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P369 High prevalence of abdominal pain in Crohn's Disease patients of the TRUST study cohort- Is there a connection to inflammatory activity?

Kugel, T.(1);Maaser, C.(2);Kucharzik, T.(3);Fischer, I.(4);Kolterer, S.(5);Hammer, L.(5);Rath, S.(5);Sturm, A.(6);

(1)Paracelsus medical university Nuernberg, Paracelsus medical university Nuernberg, Nuernberg, Germany;(2)IBD Center- Klinikum Lueneburg gGmbH, Outpatients Department of Gastroenterology, Lueneburg, Germany;(3)Klinikum Lueneburg gGmbH, Department of Gastroenterology, Lueneburg, Germany;(4)Biostatistik - Tuebingen, Biostatistik - Tuebingen, Tuebingen, Germany;(5)AbbVie Deutschland GmbH & Co. KG, Medical Department, Wiesbaden, Germany;(6)DRK hospitals Berlin Westend- academic teaching hospital of the Charité, Department of gastroenterology, Berlin, Germany

Background

Pain is a debilitating symptom in many patients with Crohn’s disease (CD) both in flare and in remission [1]. However, pain is insufficiently understood and therefore often underrepresented in disease management [2]. Thus, it is of paramount importance to raise awareness for this common but insufficiently managed IBD symptom. With this analysis, we aimed to investigate (1) the prevalence of abdominal pain (AP) and (2) the correlation of AP with further parameters including inflammatory activity assessed by intestinal ultrasound (IUS), lab parameters and patient-well-being in CD patients of the TRUST study cohort.

Methods

We evaluated the prevalence of pain in 230 of 234 CD patients of the prospective, non-interventional, multi-centre TRUST study. At baseline, all patients were in clinical flare (Harvey-Bradshaw index (HBI) of≥7) and received treatment intensification. IUS parameters such as bowel wall thickness (BWT) and clinical data were assessed at baseline and after 3, 6, and 12 months. AP was analysed using the HBI subscore 2. To investigate the connection between AP and inflammation, AP was correlated with BWT and C-reactive protein (CRP).

Results

Based on the TRUST study, we found that 95.2% of patients in clinical flare experienced AP. AP was significantly reduced within 12 weeks after treatment intensification (p < 0.001) but 30% (n=69) to 48.3% (n=111) of patients still experienced AP at the subsequent visits (p(T1-T2) = 0.668; p(T2-T3) = 1.000) (figure 1). Of note, 35.6%-42.5% of patients with clinical response had a lasting pain experience (figure 2). AP positively correlated with poor well-being which is in line with previously published results [3]. We found a weak positive correlation between AP and inflammatory activity, represented by BWT (not shown), and between AP and CRP (table 1).


Figure 1 Percentage of patients with mild, moderate or severe abdominal pain during the study. *Friedman test with post-hoc Wilcoxon tests.

Figure 2 Percentage of patients with abdominal pain and clinical response (reduction of total HBI≥3 points) at the indicated visit
Table 1. Spearmann rank correlations for abdominal pain vs. poor general well-being (as measured by the HBI subscore 1) and vs. CRP at baseline

Conclusion

Our results clearly demonstrate that more than 1/3 of CD patients suffers from AP despite treatment intensification and clinical improvement. We found a weak correlation between AP and markers of inflammatory activity suggesting the existence of a subgroup of patients with persistent pain experience even with IBD treatment. Our data emphasize the importance of adjuvant pain management in IBD.

1 Bielefeldt et al. IBD Journal, 2009
2 Zeitz et al. PloS one, 2016
3 Schirbel et al. World journal of gastroenterology, 2010

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