calprotectin levels suggest that the mechanism in most cases is likely to be occult inflammation rather than coexistent IBS.
Keohane
John
J
Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland.
O'Mahony
Caitlin
C
O'Mahony
Liam
L
O'Mahony
Siobhan
S
Quigley
Eamonn M
EM
Shanahan
Fergus
F
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis*; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex