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P142. Functional symptoms in inflammatory bowel disease

J. Berrill1, H. Ludlow1, J. Green1

1University Hospital Llandough, Gastroenterology, Cardiff, United Kingdom

Background: Functional symptoms in patients with inflammatory bowel disease (IBD) may affect the clinical assessment of disease activity. As a result, additional investigations may be performed or inappropriate medication initiated. This study aims to examine the impact of irritable bowel syndrome (IBS) in patients with IBD, and to explore the role of faecal calprotectin (FC), a non-invasive marker of intestinal inflammation, in identifying these patients.

Methods: IBD patients attending clinic completed questionnaires including assessments of disease activity (Harvey–Bradshaw index in Crohn's disease, Simple clinical colitis activity index in ulcerative colitis) and presence of IBS (defined by Rome III criteria). Serum CRP and faecal calprotectin levels were measured. Medical records were reviewed for disease characteristics and previous management.

Results: 88 out of 154 IBD patients interviewed were in clinical remission (defined by clinical activity index score and CRP <10 mg/l). 28 (32%) of the patients in clinical remission had IBS. IBS was more common in females (p = 0.004), and associated with higher levels of anxiety (p = 0.004) and depression (p = 0.015). The mean number of endoscopic and radiological investigations performed in the previous 3 years was higher in the IBS group compared to the non-IBS group (1.40 v 0.87), and the frequency of these investigations being normal was significantly higher in the IBS group (79% v 39%, p = 0.01). Mean FC levels were similar in those patients in the IBS group (192 µg/g) and the non-IBS group (195 µg/g). 20% patients who were defined as active IBD by clinical activity index scores had normal FC (<100 µg/g), and of these 60% met the criteria for IBS.

Conclusions: Functional symptoms in IBD patients are common and have the potential to influence the clinical assessment of disease activity, leading to an increased number of endoscopic and radiological investigations being performed. Whilst some cases may be due to conditions such as bile salt malabsorption, the use of FC should enable the clinician to target those individuals whose symptoms are most likely to benefit from an escalation of medical therapy, and seek alternative strategies for the others.