Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Inflamm Bowel Dis. 2013 Sep;19(10):2207-14. doi: 10.1097/MIB.0b013e31829614c6.
Chronic pain is common in patients with inflammatory bowel disease and often attributed to inflammation. However, many patients with inflammatory bowel disease without evidence of active disease continue to experience pain. This study was undertaken to determine the prevalence of pain in patients with ulcerative colitis (UC) and examine the role of inflammation and psychiatric comorbidities in patients with UC with pain.
We performed a retrospective cross-sectional analysis of adult patients with UC seen at a tertiary referral inflammatory bowel disease center. Age, gender, disease duration and extent, abdominal pain rating, quality of life, physician global assessment, endoscopic and histological rating of disease severity, C reactive protein, and erythrocyte sedimentation rate were abstracted.
A total of 1268 patients were identified using billing codes for colitis. Five hundred and two patients (48.2% women) met all inclusion criteria. Two hundred and sixty-two individuals (52.2%) complained of abdominal pain, with 108 individuals (21.5%) describing more frequent pain ("some of the time or more"). Of those with quiescent disease (n = 326), 33 patients (10%) complained of more frequent pain. Physician global assessment, endoscopic and histological severity rating, erythrocyte sedimentation rate, and C reactive protein significantly correlated with pain ratings. The best predictors of pain were physician global assessment, C reactive protein and erythrocyte sedimentation rate, female gender, and coexisting mood disorders.
Abdominal pain affects more than 50% of patients with UC. Although inflammation is important, the skewed gender distribution and correlation with mood disorders highlight parallels with functional bowel disorders and suggest a significant role for central mechanisms. Management strategies should thus go beyond a focus on inflammation and also include interventions that target psychological mechanisms of pain.
慢性疼痛在炎症性肠病患者中很常见，通常归因于炎症。然而，许多没有活动性疾病证据的炎症性肠病患者仍持续感到疼痛。本研究旨在确定溃疡性结肠炎（UC）患者疼痛的患病率，并检查炎症和精神共病在 UC 伴疼痛患者中的作用。
我们对在三级转诊炎症性肠病中心就诊的成年 UC 患者进行了回顾性横断面分析。提取了年龄、性别、疾病持续时间和范围、腹痛评分、生活质量、医生总体评估、疾病严重程度的内镜和组织学评分、C 反应蛋白和红细胞沉降率。
使用结肠炎的计费代码共确定了 1268 例患者。502 例（48.2%为女性）符合所有纳入标准。262 人（52.2%）抱怨腹痛，其中 108 人（21.5%）描述更频繁的疼痛（“有时或更频繁”）。在疾病静止（n=326）的患者中，有 33 名患者（10%）抱怨更频繁的疼痛。医生总体评估、内镜和组织学严重程度评分、红细胞沉降率和 C 反应蛋白与疼痛评分显著相关。疼痛的最佳预测因素是医生总体评估、C 反应蛋白和红细胞沉降率、女性性别和并存的情绪障碍。
腹痛影响超过 50%的 UC 患者。尽管炎症很重要，但性别分布的偏斜和与情绪障碍的相关性突出了与功能性肠病的相似之处，并表明中枢机制的重要作用。因此，管理策略不应仅侧重于炎症，还应包括针对疼痛的心理机制的干预措施。
