Introduction The prevalence of symptoms compatible with irritable bowel syndrome (IBS) in inflammatory bowel disease (IBD) has been previously described.1However, the association between the presence of these symptoms and occult disease activity is less well known, as is the effect of these symptoms on psychological health. We conducted a cross-sectional survey examining these issues.
Method Demographic and gastrointestinal symptom data were collected from 439 adult patients via the Rome III questionnaire. IBD activity was assessed via clinical scoring systems and faecal calprotectin (FC). Mood was assessed using the hospital anxiety and depression scale, whilst somatisation and quality of life data were collected using the patient health questionnaire-12 (PHQ-12) and SF-36 questionnaire respectively. Mean FC, as well as anxiety, depression and somatisation severity and quality of life were compared between CD and UC patients meeting Rome III criteria for IBS and those who did not.
Results More patients with CD met criteria for IBS than UC (97 (42.4%) of 229 vs. 63 (30.9%) of 204 respectively, P = 0.01). In CD, there was no difference in anxiety (P = 0.106), depression (P = 0.156) or somatisation severity (P = 0.104) in patients with IBS-type symptoms versus those without. Mean quality of life scores for pain (P = 0.003) and general health (P = 0.009) were significantly lower in CD patients with IBS-type symptoms. In contrast, in UC anxiety severity was higher in those with IBS-type symptoms (P = 0.001), and there was a trend towards greater depression and somatisation severity in patients with IBS-type symptoms (P = 0.035 and P = 0.011 respectively). UC patients with IBS-type symptoms had significantly lower mean quality of life scores for role limitations due to physical health (P = 0.004), energy/fatigue (P = 0.003), emotional wellbeing (P = 0.002), social functioning (P = 0.006), pain (P < 0.001) and general health (P = 0.003). Mean FC levels were higher in those with IBS-type symptoms than those without in CD (543.3 vs. 444.9; P = 0.529) and UC (423.5 vs. 282.8; P = 0.368). There was no difference in the proportion of individuals with a normal FC in CD patients fulfilling criteria for IBS (12 (63.2%) of 19) than those not (31 (56.4%) of 55) (P = 0.605). The same was true in UC (7 (50%) of 14 vs. 38 (69.1%) of 55 (P = 0.181).
Conclusion The prevalence of IBS-type symptoms is higher in CD than in UC. IBS-type symptoms are associated with more severe anxiety in UC patients and lower quality of life scores in both CD and UC. Whether such symptoms arise from occult disease activity, or true coexistence of IBS, remains unclear.
Disclosure of interest None Declared.
Halpin SJ, Ford AC. Am J Gastroenterol. 2012;107(10):1474–82