- Fecal Incontinence
|Longitudinal impact of IBS-type symptoms on disease activity, healthcare utilization, psychological health, and quality of life in inflammatory bowel disease
Gracie DJ1,2, Hamlin PJ3,4, Ford AC3,4. Am J Gastroenterol. 2018 Feb 16. doi: 10.1038/s41395-018-0021-z. [Epub ahead of print]
1 Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. email@example.com.
2 Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. firstname.lastname@example.org.
3 Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
4 Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
OBJECTIVES: The impact of irritable bowel syndrome (IBS)-type symptoms on the natural history of inflammatory bowel disease (IBD) is uncertain. We aimed to address this in a longitudinal study of secondary care patients.
METHODS: Longitudinal disease activity was defined by disease flare, escalation of medical therapy, hospitalization, or intestinal resection. The number of investigations performed and clinics attended determined healthcare utilization. Psychological well-being and quality of life were assessed using validated questionnaires. These outcomes were compared over a minimum period of 2 years between patients reporting IBS-type symptoms and patients with quiescent disease, occult inflammation, and active disease at baseline.
RESULTS: In 360 IBD patients, there were no differences in longitudinal disease activity between patients with IBS-type symptoms and patients with quiescent disease or occult inflammation. Disease flare and escalation of medical therapy was more common in patients with active disease than in patients with IBS-type symptoms (hazard ratio (HR) = 3.16; 95% confidence interval (CI) 1.93-5.19 and HR = 3.24; 95% CI 1.98-5.31, respectively). A greater number of investigations were performed in patients with IBS-type symptoms than quiescent disease (P = 0.008), but not compared with patients with occult inflammation or active disease. Anxiety, depression, and somatization scores at follow up were higher, and quality-of-life scores lower, in patients with IBS-type symptoms when compared with patients with quiescent disease, but were similar to patients with active disease.
CONCLUSIONS: IBS-type symptoms in IBD were associated with increased healthcare utilization, psychological comorbidity, reduced quality of life, but not adverse disease activity outcomes during extended follow-up.