Patients With IBD More Likely to Have IBS-Type Symptoms

Patients with inflammatory bowel disease (IBD) are at a higher risk of having irritable bowel syndrome (IBS) symptoms.

A team, led by Keeley M. Fairbrass, Leeds Gastroenterology Institute, St. James's University Hospital, assessed the long-term natural history and impact of irritable bowel syndrome (IBS)-type symptoms on outcomes in inflammatory bowel disease (IBD) in patients of secondary care.

The Study

In the longitudinal follow-up, the investigators assessed the natural history of IBS-type symptoms in IBD using the Rome III criteria applied at baseline and year 2 and year 6.

The team defined longitudinal disease activity as the need for glucocorticosteroids or flare, escalation, hospitalization, or intestinal resection. They also assessed healthcare utilization by recording the number of outpatient clinic attendances and investigations and collected anxiety, depression, and somatoform symptom scores and quality of life scores during follow-up.

The study included 125 patients with Rome III data at all 3 time points. Of this group, 32.8% (n = 410) never reported IBS-type symptoms, while 12% (n = 15) had IBS-type symptoms at baseline that resolved. In addition, 15.2% (n = 19) had fluctuating symptoms, 28.0% (n = 35) had new-onset symptoms, and 12.0% (n = 15) had persistent symptoms.

Results

For the 300 patients with IBD activity data, the investigators found IBS-type symptoms were not linked to an increased likelihood of the need for glucocorticosteroids or flare, escalation, hospitalization, or intestinal resection, but the mean number of outpatient appointments and endoscopic investigations were substantially higher in participants with IBS-type symptoms.

The results also show significantly higher anxiety, depression, and somatoform symptom scores and significantly lower quality of life scores in patients reporting IBS-type symptoms at least once during the study.

“IBS-type symptoms affected more than two-thirds of patients with IBD during >6 years of follow-up and were associated with increased healthcare utilization, and worse anxiety, depression, somatoform symptom and quality of life scores, but not adverse disease activity outcomes,” the authors wrote.

IBS and Smoking

Patients with irritable bowel syndrome who also smoke are at an increased risk of severe abdominal pain according to new research.

There are several reasons why smoking has been linked to chronic pain for patients with a variety of diseases because smoking modulates the autonomic function and it delays mouth to cecum transit time.

IBS is often linked to altered colonic motility and sensation. And while smoking can impact pain perfection and is a risk factor for post-infectious IBS, there is not much research on the effect of smoking on abdominal pain and colonic transit in patients with IBS.

The results show patients with IBS-C had a longer transit time in the right colon, while scoring more chronic pain in comparison to patients with IBS-M.

In addition, more male patients and more smokers reported severe pain (16/30 vs. 4/38 and 20/30 vs. 4/38; both P <0.001).

The study, “Natural history and impact of irritable bowel syndrome-type symptoms in inflammatory bowel disease during 6 years of longitudinal follow-up,” was published online in Ailmentary Pharmacology & Therapeutics.