Coates Matthew D, Johri Ansh, Gorrepati Venkata Subhash, Maheshwari Parth, Dalessio Shannon, Walter Vonn, Stuart August, Koltun Walter, Bernasko Nana, Tinsley Andrew, Williams Emmanuelle D, Clarke Kofi
Department of Medicine, Division of Gastroenterology & Hepatology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA.
Int J Colorectal Dis. 2021 Jan;36(1):93-102. doi: 10.1007/s00384-020-03727-3. Epub 2020 Sep 3.
Inflammation is an important driver of abdominal pain in inflammatory bowel disease (IBD). However, some patients in remission still experience pain. We aimed to identify risk factors associated with abdominal pain in quiescent IBD (QP-IBD) and to characterize differences from patients with active disease experiencing pain (AP-IBD).
We performed a retrospective analysis utilizing data from our institution's IBD Natural History Registry (January 1, 2015-August 31, 2018). Endoscopic evaluation, concurrent laboratory studies, and validated surveys were completed by participants. Demographic and clinical data were also abstracted.
We recruited 122 patients with quiescent disease (65f:57 m; 93CD:26UC:3Indeterminate) for participation in this study, 74 (60.7%) had QP-IBD. QP-IBD patients were more likely to have anxiety/depression (71.6% vs. 25.0%, p < 0.001) or to use antidepressants (47.3% vs. 22.9%, p < 0.010), opiates (18.9% vs. 2.1%, p < 0.010), other pain medications (50.0% vs. 18.8%, p < 0.010), or corticosteroids (18.9% vs. 2.1%, p < 0.010). On logistic regression analysis, corticosteroid use, anxious/depressed state, and female gender were each independently associated with QP-IBD (p < 0.050 or less). Compared with AP-IBD patients (n = 110, 59f:51 m; 69CD:38UC:3Indeterminate), QP-IBD patients were more likely to use antidepressants (45.6% vs. 26.4%, p < 0.010). Platelet, white blood cell, C-reactive protein, and sedimentation rate levels were all less likely to be elevated in QP-IBD (all p < 0.050), though 44% exhibited pathological elevation in at least one.
QP-IBD was independently associated with corticosteroid use, anxiety/depression, and female gender. Compared with AP-IBD, QP-IBD patients were more likely to use antidepressants and less likely to exhibit elevated inflammatory markers. However, many QP-IBD patients still demonstrated pathological elevation of these tests, demonstrating the need to develop new noninvasive screening methods for this condition.
炎症是炎症性肠病（IBD）中腹痛的重要驱动因素。然而，一些缓解期患者仍有疼痛。我们旨在确定静止期IBD（QP-IBD）中与腹痛相关的危险因素，并描述其与活动期疼痛患者（AP-IBD）的差异。
我们利用本机构IBD自然史登记处（2015年1月1日至2018年8月31日）的数据进行了一项回顾性分析。参与者完成了内镜评估、同期实验室检查和经过验证的调查。还提取了人口统计学和临床数据。
我们招募了122例静止期疾病患者（65名女性：57名男性；93例克罗恩病：26例溃疡性结肠炎：3例不确定型）参与本研究，其中74例（60.7%）患有QP-IBD。QP-IBD患者更有可能患有焦虑/抑郁（71.6%对25.0%，p<0.001）或使用抗抑郁药（47.3%对22.9%，p<0.010）、阿片类药物（18.9%对2.1%，p<0.010）、其他止痛药物（50.0%对18.8%，p<0.010）或皮质类固醇（18.9%对2.1%，p<0.010）。逻辑回归分析显示，使用皮质类固醇、焦虑/抑郁状态和女性性别均与QP-IBD独立相关（p<0.050或更低）。与AP-IBD患者（n=110，59名女性：51名男性；69例克罗恩病：38例溃疡性结肠炎：3例不确定型）相比，QP-IBD患者更有可能使用抗抑郁药（45.6%对26.4%，p<0.010）。QP-IBD患者的血小板、白细胞、C反应蛋白和血沉水平升高的可能性均较小（均p<0.050），尽管44%的患者至少有一项指标出现病理性升高。
QP-IBD与使用皮质类固醇、焦虑/抑郁和女性性别独立相关。与AP-IBD相比，QP-IBD患者更有可能使用抗抑郁药，炎症标志物升高的可能性较小。然而，许多QP-IBD患者这些检查仍显示病理性升高，这表明需要为此疾病开发新的非侵入性筛查方法。
