Symptoms In Inflammatory Bowel Disease Patients Research Articles

Targeting the intestinal circadian clock by meal timing ameliorates gastrointestinal inflammation

The expression of clock genes has been observed to be impaired in biopsies from patients with inflammatory bowel disease (IBD). Disruption of circadian rhythms, which occurs in shift workers, has been linked to an increased risk of gastrointestinal diseases, including IBD. The peripheral circadian clock in intestinal epithelial cells (IECs) was previously shown to balance gastrointestinal homeostasis by regulating the microbiome. Here, we demonstrated that the intestinal clock is disrupted in an IBD-relevant mouse model (IL-10−/−). A lack of the intestinal clock gene (Bmal1) in intestinal epithelial cells (IECs) in a chemically and a novel genetically induced colitis model (DSS, Bmal1IEC−/−xIL-10−/−) promoted colitis and dramatically reduced survival rates. Germ-free Bmal1IEC−/− mice colonized with disease-associated microbiota from IL-10−/− mice exhibited increased inflammatory responses, highlighting the importance of the local intestinal clock for microbiota-induced IBD development. Targeting the intestinal clock directly by timed restricted feeding (RF) in IL-10−/− mice restored intestinal clock functions, including immune cell recruitment and microbial rhythmicity; improved inflammatory responses; dramatically enhanced survival rates and rescued the histopathological phenotype. In contrast, RF failed to improve IBD symptoms in Bmal1IEC−/−xIL-10−/− mice, demonstrating the significance of the intestinal clock in determining the beneficial effect of RF. Overall, we provide evidence that intestinal clock dysfunction triggers host immune imbalance and promotes the development and progression of IBD-like colitis. Enhancing intestinal clock function by RF modulates the pathogenesis of IBD and thus could become a novel strategy to ameliorate symptoms in IBD patients.

Zinc and Inflammatory Bowel Disease: From Clinical Study to Animal Experiment.

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract (GI) with a high incidence rate globally, and IBD patients are often accompanied by zinc deficiency. This review aims to summarize the potential therapeutic value of zinc supplementation in IBD clinical patients and animal models. Zinc supplementation can relieve the severity of IBD especially in patients with zinc deficiency. The clinical severity of IBD were mainly evaluated through some scoring methods involving clinical performance, endoscopic observation, blood biochemistry, and pathologic biopsy. Through conducting animal experiments, it has been found that zinc plays an important role in alleviating clinical symptoms and improving pathological lesions. In both clinical observation and animal experiment of IBD, the therapeutic mechanisms of zinc interventions have been found to be related to immunomodulation, intestinal epithelial repair, and gut microbiota's balance. Furthermore, the antioxidant activity of zinc was clarified in animal experiment. Appropriate zinc supplementation is beneficial for IBD therapy, and the present evidence highlights that alleviating zinc-deficient status can effectively improve the severity of clinical symptoms in IBD patients and animal models.

Exploring Electrical Neuromodulation as an Alternative Therapeutic Approach in Inflammatory Bowel Diseases.

Background and Objectives: This review systematically evaluates the potential of electrical neuromodulation techniques-vagus nerve stimulation (VNS), sacral nerve stimulation (SNS), and tibial nerve stimulation (TNS)-as alternative treatments for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's Disease (CD). It aims to synthesize current evidence on the efficacy and safety of these modalities, addressing the significant burden of IBD on patient quality of life and the limitations of existing pharmacological therapies. Materials and Methods: We conducted a comprehensive analysis of studies from PubMed, focusing on research published between 1978 and 2024. The review included animal models and clinical trials investigating the mechanisms, effectiveness, and safety of VNS, SNS, and TNS in IBD management. Special attention was given to the modulation of inflammatory responses and its impact on gastrointestinal motility and functional gastrointestinal disorders associated with IBD. Results: Preliminary findings suggest that VNS, SNS, and TNS can significantly reduce inflammatory markers and improve symptoms in IBD patients. These techniques also show potential in treating related gastrointestinal disorders during IBD remission phases. However, the specific mechanisms underlying these benefits remain to be fully elucidated, and there is considerable variability in treatment parameters. Conclusions: Electrical neuromodulation holds promise as a novel therapeutic avenue for IBD, offering an alternative to patients who do not respond to traditional treatments or experience adverse effects. The review highlights the need for further rigorous studies to optimize stimulation parameters, understand long-term outcomes, and integrate neuromodulation effectively into IBD treatment protocols.

