Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.
Lancet Gastroenterol Hepatol. 2020 Dec;5(12):1053-1062. doi: 10.1016/S2468-1253(20)30300-9. Epub 2020 Oct 2.
Patients with inflammatory bowel disease (IBD) often report symptoms compatible with irritable bowel syndrome (IBS), which might have an effect on psychological health. However, previous estimates of the magnitude of this issue have not accounted for ongoing inflammation as the potential cause. We updated a previous systematic review and meta-analysis to determine prevalence of IBS-type symptoms in patients with IBD in remission to better quantify the magnitude of this issue.
In this systematic review and meta-analysis, Embase, Embase Classic, and MEDLINE were searched (from Jan 1, 2012, to May 11, 2020) to identify prospective case-control or cross-sectional studies reporting prevalence of symptoms meeting diagnostic criteria for IBS in adults with IBD in remission. Studies were required to have recruited an unselected adult population (more than 90% of participants aged ≥16 years) with histologically or radiologically confirmed IBD and include at least 50 participants. Pooled prevalence and odds ratios (ORs) with 95% CIs were calculated according to the definition of remission, criteria used to define IBS-type symptoms, and type of IBD. The association between IBS-type symptom reporting and psychological comorbidity was examined using weighted mean difference (WMD) or standardised mean difference (SMD) in anxiety and depression scores between those reporting IBS-type symptoms and those not, for cases in which these data were available.
Of 3370 studies identified, 27 were eligible, of which 18 were newly identified. Among 3169 patients with IBD in remission, pooled prevalence of IBS-type symptoms was 32·5% (95% CI 27·4-37·9; I=90·1%). Prevalence was lower when remission was defined by endoscopic assessment (23·5%, 95% CI 17·9-29·6; I=59·9%) or histological assessment (25.8%, 95% CI 20.2-31.7; I=not applicable) than when defined by validated clinical disease activity index (33·6%, 26·3-41·2; I=91·8%) and higher in Crohn's disease than in ulcerative colitis (36·6%, 29·5-44·0; I=82·9% vs 28·7%, 22·9-34·8; I=87·2%). Anxiety (WMD 2·5; 95% CI 0·8-4·3) and depression (SMD 0·64; 0·44-0·84) scores were significantly higher among those who reported IBS-type symptoms than in those who did not.
Prevalence of symptoms compatible with IBS in patients with IBD varied according to how remission was defined. However, even when stringent criteria such as endoscopic or histological remission were used, about a quarter of patients reported these symptoms. Such symptoms were more common in patients with Crohn's disease and were associated with psychological comorbidity. Addressing psychological wellbeing might improve outcomes in this specific group of patients.
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炎症性肠病（IBD）患者常报告符合肠易激综合征（IBS）症状，这可能会对心理健康产生影响。然而，先前对这一问题严重程度的估计并未考虑到持续炎症可能是潜在的原因。我们更新了之前的系统评价和荟萃分析，以确定缓解期 IBD 患者中 IBS 型症状的患病率，从而更好地量化这一问题的严重程度。
在这项系统评价和荟萃分析中，我们在 Embase、Embase Classic 和 MEDLINE 中进行了搜索（从 2012 年 1 月 1 日至 2020 年 5 月 11 日），以确定前瞻性病例对照或横断面研究报告缓解期 IBD 成人中符合 IBS 诊断标准的症状的患病率。研究必须招募了未经选择的成年人群体（≥16 岁的参与者超过 90%），且具有组织学或影像学证实的 IBD，并至少包含 50 名参与者。根据缓解的定义、用于定义 IBS 型症状的标准以及 IBD 的类型，计算了汇总患病率和比值比（OR）及其 95%置信区间。使用报告 IBS 型症状和未报告 IBS 型症状的患者之间焦虑和抑郁评分的加权均数差（WMD）或标准化均数差（SMD）来检查 IBS 型症状报告与心理合并症之间的关联，如果有这些数据可用的话。
在确定的 3370 项研究中，有 27 项符合条件，其中 18 项是新发现的。在 3169 名缓解期 IBD 患者中，IBS 型症状的总患病率为 32.5%（95%CI 27.4-37.9；I=90.1%）。当缓解通过内镜评估（23.5%，95%CI 17.9-29.6；I=59.9%）或组织学评估（25.8%，95%CI 20.2-31.7；I=不适用）定义时，其患病率较低，而当通过验证的临床疾病活动指数（33.6%，95%CI 26.3-41.2；I=91.8%）定义时，其患病率较高，在克罗恩病中比溃疡性结肠炎中更高（36.6%，95%CI 29.5-44.0；I=82.9% vs 28.7%，95%CI 22.9-34.8；I=87.2%）。报告 IBS 型症状的患者焦虑（WMD 2.5；95%CI 0.8-4.3）和抑郁（SMD 0.64；0.44-0.84）评分显著高于未报告症状的患者。
根据缓解的定义，IBD 患者符合 IBS 的症状患病率有所不同。然而，即使使用内镜或组织学缓解等严格标准，也有四分之一的患者报告了这些症状。这些症状在克罗恩病患者中更为常见，并且与心理合并症有关。解决这一特定患者群体的心理健康问题可能会改善其预后。
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