Tomita Toshihiko, Fukui Hirokazu, Morishita Daisuke, Maeda Ayako, Makizaki Yutaka, Tanaka Yoshiki, Ohno Hiroshi, Oshima Tadayuki, Miwa Hiroto
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
R&D Center, Biofermin Pharmaceutical Co, Ltd, Kobe, Japan.
J Neurogastroenterol Motil. 2023 Jan 30;29(1):102-112. doi: 10.5056/jnm22027.
BACKGROUND/AIMS: Diarrhea-predominant irritable bowel syndrome (IBS-D)-like symptoms frequently occur in patients with quiescent Crohn's disease (CD). To investigate the factors underlying IBS-D-like symptoms in patients with quiescent CD, we performed a comprehensive analysis of the clinical features and intestinal environment in those patients.
We performed a prospective observational study of 27 patients with quiescent CD (CD activity index [CDAI] ≤ 150; C-reactive protein ≤ 0.3 mg/dL). The presence and severity of IBS-D-like symptoms, health-related quality of life, disease-specific quality of life, and status of depression and anxiety were evaluated. The level of intestinal permeability, fecal calprotectin and organic acids and the profiles of gut microbiome were analyzed.
Twelve of the 27 patients with quiescent CD (44.4%) had IBS-like symptoms, and these patients showed a significantly higher CDAI, IBS severity index and anxiety score than those without. The inflammatory bowel disease questionnaire score was significantly lower in the patients with IBS-D-like symptoms. There were no significant differences in small intestinal/colonic permeability or the levels of organic acids between the patients with and without IBS-D-like symptoms. Fusicatenibacter was significantly less abundant in the patients with IBS-D-like symptoms whereas their fecal calprotectin level was significantly higher (384.8 ± 310.6 mg/kg) than in patients without (161.0 ± 251.0 mg/kg). The receiver operating characteristic curve constructed to predict IBS-D-like symptoms in patients with quiescent CD using the fecal calprotectin level (cutoff, 125 mg/kg) showed a sensitivity and specificity of 73.3% and 91.7%, respectively.
Minimal inflammation is closely associated with the development of IBS-D-like symptoms in patients with quiescent CD.
背景/目的：腹泻型肠易激综合征（IBS-D）样症状在静止期克罗恩病（CD）患者中经常出现。为了研究静止期CD患者出现IBS-D样症状的潜在因素，我们对这些患者的临床特征和肠道环境进行了全面分析。
我们对27例静止期CD患者（CD活动指数[CDAI]≤150；C反应蛋白≤0.3mg/dL）进行了前瞻性观察研究。评估了IBS-D样症状的存在和严重程度、健康相关生活质量、疾病特异性生活质量以及抑郁和焦虑状态。分析了肠道通透性、粪便钙卫蛋白和有机酸水平以及肠道微生物群谱。
27例静止期CD患者中有12例（44.4%）出现IBS样症状，这些患者的CDAI、IBS严重程度指数和焦虑评分显著高于无IBS样症状的患者。IBS-D样症状患者的炎症性肠病问卷评分显著更低。有无IBS-D样症状的患者在小肠/结肠通透性或有机酸水平上无显著差异。IBS-D样症状患者中的融合双歧杆菌明显较少，而他们的粪便钙卫蛋白水平（384.8±310.6mg/kg）显著高于无IBS-D样症状的患者（161.0±251.0mg/kg）。使用粪便钙卫蛋白水平（临界值，125mg/kg）构建的预测静止期CD患者IBS-D样症状的受试者工作特征曲线显示，敏感性和特异性分别为73.3%和91.7%。
轻度炎症与静止期CD患者IBS-D样症状的发生密切相关。
