Irritable bowel syndrome–like symptoms are re-lated to gut inflammation in clinical remission phase of inflammatory bowel disease

Abstract

• BACKGROUND: Symptoms consistent with irritable bowel syndrome (IBS) are common among patients with inflammatory bowel disease (IBD) in remission phase, and clinicians have difficulties in interpreting such symptoms as an ongoing disease activity or a coexistent IBS. We investigated if the assessment of fecal calprotectin (FC) could be helpful in this regard.
• METHODS: The study population consisted of 42 IBD patients in remission that fulfilled the IBS diagnostic criteria (Rome III), 24 IBS patients, and 30 healthy controls. Clinical remission was determined based on physician’s assessments, not using corticosteroids or biological agents within the preceding six months and activity indices. The FC and C-reactive protein (CRP) levels were investigated and compared among the groups.
• RESULTS: FC levels were significantly higher in patients with IBD (142.9 ± 216.5 µg/g) than those with IBS (24.9 ± 27.8 µg/g) and controls (17.9 ± 14.8 µg/g) (p < 0.001). CRP levels were also higher in IBD than IBS patients [3.9 (SE = 0.5) vs. 2.1 (SE = 0.5), p = 0.030]. However, FC levels were not significantly correlated with CRP levels or with severity of symptoms in IBD and IBS patients (p > 0.05).
• CONCLUSIONS: The presence of IBS-like symptoms in IBD patients in clinical remission may reflect an ongoing activity of IBD, which is undetectable by current activity indices. Serum CRP levels are not specific enough in such situation, and FC is a more accurate and specific test for investigating mucosal inflammation in this regard.
• KEYWORDS: Inflammatory Bowel Disease, Crohn’s Disease, Ulcerative Colitis, Remission, Inflammation, Irritable bowel syndrome