Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Am J Gastroenterol. 2018 May;113(5):702-712. doi: 10.1038/s41395-018-0021-z. Epub 2018 Feb 16.
The impact of irritable bowel syndrome (IBS)-type symptoms on the natural history of inflammatory bowel disease (IBD) is uncertain. We aimed to address this in a longitudinal study of secondary care patients.
Longitudinal disease activity was defined by disease flare, escalation of medical therapy, hospitalization, or intestinal resection. The number of investigations performed and clinics attended determined healthcare utilization. Psychological well-being and quality of life were assessed using validated questionnaires. These outcomes were compared over a minimum period of 2 years between patients reporting IBS-type symptoms and patients with quiescent disease, occult inflammation, and active disease at baseline.
In 360 IBD patients, there were no differences in longitudinal disease activity between patients with IBS-type symptoms and patients with quiescent disease or occult inflammation. Disease flare and escalation of medical therapy was more common in patients with active disease than in patients with IBS-type symptoms (hazard ratio (HR) = 3.16; 95% confidence interval (CI) 1.93-5.19 and HR = 3.24; 95% CI 1.98-5.31, respectively). A greater number of investigations were performed in patients with IBS-type symptoms than quiescent disease (P = 0.008), but not compared with patients with occult inflammation or active disease. Anxiety, depression, and somatization scores at follow up were higher, and quality-of-life scores lower, in patients with IBS-type symptoms when compared with patients with quiescent disease, but were similar to patients with active disease.
IBS-type symptoms in IBD were associated with increased healthcare utilization, psychological comorbidity, reduced quality of life, but not adverse disease activity outcomes during extended follow-up.
肠易激综合征（IBS）样症状对炎症性肠病（IBD）自然病程的影响尚不确定。我们旨在对二级保健患者进行一项纵向研究来解决这一问题。
通过疾病发作、药物治疗升级、住院或肠道切除术来定义纵向疾病活动。所进行的检查次数和就诊次数决定了医疗保健的利用情况。使用经过验证的问卷评估心理幸福感和生活质量。在基线时患有 IBS 样症状的患者与患有静止性疾病、隐匿性炎症和活动性疾病的患者之间，比较了至少 2 年的这些结果。
在 360 例 IBD 患者中，患有 IBS 样症状的患者与患有静止性疾病或隐匿性炎症的患者之间的纵向疾病活动没有差异。与患有 IBS 样症状的患者相比，患有活动性疾病的患者疾病发作和药物治疗升级更为常见（危险比（HR）分别为 3.16；95%置信区间（CI）为 1.93-5.19 和 HR 为 3.24；95%CI 为 1.98-5.31）。与患有静止性疾病的患者相比，患有 IBS 样症状的患者进行了更多的检查（P=0.008），但与患有隐匿性炎症或活动性疾病的患者相比则不然。与患有静止性疾病的患者相比，患有 IBS 样症状的患者在随访时焦虑、抑郁和躯体化评分更高，生活质量评分更低，但与患有活动性疾病的患者相似。
在 IBD 中，IBS 样症状与增加的医疗保健利用、心理合并症、降低的生活质量相关，但与延长随访期间的不良疾病活动结果无关。