Predictors of irritable bowel syndrome-like symptoms in quiescent inflammatory bowel disease.

Many patients with quiescent inflammatory bowel disease (IBD) suffer from irritable bowel syndrome (IBS)-like symptoms. Although these symptoms cause significant reductions in quality of life, evidence-based treatments are lacking as risk factors and pathophysiology of these symptoms are not clearly defined. We aimed to identify risk factors for development of IBS-like symptoms in IBD patients with quiescent disease. We performed a single-center retrospective cohort study of adults with IBD from 2015 to 2021. Quiescent IBD was defined by a fecal calprotectin level <250 μg/g of stool or endoscopic evidence of quiescent disease. Cox regression was performed to identify variables that were independently associated with the incident development of IBS-like symptoms in IBD patients. A total of 368 IBD patients were included for analysis, including 278 patients with UC and 88 with Crohn's disease. 15.5% of quiescent IBD patients developed IBS symptoms, with an incidence rate of (95% CI 48.0-82.0) 63.3 per 1000 person-years. In the multivariate model, mood disorders (including anxiety and depression) and Crohn's disease were associated with increased risk for developing IBS symptoms. Male sex and higher iron levels conferred lower risk for developing IBS symptoms. Results from the multivariable model were similar in sensitivity analysis with quiescent IBD defined by fecal calprotectin level <150 mcg/g. Mood disorder and Crohn's disease were positively associated with IBS-like symptoms in quiescent IBD, whereas male sex and iron levels were protective. Our results were robust to different fecal calprotectin levels, arguing against inflammation as a mechanism for IBS-like symptoms. This data suggests noninflammatory mechanisms may be important in the pathogenesis of IBS-like symptoms in quiescent IBD. Future work may address whether modifying these risk factors may alter disease course.

P1183 Perception of the role of diet on symptom exacerbation in patients with Inflammatory Bowel Disease

Abstract Background A substantial proportion of patients with inflammatory bowel disease (IBD) believe that diet plays an important role in disease activity. As a result, IBD patients often change their dietary regimen in order to improve their symptoms and to prevent recurrences, however most of them choose self-imposed dietary restrictions that may lead to malnutrition and to a significant reduction in quality of life. The aim of our study was to evaluate dietary habits and the perception of the relationship between diet and symptoms in IBD patients. Methods A semi-structured questionnaire assessing demographics, clinical features, perception of the role of diet on symptom exacerbations and dietary habits including adoption of food restrictions was developed by our gastroenterologists and dietitians and was administered to patients with IBD. Results 85 patients with IBD (56 with Ulcerative Colitis and 29 with Crohn’s Disease, mean age 55.0 ± 15.9 years, 43 males) were enrolled in the study. Most IBD patients did not perceive diet as a possible cause of disease (68/85 patients, 80.0%) or relapses (70/85 patients, 82.3%), but the majority of them (55/85 patients, 64.7%) believed that certain foods and drinks could worsen disease symptoms. Alcohol, carbonate drinks, milk, spicy and fat foods were often considered as a possible cause of symptom deterioration. Although 50/85 patients (58.8%) stated that they changed their diet after the diagnosis, only 19/85 patients (22.3%) declared to adopt a "restrictive" diet by reducing or avoiding some foods. However, 64/85 patients (75.3%) showed low/intermediate adherence to Mediterranean Diet (MD) (calculated with the MediLite Score), and no patient had high adherence to MD. Finally, the majority of IBD patients declared that they would like to receive more information on diet in relation to their disease. Conclusion In our study, the majority of IBD patients perceived that certain foods and drinks could worsen disease symptoms and accordingly changed their diet after the diagnosis. The adoption of restrictive diets is probably more frequent than declared by IBD patients, as suggested by the high prevalence of low/intermediate adherence to MD. Education of healthcare providers is important to improve knowledge and quality of nutrition in IBD patients.

