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* = Presenting author

P488 IBS-type symptoms in patients with quiescent inflammatory bowel disease are unrelated to ongoing inflammation

D. Hoekman*1, J. Zeevenhooven2, G. D’Haens3, M. Benninga1

1Academic Medical Centre (AMC), Department of Paediatric Gastroenterology, Amsterdam, Netherlands, 2Academic Medical Centre (AMC), Department of Paediatric Gastroenterology and Nutrition, Amsterdam, Netherlands, 3Academic Medical Centre (AMC), Department of Gastroenterology,

Background

Symptoms of irritable bowel syndrome (IBS) are common in inflammatory bowel disease (IBD), and are believed to result from ongoing (subclinical) inflammation. As a consequence, a low prevalence of IBS-type symptoms in IBD patients with normal surrogate markers of inflammation (ie, faecal calprotectin) is expected. In this study, we aimed to investigate the prevalence of IBS-type symptoms in patients with IBD in biochemical remission as evidenced by low levels of faecal calprotectin (FC), and the relationship of these symptoms with levels of FC.

Methods

In this observational, cross-sectional study, we included all adult patients with a previous diagnosis of IBD who had a FC level (Bühlman ELISA) < 200 µg/g during routine follow-up between August and November 2014 and between April and May 2015 at the Academic Medical Centre in Amsterdam, the Netherlands. Patients were excluded if FC was measured because of gastrointestinal complaints. All patients were approached by telephone within one month after FC measurement to evaluate the presence of IBS-type symptoms using the physician-administered Rome III-questionnaire. Patients fulfilling IBS criteria were sub-classified according to their bowel habits.

Results

In total, 74 IBD patients (51 Crohn’s disease [CD] were included in the analyses, 33 of whom [45%, 95% CI 3%–56%]) fulfilled the criteria for IBS.

Table 1 Prevalence (95% CI) of IBS-type symptoms in patients in remission with various FC cut-off points

CD+UCCDUC
IBD patients with FC < 200 µg/g (n = 74)45% (34%–56%)43% (29%–58%)48% (26%–68%)
IBD patients with FC < 100 µg/g (n = 53)45% (31%–58%)44% (26%–62%)48% (25%–68%)
IBD patients with FC < 50 µg/g (n = 34)47% (30%–63%)40% (19%–62%)57% (29%–84%)

A larger proportion of CD patients with IBS-type symptoms had ileal disease compared with CD patients without IBS-type symptoms (55% vs 24%; p = 0.03). Other characteristics were similar between groups. No difference was found in FC level between patients with and without IBS-type symptoms (median: 51 vs 77 µg/g; p = 0.91). The majority of patients with IBS-type symptoms had diarrhoea-predominant or mixed-type IBS (64% and 27% of patients with IBS-type symptoms, respectively).

Figure 1. The relationship between IBS-type symptoms and FC in patients in biochemical remission during routine evaluation. Boxes show median and interquartile range, whiskers show 5th and 9th percentile.

Conclusion

We found a high prevalence of IBS-type symptoms in IBD patients without biochemical evidence of inflammation. A significant proportion of IBS-type symptoms is unrelated to ongoing (mild) inflammation as measured with a faecal calprotectin assay, and thus appears to reflect ‘true IBS’, as frequently occurs in the general population.