Hoekman Daniël R, Zeevenhooven Judith, D'Haens Geert R, Benninga Marc A
Departments of aPediatric Gastroenterology and Nutrition bGastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Gastroenterol Hepatol. 2017 Sep;29(9):1086-1090. doi: 10.1097/MEG.0000000000000921.
Symptoms of irritable bowel syndrome (IBS) are common in inflammatory bowel disease (IBD) and are believed to reflect ongoing inflammation. Consequently, a low prevalence of IBS-type symptoms in IBD patients with normal inflammatory markers is expected. We aimed to investigate the prevalence of IBS-type symptoms in IBD patients in biochemical remission (evidenced by low fecal calprotectin levels) and the relationship of these symptoms with fecal calprotectin levels.
In this observational, cross-sectional study, we included all adults with a history of IBD who had calprotectin levels less than 200 µg/g during routine follow-up between August 2014 and May 2015 at our hospital. Patients were excluded if calprotectin was measured because of gastrointestinal complaints. All patients were approached by telephone to evaluate the presence of IBS-type symptoms using Rome III questionnaires. Patients fulfilling IBS criteria were subclassified according to bowel habits.
In total, 74 patients were included; 33 (45%, 95% confidence interval: 34-56%) fulfilled the IBS criteria. A larger proportion of Crohn's disease patients with IBS-type symptoms had ileal disease compared with Crohn's disease patients without IBS symptoms (55 vs. 24%; P=0.03). Other characteristics were similar between groups. No difference was found in calprotectin levels between patients with and without IBS-type symptoms (P=0.91). The majority of patients with IBS-type symptoms had diarrhea-predominant or mixed-type IBS (64 and 27% of patients with IBS-type symptoms, respectively).
The prevalence of IBS-type symptoms in IBD patients in biochemical remission is high. A significant proportion of IBS-type symptoms is unrelated to ongoing inflammation and probably reflects 'true IBS'.
肠易激综合征（IBS）的症状在炎症性肠病（IBD）中很常见，且被认为反映了持续的炎症。因此，预计炎症标志物正常的IBD患者中IBS型症状的患病率较低。我们旨在调查生化缓解（以低粪便钙卫蛋白水平为证据）的IBD患者中IBS型症状的患病率，以及这些症状与粪便钙卫蛋白水平的关系。
在这项观察性横断面研究中，我们纳入了2014年8月至2015年5月在我院常规随访期间粪便钙卫蛋白水平低于200µg/g的所有有IBD病史的成年人。因胃肠道不适而检测钙卫蛋白的患者被排除。通过电话联系所有患者，使用罗马III问卷评估IBS型症状的存在情况。符合IBS标准的患者根据排便习惯进行亚分类。
总共纳入了74例患者；33例（45%，95%置信区间：34 - 56%）符合IBS标准。与无IBS症状的克罗恩病患者相比，有IBS型症状的克罗恩病患者中回肠疾病的比例更高（55%对24%；P = 0.03）。两组间的其他特征相似。有和无IBS型症状的患者之间钙卫蛋白水平无差异（P = 0.91）。大多数有IBS型症状的患者为腹泻型或混合型IBS（分别占IBS型症状患者的64%和27%）。
生化缓解的IBD患者中IBS型症状的患病率较高。相当一部分IBS型症状与持续炎症无关，可能反映了“真性IBS”。
