Abdalla Maisa I, Sandler Robert S, Kappelman Michael D, Martin Christopher F, Chen Wenli, Anton Kristen, Long Millie D
*Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Department of Medicine, Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California; ‡Department of Pediatrics. Division of Pediatric Gastroenterology, University of North Carolina, Chapel Hill, North Carolina; and §Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Inflamm Bowel Dis. 2017 Feb;23(2):325-331. doi: 10.1097/MIB.0000000000001017.
Inflammatory bowel disease (IBD) patients with persistent symptoms despite no or minimal inflammation are frequently described as having an overlap of IBD and irritable bowel syndrome (IBD-IBS). Limited data are available on how IBS impacts the individual patient with IBD. In this study, we aimed to evaluate the prevalence of IBD-IBS and investigate its impact on patient-reported outcomes.
We performed a cross-sectional analysis within the CCFA Partners Study. Bivariate analyses and logistic regression models were used to investigate associations between IBD-IBS and various demographic, disease factors, and patient-reported outcomes including anxiety, depression, sleep disturbances, pain interference, and social satisfaction.
Of the 6309 participants included, a total of 1279 (20%) reported a coexisting IBS diagnosis. The prevalence of IBD-IBS in this cohort was similar within disease subtypes. A diagnosis of IBD-IBS was associated with higher narcotic use compared with those with no IBS diagnosis for both Crohn's disease, 17% versus 11% (P < 0.001) and ulcerative colitis/indeterminate colitis, 9% versus 5% (P < 0.001). Quality of life, as measured by Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was lower in patients with IBD-IBS compared with those without. IBD-IBS diagnosis was associated with anxiety, depression, fatigue, sleep disturbances, pain interference, and decreased social satisfaction.
In this sample of patients with IBD, high prevalence of concomitant IBS diagnosis was observed. IBD-IBS diagnosis was associated with increased narcotic use and adverse patient-reported outcome. Appropriate diagnosis, treatment, and counseling may help improve the functional status of IBD-IBS patients and decrease narcotic use.
尽管炎症不明显或无炎症，但仍有持续症状的炎症性肠病（IBD）患者常被描述为患有IBD与肠易激综合征（IBD-IBS）重叠。关于IBS如何影响个体IBD患者的数据有限。在本研究中，我们旨在评估IBD-IBS的患病率，并调查其对患者报告结局的影响。
我们在CCFA合作伙伴研究中进行了横断面分析。采用双变量分析和逻辑回归模型来研究IBD-IBS与各种人口统计学、疾病因素以及患者报告结局之间的关联，这些结局包括焦虑、抑郁、睡眠障碍、疼痛干扰和社会满意度。
在纳入的6309名参与者中，共有1279名（20%）报告同时患有IBS。该队列中IBD-IBS的患病率在疾病亚型中相似。与未诊断为IBS的患者相比，IBD-IBS诊断与更高的麻醉药物使用相关，克罗恩病患者中分别为17%和11%（P<0.001），溃疡性结肠炎/不确定性结肠炎患者中分别为9%和5%（P<0.001）。通过简短炎症性肠病问卷（SIBDQ）测量的生活质量，IBD-IBS患者低于无IBD-IBS的患者。IBD-IBS诊断与焦虑、抑郁、疲劳、睡眠障碍、疼痛干扰以及社会满意度降低相关。
在这个IBD患者样本中，观察到IBS诊断的高患病率。IBD-IBS诊断与麻醉药物使用增加和不良的患者报告结局相关。适当的诊断、治疗和咨询可能有助于改善IBD-IBS患者的功能状态并减少麻醉药物使用。