Lower gastric sensitivity in quiescent inflammatory bowel disease than in irritable bowel syndrome

ObjectiveVisceral hypersensitivity is considered a key symptom in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), both of which seriously affect health-related quality of life (HrQoL). Previous findings are mostly based on invasive procedures that may interfere with the assessment of visceral perception. The current study, therefore, investigates whether IBD and IBS are characterized by altered perception of ‘natural’ gastric distensions (‘interoception’). MethodsTwenty IBD patients in remission (13 Crohn's disease, 7 ulcerative colitis), 12 IBS patients, and 20/12 matched healthy control (HC) individuals, respectively, underwent the water load test, in which they could drink ad libitum until the subjective thresholds of satiation (stage 1) and fullness (stage 2) were reached. Gastric motility was assessed using electrogastrography. ResultsIBD patients drank significantly more water until satiation than IBS patients, whereas no differences between patients and HC groups were observed. Electrogastrographic patterns were comparable between groups, suggesting no pathologies in gastric motility in IBD or IBS. The amount of water consumed until satiation negatively correlated with HrQoL related to bowel symptoms in IBD patients, but was positively associated with emotional well-being in IBS patients. ConclusionOur findings implicate relative gastric hypersensitivity in IBS, and relative hyposensitivity in IBD patients, which are both related to specific HrQoL aspects.

The Effect of Exercise on the Signs and Symptoms of Inflammatory Bowel Disease.

Introduction: Inflammatory Bowel Disease (IBD) generally describes several autoimmune disorders that involve inflammation of the gastrointestinal tract, including Ulcerative Colitis (UC) and Crohn’s disease (CD). An estimated 3.1 million Americans are affected by IBD. Although the inflammation caused by IBD mainly affects the gastrointestinal tract, when IBD is exacerbated, the inflammation can become systemic. Consistent exercise is theorized to reduce chronic inflammation and reduce signs and symptoms of IBD. Objective: This meta-analysis aims to examine the effects of exercise on the signs and symptoms of IBD. Methods: A literary search was conducted using Cochrane Library, PubMed, and Cinahl databases. Of the 1031 records identified, twelve articles met the inclusion criteria, with seven articles presenting data that could be metaanalyzed. The reported data from the seven included articles were standardized to compare dependent variables using the Stata17 statistical package. Pooled effect sizes and 95% confidence intervals were obtained through the random-effects model. The results were used to examine the effects of exercise on C-reactive protein (CRP), fecal calprotectin (FC), and IBD signs and symptoms related questionnaires. Results: Signs and symptoms questionnaires were standardized and compared, resulting in a low risk of heterogeneity of 0.00% (I2), an effect size of 0.02, 95% CI [–0.66 to 0.70], p=0.96. Biomarkers were pooled, standardized, and compared, resulting in heterogeneity of 0.00% (I2) and an effect size of -0.48, 95% CI [–1.60 to 1.42], p=0.40. Conclusions: These results suggest that exercise does not decrease signs and symptoms in IBD patients.

Targeting pathophysiological changes using biomaterials-based drug delivery systems: A key to managing inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a gastrointestinal disorder, affecting about several million people worldwide. Current treatments fail to adequately control some clinical symptoms in IBD patients, which can adversely impact the patient's quality of life. Hence, the development of new treatments for IBD is needed. Due to their unique properties such as biocompatibility and sustained release of a drug, biomaterials-based drug delivery systems can be regarded as promising candidates for IBD treatment. It is noteworthy that considering the pathophysiological changes occurred in the gastrointestinal tract of IBD patients, especially changes in pH, surface charge, the concentration of reactive oxygen species, and the expression of some biomolecules at the inflamed colon, can help in the rational design of biomaterials-based drug delivery systems for efficient management of IBD. Here, we discuss about targeting these pathophysiological changes using biomaterials-based drug delivery systems, which can provide important clues to establish a strategic roadmap for future studies.

