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* = Presenting author

P344 Restless-Legs-Syndrome and iron deficiency in patients with inflammatory bowel disease

J. Becker1, F. Berger1, K. Schindelbeck2, P. Koch2, J. Preiß1, T. Karge1, B. Siegmund1, F. Marzinzik2, J. Maul*1

1Charité - University Medicine Berlin, Department of Medicine (Gastroenterology, Infectious Diseases, Rheumatology), Berlin, Germany, 2Charité - University Medicine Berlin, Campus Benjamin Franklin, Deptartment of Neurology, Berlin, Germany

Background

Patients with inflammatory bowel disease (IBD) frequently develop deficiency symptoms in addition to their characteristic IBD symptoms. In iron deficiency (ID), a modified cerebral iron metabolism may cause restless legs syndrome (RLS). In a previous study a prevalence of 30% for RLS in patients with Crohn´s disease (CD) was shown (Weinstock et al. 2010). In that study, RLS symptoms in patients with CD were not associated with current iron deficiency. Data for ulcerative colitis (UC) is lacking so far.

This study wants to determine the prevalence of RLS in patients with CD and UC of an IBD tertiary referral center evaluated by a questionnaire and confirmed by a neurologist. Furthermore, we study the effect of iron supplementation in CD and UC patients with RLS and ID.

Methods

Patients were consecutively screened for symptoms of ID and RLS by a self-developed questionnaire and explored for specific RLS-Symptoms by a gastroenterologist/internal medicine specialist. If RLS was suspected, patients were seen by a neurologist for conclusive RLS diagnosis or differential diagnosis, and additional tests (ultrasound with midbrain planimetrics, neuro-psychological tests (SF36, IBDQ-D, International RLS Severity Scale (IRLS), Epworth Sleepingness Scale, Pittsburgh Sleep Quality Index) were performed. Patients with RLS and ID received parenteral iron supplementation and were followed-up on week 4 and 11 after iron substitution.

Results

A total of 315 IBD patients were included in the study. (201 CD, 110 UC, 4 indeterminate colitis IC). RLS was suspected in 11% (n=33) of all patients by a gastroenterologist/internal medicine specialist (MC 10%, n=20; CU 10%, n=11; IC 50%, n=4). Diagnosis was confirmed in 73% of these patients by a neurologist (n=24; MC 70%, n=14; CU 73%, n=8; IC 100%, n=2). 25% of patients (n=6) showed mild, 42% (n=10) moderate, 29% (n=7) severe and 4% (n=1) very severe RLS according to IRLS score. The most common differential diagnosis was polyneuropathy (n=8). Estimated prevalence was 7% in both, CD and UC, respectively. 21% of RLS patients had concurrent ID. Iron supplementation resulted in 3 of 4 patients in improvement of IRLS score

Conclusion

RLS is seen in IBD, although prevalence in our study was much lower than in a previously published study. This may be due to the fact that diagnosis has to be established in close collaboration with a neurologist. CD and UC showed the same prevalence. Especially, sensomotoric peripheral neuropathy has to be considered as a differential diagnosis in IBD patients and can easily be misdiagnosed as RLS. Improvement of IRLS score after iron supplementation indicates a link between ID and RLS. However, further investigations with a larger cohort of RLS patients are necessary.