Abdominal pain in quiescent inflammatory bowel disease
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ORIGINAL ARTICLE
Abdominal pain in quiescent inflammatory bowel disease Matthew D. Coates 1 & Ansh Johri 2 & Venkata Subhash Gorrepati 1 & Parth Maheshwari 2 & Shannon Dalessio 1 & Vonn Walter 3 & August Stuart 1 & Walter Koltun 4 & Nana Bernasko 1 & Andrew Tinsley 1 & Emmanuelle D. Williams 1 & Kofi Clarke 1 Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Abdominal pain . Quiescent . Inflammatory bowel disease . Ulcerative colitis . Crohn’s disease
Introduction * Matthew D. Coates [email protected] 1
Department of Medicine, Division of Gastroenterology & Hepatology, Pennsylvania State University College of Medicine, Hershey, PA, USA
2
Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
3
Department of Public Health Sciences and Department of Biochemistry, Pennsylvania State University College of Medicine, Hershey, PA, USA
4
Department of Surgery, Division of Colorectal Surgery, Pennsylvania State
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