Abdominal pain in IBD remission

January 29, 2024

Issue 03

Clinical Question

What factors are associated with chronic abdominal pain despite being in IBD remission?

Editor’s Bottom Line

Effective management of chronic pain remains an unmet need for many patients with chronic pain. These data identify subgroups at risk and may provide insight into pathogenesis.

Reference

Janssen LM, Rezazadeh Ardabili A, Romberg-Camps MJL, et al. Abdominal pain in patients with inflammatory bowel disease in remission: A prospective study on contributing factors Aliment Pharmacol Ther. 2023;58(10):1041–51; https://onlinelibrary.wiley.com

Synopsis

This prospective study included 429 consecutive adult patients with IBD treated at two Dutch tertiary care centers between January 2020 and July 2021. Patients were in biochemical IBD remission throughout the 18-month study period. Biochemical remission was defined as fecal calprotectin (FC) <150 μg/g.

Disease activity, lifestyle and psychosocial factors and abdominal pain were assessed every 1–3 months. Abdominal pain was measured using a 10-point numerical rating scale and those who had an abdominal pain score ≥3 during at least one-third of the assessments were considered to have chronic abdominal pain.

According to the analysis, 46.2% of patients had chronic abdominal pain throughout the study. Individuals who reported abdominal pain at baseline had lower general well-being scores, more anxiety, depression, fatigue and perceived stress (p<0.001 for all).

A multivariate analysis of factors associated with chronic abdominal pain longitudinally during the course of the study found that female sex (Estimate of fixed effects [EFE]: 0.492; p=0.002), ulcerative colitis (EFE: -0.298; p=0.007), baseline depressive symptoms (EFE: 0.174; p=0.021), fatigue (EFE: 0.242; p<0.001), significant life events (EFE: 0.375; p=0.023) and perceived stress (EFE: 0.101; p<0.001) were all linked to chronic abdominal pain in the presence of biochemical remission.

Details

Study Design: Prospective cohort
Funding: Not stated
Allocation: None
Setting: Multicenter
Level of Evidence: 1b