S904 Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease After SARS-CoV-2 mRNA Vaccination

Introduction: In the SARS-CoV2 mRNA vaccine trials, post-vaccination gastrointestinal (GI) symptoms were reported in 10-20% of participants. These symptoms could be perceived as inflammatory bowel disease (IBD) flare which could lead to patient anxiety, and unnecessary tests or treatment. We aimed to assess GI symptoms after SARS-CoV2 mRNA vaccination in patients with IBD relative to non-IBD healthcare workers (HCW). Methods: We assessed GI symptoms in adults with IBD and HCW at baseline and after each dose of a SARS-CoV-2 mRNA vaccine. We analyzed patient-reported IBD-specific disease activity (PRO2) after each dose (stool frequency (SF) and rectal bleeding for ulcerative colitis (UC), SF and abdominal pain for Crohn's disease (CD)). We also compared the frequency, severity, and duration of postvaccination GI symptoms in IBD patients compared to HCW. Severity was defined by impact on daily activities (mild, did not interfere;moderate, some interference;severe, prevented routine activity;extreme, required hospitalization). Severe and extreme were combined and designated as severe+. Duration was classified as 7 days. Results: Post-vaccination GI symptoms were assessed after dose 1 (D1) (1391 IBD, 933 HCW) and dose 2 (D2) (1271 IBD, 884 HCW) (Table). About 60% of IBD and>99% of HCW received the BNT162b vaccine (Pfizer);the remainder received mRNA-1273 (Moderna). New GI symptoms after D1 were more frequent among IBD than HCW (6.0% vs 2.9%, p=0.001) but not after D2 (12.1% vs 12.7%, p=NS). Relative to HCW, IBD patients reported more diarrhea (3.8% vs. 1% (p<0.001) after D1 and 7.5% vs 4.2% (p=0.003) after D2) and abdominal pain (2.2% vs. 0.4% (p=0.001) after D1 and 6.2% vs 3% (p=0.002) after D2). Severe1 symptoms were noted in 1.5% IBD and 0.3% HCW (p=NS) after D1 and in 3.3% IBD and 0.1% HCW (p<0.001) after D2 (Figure 1). Longer GI symptom duration was more common in IBD than HCW after D1 (2.1% vs 0.5%, p=0.002) and D2 (5.4% vs. 2.1%, p<0.001). Among 423 CD and 300 UC patients with PRO2 data, 71%, 68%, and 65% of CD and 86%, 86%, and 83% of UC were in clinical remission at baseline, after D1, and after D2, respectively. Conclusion: The frequency of GI symptoms in IBD was greater than HCW after D1, but similar after D2. More severe and longer duration of GI symptoms were noted in a small number of IBD patients. Reassuringly, the mRNA vaccines do not seem to increase the risk of a disease flare in the vast majority of IBD patients.

Nutrition and inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) are always interested in the effects of diet on their disease and are often puzzled by the apparent lack of concern in this regard expressed by their doctors. This lack of concern too often reflects the lack of knowledge but it must be recognized that the evidence base for nutritional interventions is weak and compares poorly with that underlying the use of modern biologic drugs. The past year has had its usual collection of personal and systematic reviews of the topic and a regrettably large number of poor quality publications on nutrition in IBD. The present contribution aims to highlight some of the more original articles of the past year and to identify areas where useful progress is being made both in cause (sugar perhaps less important than was thought) and habitual diet (where more fruit and less red meat are cautiously promoted). With regard to specific interventions, there is a swing back toward an exclusion diet in children with Crohn's disease and to dietary management of persistent symptoms in IBD patients in whom objective evidence of disease activity is absent or very low. The quality of articles in the field is slowly improving and it is encouraging to find several pertinent publications in the highest caliber journals. Hopefully, this will encourage improvement in clinical practice and further investment in research.

Prevalence of irritable bowel syndrome-like symptoms using Rome IV criteria in patients with inactive inflammatory bowel disease and relation with quality of life.

Irritable bowel syndrome (IBS)-like symptoms tend to be common in inflammatory bowel disease (IBD) patients even during the long-standing remission phase, and quality of life (QOL) seem to reduce in IBD patients with such symptoms. Thus, the aim of this study was to define the prevalence of IBS-like symptoms in inactive IBD patients using Rome IV criteria and evaluate the effect of IBS-like symptoms on QOL.Total 137 patients with IBD (56 with ulcerative colitis (UC) and 81 with Crohn disease (CD), who had been in long-standing remission according to the clinical scoring system and 123 control participants were included. These patients completed questionnaires to evaluate IBS-like symptoms according to Rome IV criteria, and the impact of these symptoms on the QOL of inactive IBD patients was compared with and without IBS-like symptoms according to disease-specific inflammatory bowel disease questionnaire (IBDQ).Depending on our research, IBS-like symptoms were found in 32% (18/56) of patients with inactive UC, 35% (29/81) of patients with inactive CD, and 13.8% (17/123) of control participants (P < .001). The QOL seemed to be significantly lower in both inactive UC and CD patients with IBS-like symptoms than in those without such symptoms (P < .001).In conclusion, we defined that the prevalence of IBS-like symptoms in IBD patients in remission is 2 to 3 times higher than that in healthy control participants, and significantly lower IBDQ scores showed QOL was reduced in inactive IBD patients with IBS-like symptoms as compared with patients without IBS-like symptoms.

