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P343 The prevalence of irritable bowel syndrome-type symptoms in paediatric inflammatory bowel disease and the relationship with biochemical markers of disease activity

K. Diederen1, D. Hoekman*1, T. Hummel2, T. de Meij3, B. Koot1, M. Tabbers1, A. Vlieger4, A. Kindermann1, M. Benninga1

1Academic Medical Centre (AMC), Department of Paediatric Gastroenterology, Amsterdam, Netherlands, 2Medisch Spectrum Twente, Department of Paediatrics, Enschede, Netherlands, 3VU University Medical Centre, Department of Paediatric Gastroenterology, Amsterdam, Netherlands, 4St. Antonius Hospital, Department of Paediatrics, Nieuwegein, Netherlands

Background

A large proportion (25%–46%) of adults with inflammatory bowel disease (IBD) in remission has symptoms of irritable bowel syndrome (IBS). These symptoms have been suggested to reflect ongoing inflammation. Data on paediatric IBD patients are lacking. Therefore, we aimed to investigate the prevalence of IBS-type symptoms in paediatric IBD patients in clinical remission and the relationship of IBS-type symptoms with biochemical markers of disease activity.

Methods

In this cross-sectional study, we included all patients (<18 years) with Crohn’s disease (CD), ulcerative colitis (UC), or IBD unclassified attending the outpatient clinic of one of 3 Dutch hospitals between March 2014 and June 2015. Clinical disease activity was determined using the abbreviated Paediatric CD Activity Index or Paediatric UC Activity Index. Biochemical disease activity was assessed using faecal calprotectin (FC) and serum CRP. The physician-administered Rome III-questionnaire was used to determine the presence of IBS. Differences between groups were analysed using t-tests, Mann–Whitney U-tests or Fisher’s exact tests, where appropriate, and 95% CI was based on bootstrapping with 1 000 iterations.

Results

In total, 186 patients (94 female; mean age 14.4 years) were included (CD 123 and UC 61). The prevalence of IBS-type symptoms in children with IBD in clinical remission without steroid use (n = 113) was 6.2% (95% CI 1. 9%–11.1%; CD 4.8%; UC 10.3%). No difference in levels of FC or CRP was found between patients with or without IBS-type symptoms (FC IBS+ median 88 µg/g, IBS-146 µg/g, p = 0.24; CRP IBS+ median 1.1 mg/L, IBS- 1.0 mg/L, p = 0.63). The majority of children with IBS-type symptoms had diarrhoea-predominant IBS (IBS-D, 56.2%) or constipation-predominant IBS (IBS-C, 25.0%). Children with IBS-type symptoms had a shorter disease duration, compared with children without IBS-type symptoms (p = 0.03). Other characteristics did not differ significantly between patients with and without IBS-type symptoms.

Table 1. Characteristics of patients with and without IBS-type symptoms

IBS+ (n = 24)IBS- (n = 162)p
Age (mean, SD)13.8 (3.3)14.5 (2.4)0.23
Females (n, %)14 (58.3%)80 (49.4%)0.51
Crohn’s disease (n, %)16 (66.7%)107 (66.0%)1.0
Months since diagnosis of IBD (median, IQR)11.7 (8.11–9.0)26.3 (9.5–42.4)0.03
Age at diagnosis (mean, SD)11.9 (4.8)11.8 (3.5)0.86
Currently receiving medical therapy for IBD (n, %)21 (87.5%)154 (95.1%)0.16

Conclusion

The prevalence of IBS-type symptoms in children with IBD is much lower than previously reported in studies in adult IBD patients. IBS-type symptoms appear to be unrelated to gastrointestinal inflammation.