Short communication
Fatigue and disease-related worries among inflammatory bowel disease patients in remission; is it a reflection of coexisting IBS-like symptoms? A short report

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Abstract

Objectives

Irritable bowel syndrome (IBS) like symptoms and fatigue are frequently reported in quiescent inflammatory bowel disease (IBD). We hypothesized that coexisting IBS-like symptoms might be associated with increased levels of fatigue and disease-related worries.

Methods

A total of 140 IBD outpatients were assessed. Cut-off for remission was < 4 and < 3 on the disease activity indices SCDAI and SCCAI. In addition patients on current steroid treatment were excluded. A diagnosis of IBS was based on the Rome criteria. Fatigue was measured with the Fatigue Questionnaire (FQ), disease related worries with the Rating Form of IBD Patient Concerns (RFIPC).

Results

Eighty-nine patients fulfilled the criteria for remission. Of these 89 patients, 21 and 30 were IBS positive according to the Rome II and III criteria, respectively. FQ scores were significantly elevated in IBS positive UC patients. Clinical significant differences were also found in relation to RFIPC scores.

Conclusion

Coexisting IBS-like symptoms among IBD patients in remission are associated with an increased level of fatigue and disease-related worries.

Introduction

Ulcerative colitis (UC) and Crohn's disease (CD) are two chronic and idiopathic gastrointestinal disorders called inflammatory bowel disease (IBD). Key features include abdominal bloating and diarrhea [1]. Much of the etiology of IBD remains unclear; however both genetic and environmental factors have been revealed as trigger factors [2].

In clinical practice we have long been aware of the potential coexistence and overlap of IBS like symptoms in inflammatory bowel disease (IBD) [3], [4], [5]. Simrén et al. [6] studied 43 patients with UC and 40 with CD who had been in remission for at least 1 year. Thirty-three and fifty‐seven percent of UC and CD patients, respectively, were found to be IBS positive [6]. A recent report by Keohane et al. [5] found the Rome II criteria to be fulfilled in 59.7 and 38.6% of CD and UC patients, respectively.

IBS is characterized by abdominal pain or discomfort associated with altered bowel habits [3], [4], [5], and has, like IBD, a partially unknown etiology. The overlap in symptoms between IBD in remission and IBS may cause challenges in daily clinical practice, particularly related to treatment choices [5]. Consequently, the distinction between the two conditions is important in order to avoid overtreatment of IBD [5].

Symptoms such as fatigue have been reported to be prevalent and with an inverse effect on health-related quality of life in both IBD and IBS [3], [7], [8], [9]. A review by Whitehead et al. [9] found IBS to be present in 35 to 92% of patients with chronic fatigue. Fatigue is also associated with increased levels of disease-related worries and concerns in IBD [10].

The current study was conducted primarily to investigate the occurrence of fatigue symptoms among IBD patients in remission that are IBS positive, and secondarily to study the impact of such symptoms on disease-related worries.

Section snippets

Subjects

Patients aged 18 years old or above, with previously verified IBD (clinically, endoscopically and histologically), without severe disease activity [defined as SCCAI (simple clinical colitis activity index) [11] or SCDAI (simple Crohn's disease activity index) [12] score under 10] were eligible for inclusion in this study. To define remission values of less than three and less than four were chosen for the SCCAI and SCDAI, respectively [5], [13], [14]. Patients were excluded if they had cognitive

Results

A total of 140 patients (UC, n = 92; CD, n = 48) were assessed for inclusion in the analyses. When a cut-off of < 4 on the SCDAI and < 3 on the SCCAI was used, and patients on current steroid treatment had been excluded, a total of 89 patients, 63.6% of the initial sample, were identified. Out of these 89 patients, 61 were diagnosed with UC and 28 with CD. The Rome II criteria for irritable bowel syndrome were fulfilled in 15 and six UC and CD patients, respectively. The comparable number when using

Discussion

Studies that have compared patients with organic and functional gastrointestinal disease report a significantly higher level of fatigue in the latter group [20]. We thus hypothesized that fatigue symptoms among IBD patients in remission consequently might be a reflection of coexisting IBS-like symptoms.

We found, as expected, that coexisting IBS in IBD is associated with increased levels of fatigue. Questions have been raised as to whether or not IBS is a low-grade IBD [4], and Keohane et al. [5]

Statement of originality

The authors declare that the paper submitted has never before been published and is not under review in any other journals.

Statement of conflict of interest

The authors declared no conflict of interest.

Statement of author contributions

We declare that all authors of this article have made substantial contributions to the article according to the Vancouver rules.

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