Presence of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease Is Associated with High Rate of Anxiety and Depression

  • Lilani P. PereraEmail author
  • Mark Radigan
  • Corinne Guilday
  • Indrani Banerjee
  • Daniel Eastwood
  • Reji Babygirija
  • Benson T. Massey
Original Article



Inflammatory bowel disease (IBD; Crohn’s disease, CD and Ulcerative colitis, UC) and irritable bowel syndrome (IBS) have overlapping symptoms. Few prevalence studies of IBS in quiescent IBD have used colonoscopy with histology to confirm inactive disease. The aims were (1) to determine the percentage of IBD patients in deep remission whose persistent IBS-like symptoms (IBD/IBS+) would cause them to be classified as having active disease, based on the calculation of Harvey Bradshaw Index (HBI) or UC disease activity index (UCDAI); (2) to identify demographic and disease characteristics that are associated with IBD/IBS+.


This was a prospective study at a single tertiary care IBD center. 96/112 patients with colonoscopy and histology confirmed quiescent disease consented and completed Rome III criteria for IBS Survey, and the hospital anxiety and depression scale (HADS). Other demographic and disease specific data were collected.


36% (28/77) and 37% (7/19) of CD and UC patients, respectively, met diagnostic criteria for IBS. Significantly higher HBI/UCDAI scores (p = 0.005) and low short inflammatory bowel disease questionnaire (SIBDQ) scores (p ≤ 0.0001) were seen in IBD/IBS+ patients. 29% of patients in deep remission were mis-categorized by HBI/UCDAI as having active disease when they fulfilled Rome III criteria for IBS. Psychiatric diagnosis (OR 3.53 95% CI 1.2–10.2) and earlier onset of IBD (OR 1.056 95% CI 1.015–1.096) were associated with IBD/IBS+. Patients fulfilling IBS criteria had higher hospital anxiety and depression scale (HADS).


IBD/IBS+ affect scoring of IBD disease activity scales and become less useful in guiding treatment plans.


Irritable bowel syndrome Inflammatory bowel disease Disease activity measurements Ulcerative colitis Crohn’s disease 



This publication has been supported by the National Center for Research, National Center for Advancing Translational Sciences (NCATS), and National Institutes of Health through Grant Number 8UL1TR000055. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Authors and Affiliations

  1. 1.Inflammatory Bowel Disease CenterAurora HealthcareGraftonUSA
  2. 2.Medical College of WisconsinMilwaukeeUSA
  3. 3.Washington UniversitySt. LouisUSA
  4. 4.Michigan State UniversityEast LansingUSA
  5. 5.Division of BiostatisticsMedical College of WisconsinMilwaukeeUSA
  6. 6.Aurora Research InstituteMilwaukeeUSA

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