Patterns and mechanisms of visceral and rectal hypersensitivity in patients with ulcerative colitis in remission

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Abstract Background and aims Ulcerative colitis (UC) is a chronic inflammatory disorder affecting the colorectum, with a disease course characterized by periods of flare and remission. Despite the progression of medical therapy and although the clinical and laboratory findings of UC improve during remission, chronic abdominal pain and changes in the frequency and the consistency of stool are frequently observed. It has been reported that abdominal pain occurs in 20-50% of IBD patients even when clinical and endoscopic remission is achieved. Previous studies have suggested that this may reflect visceral hypersensitivity in these patients, with lower thresholds for pain sensation. The aim of this study is to provide a granular classification of symptom patterns and physiological abnormalities in distinct cohorts among patients with UC in remission, and to dissect the underlying mechanisms. Methods The aim of this study is to provide a granular classification of symptom patterns and physiological abnormalities in distinct cohorts among patients with UC in remission, and to dissect the underlying mechanisms. The project will build on an ongoing Greek study (for which the applicant is also the lead investigator). Using validated symptom questionnaires and high resolution anorectal manometry, the Greek cohort will identify clusters of symptomatology and associated physiological changes. Then, as part of this proposal, we will use the same questionnaires in a cohort of patients in Cambridge, UK to validate clusters of symptoms observed. We will use biopsies< from these patients to confirm the presence of a pro-nociceptive bowel environment in patients with pain in remission and investigated how this can be targeted with specific drugs. Anticipated impact The result will be a more detailed understanding of the patterns of functional symptoms experienced by patients with UC in remission, along with the functional correlates and putative nociceptive mediators. This will provide immediate insight into how to support patients with these symptoms as well as supporting future studies using therapeutic agents to alleviate symptoms in subgroups of patients.