P082 Spicy food is a vital trigger for relapse in patient with inflammatory bowel disease

Abstract Background The dietary is one of the environmental triggers for inflammatory bowel disease (IBD). We investigated which types of food can induce the relapse and worsen the symptoms in IBD patients through the epidemiologic study, and then explored the underlying mechanisms in an animal study. Methods A questionnaire assessing demographics, dietary habits and relapse-associated risk factors in patients has been administered to consecutive IBD patients who suffered one or more relapses at West China Hospital from September 2016 to November 2018. The mice with dextran sulphate sodium (DSS)-induced chronic colitis were orally administrated with top one type of risk food. The severity of mice colitis after administration was evaluated by disease activity index (DAI), histology, activity of myeloperoxidase (MPO) and the level of inflammatory cytokines. The infiltration of immune cells in lamia propria (LP) of mice was analysed by flow cytometry (FCM). Results A total of 306 patients participated in the survey, including 188 ulcerative colitis (UC) patients and 118 Crohn’s disease (CD) patients. Spicy food ranked first for the relapse in patients with IBD. In particular, 54.3% (n = 102) UC patients and 53.4% (n = 63) CD patients reported that the intake of spicy food could cause a relapse. Fifty per cent UC (n = 94) patients and 40.7% (n = 48) CD patients reported that the intake of spicy food could worsen their symptoms. In the animal study, the oral administration of capsaicin aggravated the chronic colitis in mice, along with the increased activity of MPO and the upregulated level of inflammatory cytokines. The pro-inflammatory effect of capsaicin was dose independent but time dependent. The antagonist for transient receptor potential vanilloid 1 (TRPV1), the receptor of capsaicin, could significantly suppress the capsaicin-induced deterioration of colitis. FCM revealed that capsaicin-administration led to the recruitment of multiple types of immune cells in mice LP and the recruitment of neutrophils was the most prominent. Conclusion The intake of spicy food can contribute to the relapse and deterioration of symptoms in IBD patients with UC and CD. In mice, the oral administration of capsaicin exacerbated DSS-induced colitis which was characterised by the recruitment of neutrophils, indicating the association between neutrophils and the relapse-triggering effect of capsaicin in colitis.

Inflammatory Bowel Diseases and Parkinson's Disease.

The etiology of Parkinson’s disease (PD) is multifactorial, with genetics, aging, and environmental agents all a part of the PD pathogenesis. Widespread aggregation of the α-synuclein protein in the form of Lewy bodies and Lewy neurites, and degeneration of substantia nigra dopamine neurons are the pathological hallmarks of PD. Inflammatory responses manifested by glial reactions, T cell infiltration, and increased expression of inflammatory cytokines, as well as other toxic mediators derived from activated glial cells, are currently recognized as prominent features of PD. Experimental, clinical and epidemiological data suggest that intestinal inflammation contributes to the pathogenesis of PD, and the increasing number of studies suggests that the condition may start in the gastrointestinal system years before any motor symptoms develop. Patients with inflammatory bowel disease (IBD) have a higher risk of developing PD compared with non-IBD individuals. Gene association study has found a genetic link between IBD and PD, and an evidence from animal studies suggests that gut inflammation, similar to that observed in IBD, may induce loss of dopaminergic neurons. Based on preclinical models of PD, it is suggested that the enteric microbiome changes early in PD, and gut infections trigger α-synuclein release and aggregation. In this paper, the possible link between IBD and PD is reviewed based on the available literature. Given the potentially critical role of gastrointestinal pathology in PD pathogenesis, there is reason to suspect that IBD or its treatments may impact PD risk. Thus, clinicians should be aware of PD symptoms in IBD patients.

