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Abdominal pain in quiescent inflammatory bowel disease

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objectives

Inflammation is an important driver of abdominal pain in inflammatory bowel disease (IBD). However, some patients in remission still experience pain. We aimed to identify risk factors associated with abdominal pain in quiescent IBD (QP-IBD) and to characterize differences from patients with active disease experiencing pain (AP-IBD).

Methods

We performed a retrospective analysis utilizing data from our institution’s IBD Natural History Registry (January 1, 2015–August 31, 2018). Endoscopic evaluation, concurrent laboratory studies, and validated surveys were completed by participants. Demographic and clinical data were also abstracted.

Results

We recruited 122 patients with quiescent disease (65f:57 m; 93CD:26UC:3Indeterminate) for participation in this study, 74 (60.7%) had QP-IBD. QP-IBD patients were more likely to have anxiety/depression (71.6% vs. 25.0%, p < 0.001) or to use antidepressants (47.3% vs. 22.9%, p < 0.010), opiates (18.9% vs. 2.1%, p < 0.010), other pain medications (50.0% vs. 18.8%, p < 0.010), or corticosteroids (18.9% vs. 2.1%, p < 0.010). On logistic regression analysis, corticosteroid use, anxious/depressed state, and female gender were each independently associated with QP-IBD (p < 0.050 or less). Compared with AP-IBD patients (n = 110, 59f:51 m; 69CD:38UC:3Indeterminate), QP-IBD patients were more likely to use antidepressants (45.6% vs. 26.4%, p < 0.010). Platelet, white blood cell, C-reactive protein, and sedimentation rate levels were all less likely to be elevated in QP-IBD (all p < 0.050), though 44% exhibited pathological elevation in at least one.

Discussion

QP-IBD was independently associated with corticosteroid use, anxiety/depression, and female gender. Compared with AP-IBD, QP-IBD patients were more likely to use antidepressants and less likely to exhibit elevated inflammatory markers. However, many QP-IBD patients still demonstrated pathological elevation of these tests, demonstrating the need to develop new noninvasive screening methods for this condition.

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Funding

This research was supported by the Peter and Marsha Carlino Early Career Professorship in Inflammatory Bowel Disease and the Margot E. Walrath Career Development Professorship in Gastroenterology.

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology & Hepatology, Pennsylvania State University College of Medicine, Hershey, PA, USA

    Matthew D. Coates, Venkata Subhash Gorrepati, Shannon Dalessio, August Stuart, Nana Bernasko, Andrew Tinsley, Emmanuelle D. Williams & Kofi Clarke

  2. Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA

    Ansh Johri & Parth Maheshwari

  3. Department of Public Health Sciences and Department of Biochemistry, Pennsylvania State University College of Medicine, Hershey, PA, USA

    Vonn Walter

  4. Department of Surgery, Division of Colorectal Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA

    Walter Koltun

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  1. Matthew D. Coates
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Contributions

MC developed the conceptual framework for this study, assisted with, and oversaw data collection and analysis in addition to assisting with writing and editing the manuscript. AJ assisted with data collection and analysis and helped in writing and editing the manuscript. VG assisted with analysis along with writing and editing the manuscript. PM assisted with data collection and review and editing the manuscript. SD assisted with writing and editing the manuscript. VW assisted with data analysis and helped edit the manuscript. AS assisted with data collection and organization and assisted with editing the manuscript. WK assisted in providing data and some of the conceptual frameworks for the study and edited the manuscript. NB, AT, EW, and KC assisted with the collection of data, providing the conceptual framework of the study and editing the study.

Corresponding author

Correspondence to Matthew D. Coates.

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Conflicts of interest

The authors of this manuscript have no relevant conflicts of interest or financial disclosures to report.

Ethics approval

This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments and approved by the Pennsylvania State University College of Medicine Institutional Review Board.

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A written informed consent was obtained by all individual participants included in this study.

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Every patient involved in this study signed a consent form to participate in research work that could eventually be published.

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Coates, M.D., Johri, A., Gorrepati, V.S. et al. Abdominal pain in quiescent inflammatory bowel disease. Int J Colorectal Dis 36, 93–102 (2021). https://doi.org/10.1007/s00384-020-03727-3

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