Silva Andrea, Temido Maria José, Madeira Joana, Sant'Anna Mariana, Lopes Sandra, Silva Mário Rui, Figueiredo Pedro, Portela Francisco
Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Portugal.
Pathology , Centro Hospitalar e Universitário de Coimbra, Portugal.
Rev Esp Enferm Dig. 2024 Sep 5;119. doi: 10.17235/reed.2024.10695/2024.
Understand the cause of gastrointestinal symptoms compatible with irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) in remission is challenging. Those patients are known to show more anxiety, that may influence the course of IBD. The aim of this study was to determine the prevalence of IBS-like symptoms and anxiety by a questionnaire, and his association with subclinical inflammation using calprotectin levels (FC), Mayo Endoscopic Score (MES) and Geboes score (GS) in patients with ulcerative colitis (UC) in clinical remission.
Recruitment occurred between January 2020 and December 2021 and included UC patients scheduled for colonoscopy. Clinical remission was defined by stool frequency, ulcerative colitis activity index and serum C-reactive protein. IBS diagnosis was evaluated by Roma IV criteria.
We included 106 patients (51.9% women; mean age 51 years ±14.8). Rome IV criteria were fulfilled by 29 patients (27.4%). In the UC+IBS group more individuals had calprotectin >100mg/Kg (58.6% vs 23.4%, P=0.001), MES≥1 (37.9% vs 16.9%, P=0.023) and GS>2 (69.0% vs 29.9%, P=0.000). Thirty-three patients reported anxiety (31.3%). UC+IBS group also showed higher anxiety rates (51.7% vs 23.4, P=0.006). In multivariate logistic regression analyses: FC>100mg/Kg, histological activity, and higher anxiety were associated with IBS-like symptoms.
IBS-like symptoms are common in UC patients considered in clinical remission and relates with anxiety and subclinical inflammation. Our findings underscore the necessity for a comprehensive strategy for these patients, targeting not only inflammation but also psychological conditions.
了解炎症性肠病（IBD）缓解期患者出现与肠易激综合征（IBS）相符的胃肠道症状的原因具有挑战性。已知这些患者表现出更多焦虑情绪，这可能会影响IBD的病程。本研究的目的是通过问卷调查确定IBS样症状和焦虑的患病率，并使用钙卫蛋白水平（FC）、梅奥内镜评分（MES）和格博斯评分（GS）评估其与临床缓解期溃疡性结肠炎（UC）患者亚临床炎症的关联。
招募时间为2020年1月至2021年12月，纳入计划进行结肠镜检查的UC患者。临床缓解通过大便频率、溃疡性结肠炎活动指数和血清C反应蛋白来定义。IBS诊断根据罗马IV标准进行评估。
我们纳入了106例患者（51.9%为女性；平均年龄51岁±14.8）。29例患者（27.4%）符合罗马IV标准。在UC+IBS组中，更多个体的钙卫蛋白>100mg/Kg（58.6%对23.4%，P=0.001）、MES≥1（37.9%对16.9%，P=0.023）和GS>2（69.0%对29.9%，P=0.000）。33例患者报告有焦虑（31.3%）。UC+IBS组的焦虑率也更高（51.7%对23.4%，P=0.006）。在多因素逻辑回归分析中：FC>100mg/Kg、组织学活动和更高的焦虑与IBS样症状相关。
IBS样症状在临床缓解期的UC患者中很常见，且与焦虑和亚临床炎症有关。我们的研究结果强调了针对这些患者制定综合策略的必要性，不仅要针对炎症，还要关注心理状况。
