Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub‐clinical inflammation and the impact on clinical assessment of disease activity

• Published in: Alimentary pharmacology & therapeutics 2013-07, Vol.38 (1), p.44-51
• Main Authors: Berrill, J. W., Green, J. T., Hood, K., Campbell, A. K.
• Format: Article
• Language: English
• Subjects: Adult; Anxiety - psychology; Biological and medical sciences; Cross-Sectional Studies; Depression - psychology; Digestive system; Disease Progression; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Inflammation - complications; Inflammation - psychology; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - diagnosis; Inflammatory Bowel Diseases - psychology; Irritable Bowel Syndrome - complications; Irritable Bowel Syndrome - diagnosis; Irritable Bowel Syndrome - psychology; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Severity of Illness Index; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surveys and Questionnaires
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12335

Summary Background Symptoms compatible with irritable bowel syndrome (IBS) are frequently present in patients with inflammatory bowel disease (IBD); however, the cause of this phenomenon is unclear. Aim To determine the different contributions of ‘true IBS’ and sub‐clinical inflammation in producing IBS‐type symptoms in IBD patients, and to ascertain the impact these symptoms have on the clinical assessment of IBD activity. Methods In this cross‐sectional study, 169 IBD patients completed questionnaires to assess disease activity, presence of IBS‐type symptoms, and levels of anxiety and depression. Stool samples were collected for analysis of faecal calprotectin (FC). Results IBS‐type symptoms were significantly more common in female patients (OR = 4.64, 1.55–13.88) and were associated with higher levels of anxiety (OR = 1.11, 1.01–1.21). There was no statistical difference between the FC levels of patients in clinical remission with IBS‐type symptoms compared with those without (median values = 111 μg/g vs. 45.5 μg/g respectively, P = 0.171). The prevalence of IBS‐type symptoms in patients with a normal FC level was 31%. Conclusions A substantial number of IBD patients with normal faecal calprotectin level experience IBS‐type symptoms. These patients exhibit similar features to people diagnosed with IBS in the general community, suggesting that the conditions are not mutually exclusive and may coexist in a considerable number of IBD patients. A systematic diagnostic approach is required to assess IBD patients with IBS‐type symptoms as sub‐clinical inflammation may play a role in a proportion of cases.