title: IBS-like Symptoms in Patients with Ulcerative Colitis in Deep Remission Are Associated with Increased Levels of Serum Cytokines and Poor Psychological Well-being.
abstract: Gastrointestinal symptoms (GI) compatible with irritable bowel syndrome (IBS) are common in patients with ulcerative colitis (UC) in remission. The causes of these symptoms remain to be clarified. Our aim was to investigate prevalence and factors associated with IBS-like symptoms in patients with UC in deep remission.
  
  
  
  We included 298 patients with UC and used Mayo score, sigmoidoscopy, and fecal calprotectin to define deep remission versus active disease. Presence of IBS-like symptoms according to the Rome III criteria, severity of GI, extraintestinal and psychological symptoms, stress levels, and quality of life were measured with validated questionnaires. Serum cytokines and high-sensitive C-reactive peptide were determined.
  
  
  
  The criteria for deep remission was fulfilled by 132 patients (44%) and 24 of these fulfilled the Rome III criteria for IBS (18%). Patients with UC in deep remission with IBS-like symptoms had comparable levels of GI symptoms, non-GI somatic symptoms, and quality of life as patients with active UC. The patients with UC in deep remission with IBS-like symptoms had similar levels of fecal calprotectin as patients in deep remission without IBS-like symptoms (18 versus 31 μg/g, P = 0.11), but higher levels of serum cytokines (interleukin [IL]-1β, IL-6, IL-13, IL-10 and IL-8, P < 0.05) and higher levels of anxiety (P < 0.001), depression (P = 0.02) and perceived stress (P = 0.03).
  
  
  
  IBS-like symptoms in patients with UC in deep remission are common, but not as prevalent as previously reported. Poor psychological well-being and increased serum cytokine levels, but not colonic low-grade inflammation, were associated with IBS-like symptoms.
authors.affiliation: *Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; †Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden; ‡Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; §School of Health and Education, University of Skövde, Skövde, Sweden; ‖Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina; and ¶Department of Internal Medicine, Södra Älvsborg Hospital, Borås, Sweden.
authors.forename: Börje
authors.initials: B
authors.lastname: Jonefjäll
authors.forename: Lena
authors.initials: L
authors.lastname: Öhman
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.forename: Hans
authors.initials: H
authors.lastname: Strid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D003093:Colitis, Ulcerative / Q000097:blood* / Q000188:drug therapy / Q000523:psychology*; D016207:Cytokines / Q000097:blood*; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D000067251:Symptom Flare Up; D055815:Young Adult
chemical_list: D016207:Cytokines