Anti-inflammatory effect of Lycium barbarum on polarized human intestinal epithelial cells.

BACKGROUND/OBJECTIVESInflammatory Bowel Disease (IBD) has rapidly escalated in Asia (including Korea) due to increasing westernized diet patterns subsequent to industrialization. Factors associated with endoplasmic reticulum (ER) stress are demonstrated to be one of the major causes of IBD. This study was conducted to investigate the effect of Lycium barbarum (L. barbarum) on ER stress.MATERIALS/METHODSMouse embryonic fibroblast (MEF) cell line and polarized Caco-2 human intestinal epithelial cells were treated with crude extract of the L. chinense fruit (LF). Paracellular permeability was measured to examine the effect of tight junction (TJ) integrity. The regulatory pathways of ER stress were evaluated in MEF knockout (KO) cell lines by qPCR for interleukin (IL) 6, IL8 and XBP1 spliced form (XBP1s). Immunoglobulin binding protein (BiP), XBP1s and CCAAT/enhancer-binding homologous protein (CHOP) expressions were measured by RT-PCR. Scanning Ion Conductance Microscopy (SICM) at high resolution was applied to observe morphological changes after treatments.RESULTSExposure to LF extract strengthened the TJ, both in the presence and absence of inflammation. In polarized Caco-2 pretreated with LF, induction in the expression of proinflammatory marker IL8 was not significant, whereas ER stress marker XBP1s expression was significantly increased. In wild type (wt) MEF cells, IL6, CHOP and XBP1 spliced form were dose-dependently induced when exposed to 12.5–50 µg/mL extract. However, absence of XBP1 or IRE1α in MEF cells abolished this effect.CONCLUSIONResults of this study show that LF treatment enhances the barrier function and reduces inflammation and ER stress in an IRE1α-XBP1-dependent manner. These results suggest the preventive effect of LF on healthy intestine, and the possibility of reducing the degree of inflammatory symptoms in IBD patients.

No Significant Association Between the Fecal Microbiome and the Presence of Irritable Bowel Syndrome-type Symptoms in Patients with Quiescent Inflammatory Bowel Disease.

The microbiome is implicated in the pathogenesis of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Whether a distinct microbiome profile is associated with the reporting of IBS-type symptoms in IBD patients is uncertain. We aimed to resolve this issue using a cross-sectional study design. Using clinical disease activity indices, the Rome III criteria for IBS and fecal calprotectin levels, we divided IBD patients into 4 groups: IBS-type symptoms, quiescent disease, occult inflammation, and active disease. A16S rRNA microbiome analysis was performed to determine whether any taxa were differentially abundant, and whether there were any differences in alpha or beta diversity in patients reporting IBS-type symptoms compared with those in the other 3 groups. Of 270 patients included, 70 (25.9%) had IBS-type symptoms, 81 (30.0%) quiescent IBD, 66 (24.4%) occult inflammation, and 53 (19.6%) active IBD. At phylum level, there was a nonsignificant increase in the abundance of Actinobacteria in patients reporting IBS-type symptoms, but no other differences at any taxonomic level. When compared with patients reporting IBS-type symptoms, mean alpha diversity was greater in patients with quiescent disease, although this was nonsignificant (28.6 vs 31.7, P = 0.33), and similar to those with occult inflammation and active disease. Beta diversity variation among the 4 groups was significant for unweighted (P = 0.002) but not weighted (P = 0.21) UniFrac analysis. Reporting IBS-type symptoms was not associated with distinct microbiome alterations. Unmeasured confounding could have impacted the significance of our findings.

Debatable aspects of pathogenesis and diagnostics of irritable bowel syndrome (IBS) and inflammatory bowel diseases with IBS-like diseases

To analyze current publications devoted to controversial issues of pathogenesis, diagnosis and differential diagnosis of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in remission with IBS-like symptoms. There are three main hypotheses discussed in the literature: 1) IBS as a prodrome, pre-stage of the IBD; 2) IBS and IBD are different variants of inflammatory disorder which is common to both diseases; 3) The onset of IBS-like symptoms in IBD patients in remission. It is shown that modern literature data on this issue is contradictory and ambiguous.

