A Pilot Study of Clinical Evaluation and Formation Mechanism of Irritable Bowel Syndrome-like Symptoms in Inflammatory Bowel Disease Patients in Remission

Abstract

Background/AimsSome inflammatory bowel disease (IBD) patients in remission suffer from irritable bowel syndrome (IBS)-like symptoms (IBD-IBS). The pathogenesis has not yet been elucidated. The study aim is to evaluate relationships among quality of life (QOL), psychological status, and visceral sensitivity, and explore the formation mechanism of IBD-IBS. MethodsForty-seven patients with Crohn's disease in remission, 24 ulcerative colitis in remission, 26 IBS, and 20 healthy controls were included in the study. The abdominal pain, QOL, anxiety, and depression were evaluated through questionnaires. Visceral sensitivity was measured by rectal balloon distension. The serum levels of 5-hydroxytryptamine (5-HT) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay. The expressions of tryptase, 5-HT, NGF, and related receptors in colonic tissues were detected by immunohistochemistry and western blot. ResultsPrevalence of IBS-like symptoms in Crohn's disease and ulcerative colitis patients in clinical remission was 29.8% and 50.0%, respectively. The QOL was lower, the anxiety/depression scores were higher in IBD-IBS patients than those without IBS-like symptoms. Additionally, patients with IBD-IBS existed visceral hypersensitivity. Besides, abdominal pain was associated with poor QOL, visceral hypersensitivity, anxiety, and depression in IBD-IBS patients. The number of mast cells (MCs) and expressions of 5-HT, NGF, and related receptors were higher in IBD-IBS patients than those with no such symptoms. The serum levels of 5-HT and NGF positively correlated with abdominal pain and visceral hypersensitivity. ConclusionIBD-IBS patients may have low QOL and psychological abnormalities, as wells as visceral hypersensitivity which may be related to increased 5-HT and NGF levels released from activated mast cells.

Natural history and impact of irritable bowel syndrome‐type symptoms in inflammatory bowel disease during 12 months of longitudinal follow‐up

“…A smaller study, enrolling 47 patients with CD and 24 with UC in clinical remission, demonstrated a prevalence of Rome III IBS-like symptoms in 29.8% and 50.0% of patients, respectively. 30 As observed in our cohort, quality of life scores were lower, and anxiety or depression scores higher, in patients with IBS-type symptoms than those without. However, the authors did not evaluate fluctuations in, or stability of, these scores over time.…”

“…However, in our study, which recruited patients with IBD in clinical remission, patients with IBD with IBS‐type symptoms had higher anxiety or depression scores compared to those without IBS‐type symptoms at baseline and multiple other time points. A smaller study, enrolling 47 patients with CD and 24 with UC in clinical remission, demonstrated a prevalence of Rome III IBS‐like symptoms in 29.8% and 50.0% of patients, respectively 30 . As observed in our cohort, quality of life scores were lower, and anxiety or depression scores higher, in patients with IBS‐type symptoms than those without.…”

Beneficial Effects of Eruca sativa Defatted Seed Meal on Visceral Pain and Intestinal Damage Resulting from Colitis in Rats

“…According to previous evidence collected in both human and animals, visceral pain is correlated with an augmented activity of MCs through the intestine [ 14 , 26 ]. In the post-inflammatory phase of colitis induced by DNBS, an increased density of MCs has been detected in the submucosa with respect of controls ( p < 0.01), accompanying pain persistence.…”

The Efficacy of Camelina sativa Defatted Seed Meal against Colitis-Induced Persistent Visceral Hypersensitivity: The Relevance of PPAR α Receptor Activation in Pain Relief

“…Gut inflammation represents a major risk factor for the development of the persistent visceral hypersensitivity that underlies the onset of pain and altered motility and that often persists after the resolution of intestinal damage [ 2 ]. It is particularly evident in patients affected by inflammatory bowel diseases (IBDs), who continue suffering from abdominal pain and discomfort even after achieving clinical remission, developing a post-inflammatory irritable bowel syndrome (PI-IBS) [ 2 , 3 ].…”

“…The broad range of beneficial effects shown by Brassicaceae constituents, such as the glucosinolates (GSLs) [ 9 , 10 ], raised our interest in studying the potential of employing these plants in the therapy for gastrointestinal pain. Indeed, the main derivatives of GSL hydrolysis, isothiocyanates (ITCs), have been reported to modulate both inflammatory processes and oxidative stress [ 10 , 11 ], two factors contributing to the development of chronic pain in patients [ 3 , 6 , 12 , 13 ]. ITCs also display a prebiotic activity [ 12 , 13 , 14 ] that is highly relevant in the context of gut pain [ 15 , 16 , 17 ].…”