P221 Association between Irritable Bowel Syndrome-type symptoms and Ulcerative Colitis: is it real?
Silva, A.P.(1);Madeira, J.(2);Sant’Anna, M.(1);Temido, M.J.(1);Fernandes, A.(3);Lopes, S.(1);Ferreira, A.M.(1);Mendes, S.(1);Ferreira, M.(1,4);Silva, M.R.(2);Cipriano, M.A.(2);Figueiredo, P.(1,4);Portela, F.(1,4);
(1)Centro Hospitalar e Universitário de Coimbra, Gastroenterology Department, Coimbra, Portugal;(2)Centro Hospitalar e Universitário de Coimbra, Anatomy Pathology Department, Coimbra, Portugal;(3)Centro Hospitalar de Leiria, Gastroenterology Department, Leiria, Portugal;(4)Universidade de Coimbra, Faculty of Medicine, Coimbra, Portugal;
Background
The origin of gastrointestinal symptoms compatible with irritable bowel syndrome (IBS) in patients with inflammatory bowel disease in remission is a challenge. Our aim was to prospectively determine the relation of IBS symptoms with calprotectin levels (FC), endoscopic Mayo score and histologic findings, in patients with ulcerative colitis (UC) in clinical remission.
Methods
Patient recruitment was between January – March of 2020 and November of 2020 - August of 2021 and included consecutive UC patients in clinical remission and scheduled for a colonoscopy. Clinical remission was defined by a stool frequency ≤3/day with no bleeding, ulcerative colitis activity index <4 and serum C-reactive protein lower than 1mg/dL. Exclusion criteria were therapeutic with corticosteroids over the prior 6 months or initiation of biological agents in the last 6 months. IBS diagnosis was evaluated by Roma IV criteria (IBS-like group). FC level was assessed before colonoscopy and during the exam Mayo endoscopy subscore was applied and random biopsies of all segments of colon and rectum were made to achieve histologic activity using Geboes index. This study was approved by Centro Hospitalar e Universitário de Coimbra Ethics Committee.
Results
A total of 106 patients (50% women; mean age 51 years ±14.8) were included. The mean of disease duration was 15.7 years (±9.06) and 13 of them (12.3%) had proctitis, 64 (60%) left-sided colitis and 29 (27.4%) extensive colitis. Regarding disease activity: mean FC was 189.48mg/Kg (±382), endoscopic Mayo score lower than 1 was found in 63 patients (59.4%) and Geboes index lower than 1.1 was found in 66 patients (62.3%). Rome IV criteria for IBS were fulfilled by 29 patients (27.4%). The IBS-like group showed FC levels significantly higher (303±483mg/Kg vs. 139±319mg/Kg; P<0.05), with greater histologic activity (Geboes index >1.1 in 65,5% vs. 27.3%, P<0.05). Besides, in the same group (IBS-like group), Mayo endoscopy subscore was numerical higher but with no statistical significancy (subscore ≥1: 55.2% vs. 36.4%; P>0.05).
Conclusion
IBS-like symptoms are common in patients with UC considered to be in clinical remission. Higher levels of FC and histological activity support the idea of the presence of subclinical inflammation rather than coexistent IBS.