Abstract
BackgroundIrritable bowel syndrome (IBS) is more common in patients with ulcerative colitis (UC) than expected. The prevalence of IBS in patients with UC with longstanding disease is not known. We investigated the prevalence of IBS-like symptoms in patients with UC in remission and longstanding disease in comparison to control subjects.MethodsSixty-eight patients with UC and 33 patients with hereditary familiar colon cancer and who underwent colonoscopy surveillance were included. Faecal calprotectin (FC), Gastrointestinal Symptoms Rating Scale-Irritable Bowel Syndrome (GSRS-IBS) and Hospital Anxiety and Depression scale were fulfilled prior to endoscopy. UC in remission was define by steroid-free clinical remission, a Mayo Score ≤ 1 on endoscopy, a FC ≤ 200 μg/g and no significant active inflammation on colon biopsies.ResultsFifty-five UC patients met the criteria for being in remission. The median disease duration was 17 years. The patients with UC in remission tended to have lower scores on total GSRS-IBS score (6 vs 10.5; p = 0.062) and lower or equal scores on all specific IBS symptoms in comparison to controls. There was a moderate but significant correlation between diarrhoea scores and FC levels (in the span ≤ 200 μg/g) (rs 0.38; p = 0.004) in the UC in remission group.ConclusionPatients with UC with longstanding disease and in remission do not have more IBS symptoms than controls. In UC patients in remission the FC level in the lower span showed a moderate correlation to symptoms of diarrhoea.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0553-x) contains supplementary material, which is available to authorized users.
Highlights
Irritable bowel syndrome (IBS) is more common in patients with ulcerative colitis (UC) than expected
IBS-like symptoms in patients with UC and controls There was no difference in the total GSRS-IBS scores between patients with UC in remission and controls (Table 2)
Symptoms of constipation were significantly higher in the controls in comparison to the UC patients in remission but there were no differences in the other symptom clusters
Summary
Irritable bowel syndrome (IBS) is more common in patients with ulcerative colitis (UC) than expected. The prevalence of IBS in patients with UC with longstanding disease is not known. We investigated the prevalence of IBS-like symptoms in patients with UC in remission and longstanding disease in comparison to control subjects. A meta-analysis showed that approximately 30% of patients with UC in remission reported irritable bowel syndrome (IBS)-like symptoms [5], which is more than twice as high as the prevalence in a normal population [6]. There is some evidence that IBS-like symptoms in patients with UC may be due to inflammatory activity that is not apparently seen on endoscopy. UC patients in remission with IBS-like symptoms had higher levels of calprotectin in faeces than patients without IBS symptoms [7]. A faecal calprotectin (FC) cut-off level of 50–150 μg/g helps to discriminate patients with functional gastrointestinal
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