750 Incidence and Risk Factors of Constipation in Inflammatory Bowel Disease Patients During Remission

Abstract

INTRODUCTION: The incidence of constipation in long term follow-up of chronic IBD patients during remission hasn't been studied. Though constipation was observed in patients with proctitis, and hard stools reported in 27% of patients with active UC (1), constipation was not the focus of IBD studies in the past. The overlap of IBS with IBD was studied, a small and similar incidence of constipation was reported in both groups (2). This five-year follow-up study documented the incidence of constipation in IBD patients during remission, analyzing the risk factors related to the IBD Illness. METHODS: 259 Patients with IBD in the GI clinic were followed for 5 years, between 2013-2018. Patients who developed constipation during the remission period were studied to find the incidence of constipation and risk factors related to IBD. The remission was identified as clinical remission for more than 6 mo, or by endoscopic or histologic remission. All patients had KUB documented the high fecal load without obstruction at the time of clinical presentation with constipation. Factors related to IBD illness were analyzed, including gender, type of IBD, period of illness, and intestinal involvement. Those with Proctitis only and those with previous surgeries were extracted. RESULTS: 89/259 patients (34%) developed constipation. 43/89 with UC vs 41/89 with CD (P > 0.1). No statistical significance also found for the gender (54M Vs 35F) and the period of the illness (52 < 5 years, vs 37 > 5 years). The involvement of the distal colon including pancolitis involvement was significantly higher than the involvement of the right side of the colon (67/89 had distal involvement vs 3/89 proximal involvement), to the point of statistical significance (P < 0.05). Patients with skipping lesions with distal involvement were 19/89. CONCLUSION: This study showed a high incidence of constipation in patients with inactive IBD (34%), it was higher than the incidence of patients with hard stools at the time of diagnosis (4/50). The clinical setting of this study with long term observation was different from the clinical setting of the 2 surveillance that reported constipation in IBD patients in the medical literature. Though constipation is a functional symptom, the risk factor of IBD involvement is not related to the IBS. The successful treatment of constipation in this group impacted the quality of life and the management of IBD with medications, only 3 patients in this group required treatment with immunosuppressive or biologic medications.