Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom.
Clin Gastroenterol Hepatol. 2017 Mar;15(3):376-384.e5. doi: 10.1016/j.cgh.2016.05.012. Epub 2016 May 14.
BACKGROUND & AIMS: Symptoms compatible with irritable bowel syndrome (IBS) are common in patients with inflammatory bowel disease (IBD), but it is unclear whether this relates to occult IBD activity. We attempted to resolve this issue in a secondary care population by using a cross-sectional study design. METHODS: We analyzed Rome III IBS symptoms, disease activity indices, and psychological, somatization, and quality of life data from 378 consecutive, unselected adult patients with IBD seen in clinics at St James's University Hospital in Leeds, United Kingdom from November 2012 through June 2015. Participants provided a stool sample for fecal calprotectin (FC) analysis; levels ≥250 μg/g were used to define mucosal inflammation. By using symptom data and FC levels we identified 4 distinct groups of patients: those with true IBS-type symptoms (IBS-type symptoms with FC levels <250 μg/g, regardless of disease activity indices), quiescent IBD (no IBS-type symptoms with FC levels <250 μg/g, regardless of disease activity indices), occult inflammation (normal disease activity indices and FC levels ≥250 μg/g, regardless of IBS symptom status), or active IBD (abnormal disease activity indices with FC levels ≥250 μg/g, regardless of IBS symptom status). We compared characteristics between these groups. RESULTS: Fifty-seven of 206 patients with Crohn's disease (27.7%) and 34 of 172 patients with ulcerative colitis (19.8%) had true IBS-type symptoms. Levels of psychological comorbidity and somatization were significantly higher among patients with true IBS-type symptoms than patients with quiescent IBD or occult inflammation. Quality of life levels were also significantly reduced compared with patients with quiescent disease or occult inflammation and were similar to those of patients with active IBD. By using FC levels ≥100 μg/g to define mucosal inflammation, we found a similar effect of IBS-type symptoms on psychological health and quality of life. CONCLUSIONS: In a cross-sectional study, we identified a distinct group of patients with IBD and genuine IBS-type symptoms in the absence of mucosal inflammation. These symptoms had negative effects on psychological well-being and quality of life to the same degree as active IBD. New management strategies are required for this patient group.
背景与目的：伴有肠易激综合征（IBS）症状的患者在炎症性肠病（IBD）患者中很常见，但尚不清楚这是否与隐匿性 IBD 活动有关。我们试图通过使用横断面研究设计来解决这一问题，该研究纳入了来自英国利兹圣詹姆斯大学医院的 378 例连续、未经选择的成年 IBD 患者。分析了这些患者的罗马 III IBS 症状、疾病活动指数以及心理、躯体化和生活质量数据。参与者提供粪便样本进行粪便钙卫蛋白（FC）分析；将 FC 水平≥250μg/g 定义为黏膜炎症。根据症状数据和 FC 水平，我们确定了 4 组不同的患者：具有真正 IBS 型症状的患者（无论疾病活动指数如何，IBS 型症状伴有 FC 水平<250μg/g）、静止性 IBD 患者（无论疾病活动指数如何，无 IBS 型症状伴有 FC 水平<250μg/g）、隐匿性炎症患者（无论 IBS 症状状态如何，正常疾病活动指数和 FC 水平≥250μg/g）或活动性 IBD 患者（无论 IBS 症状状态如何，异常疾病活动指数伴有 FC 水平≥250μg/g）。我们比较了这些组之间的特征。
结果：206 例克罗恩病患者中有 57 例（27.7%）和 172 例溃疡性结肠炎患者中有 34 例（19.8%）存在真正的 IBS 型症状。与静止性 IBD 或隐匿性炎症患者相比，具有真正 IBS 型症状的患者心理共病和躯体化的水平显著更高。与静止性疾病或隐匿性炎症患者相比，生活质量水平也显著降低，与活动性 IBD 患者相似。当使用 FC 水平≥100μg/g 来定义黏膜炎症时，我们发现 IBS 型症状对心理健康和生活质量有类似的影响。
结论：在一项横断面研究中，我们发现了一组具有 IBD 和真正 IBS 型症状但无黏膜炎症的患者。这些症状对心理健康和生活质量的负面影响与活动性 IBD 相同。需要为这组患者制定新的管理策略。
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