Diagnosis and management of functional symptoms in inflammatory bowel disease in remission

Inflammatory bowel disease (IBD) patients in remission may suffer from gastrointestinal symptoms that resemble irritable bowel syndrome (IBS). Knowledge on this issue has increased considerably in the last decade, and it is our intention to review and summarize it in the present work. We describe a problematic that comprises physiopathological uncertainties, diagnostic difficulties, as IBS-like symptoms are very similar to those produced by an inflammatory flare, and the necessity of appropriate management of these patients, who, although in remission, have impaired quality of life. Ultimately, from almost a philosophical point of view, the presence of IBS-like symptoms in IBD patients in remission supposes a challenge to the traditional functional-organic dichotomy, suggesting the need for a change of paradigm.

THU0101 The Incidence of DE Novo Joint Symptoms in A Cohort of IBD Patients during Anti-TNF Treatment

BackgroundIncidence of de novo joint symptoms in patients with inflammatory bowel disease (IBD) treated with anti-TNF has not been well defined.ObjectivesWe aimed to evaluate the incidence and characteristics of joint...

PWE-077 Access To A Faecal Calprotectin Service Provides Clinicians With The Confidence To Diagnose And Treat Concomitant Functional Bowel Symptoms In Known Ibd Patients

IntroductionAn accurate clinical assessment of disease activity in inflammatory bowel disease (IBD) is essential to provide appropriate management strategies. The concurrent presence of functional symptoms in IBD patients is common...

Tu1190 Clinical Outcome and Prediction of Final Diagnosis in Pediatric Inflammatory Bowel Disease Unclassified (IBD-U) Patients

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory condition associated with significant morbidity, including psychiatric disease such as depression. The prevalence of depression, and the effect of anti-tumor necrosis factor alpha (TNFα) therapy on cognitive and somatic symptoms is not yet fully understood. Objectives: To examine (1) the prevalence of depression, using the validated Beck Depression Inventory-II (BDI-II) in patients with IBD, and (2) the association between depression with anti-TNFα therapy, disease type, disease activity, CRP, anemia, fatigue, and health related quality of life (HRQoL). Methods: Using a cross-sectional design in adult outpatients with a confirmed diagnosis of IBD, participants completed questionnaires assessing depression (BDI-II), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)), andHRQoL (Short IBDQuestionnaire (SIBDQ)). The BDI-II is categorized into minimal (0-13), mild (14-19), moderate (2028) and severe (29-63) depression, and can be grouped into cognitive and somatic domains. Demographic characteristics were also obtained. Results: Two hundred and ninety-five patients (50.8% female) with IBD (69.8% CD), including 55.2% anti-TNFα were enrolled. The prevalence of mild (14.2%), moderate (11.5%), and severe (7.5%) depressive symptoms in IBD patients was higher than reported population prevalences (13.7%; 7.1%; 2.1%, respectively). The proportion of depressed female patients (37.3%) was not statistically different to that of depressed males (28.9%, p=0.13). There was a trend seen in mean BDIII scores between CD (12.4±10.0) and UC (10.2±8.4, p=0.07) patients. Anti-depressant use (17.1±11.8, p=0.002), clinical assessment of active disease (15.0±10.0, p<0.001), and steroid use (14.1±11.0, p=0.043) were associated with a higher mean depression inventory, but anti-TNFα use (12.4±9.8, p=0.17), high CRP (13.5±9.3, p=0.29), and anemia (13.4±10.6, p=0.25) were not significantly different. In depressed patients, mean HRQoL scores (SIBDQ 3.7±1.4) were significantly lower than non-depressed patients (5.2±1.5, p<0.001). Somatic scores were significantly higher in IBD patients with features of active disease (7.7±4.2 vs 5.1±3.7, p=0.005) or high CRP (7.4±4.0 vs 5.8±4.3, p<0.001). Conversely, those with antiTNFα therapy had significantly more cognitive depressive symptoms (6.3±6.1 vs 4.9±5.7, p=0.047) than those not on biologics, but not somatic symptoms (6.2±4.1 vs 6.0±4.2, p= 0.69). Conclusions: Prevalence of depression in adult outpatient IBD practice is significantly higher compared with the general population, especially in those patients with active disease. AntiTNFα therapy was associated with increased cognitive, but not somatic depressive symptoms.