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IBS-like Symptoms in Patients with Ulcerative Colitis in Deep Remission Are Associated with Increased Levels of Serum Cytokines and Poor Psychological Well-being
Open accessAbstract
BACKGROUND: Gastrointestinal symptoms (GI) compatible with irritable bowel syndrome (IBS) are common in patients with ulcerative colitis (UC) in remission. The causes of these symptoms remain to be clarified. Our aim was to investigate prevalence and factors associated with IBS-like symptoms in patients with UC in deep remission. METHODS: We included 298 patients with UC and used Mayo score, sigmoidoscopy, and fecal calprotectin to define deep remission versus active disease. Presence of IBS-like symptoms according to the Rome III criteria, severity of GI, extraintestinal and psychological symptoms, stress levels, and quality of life were measured with validated questionnaires. Serum cytokines and high-sensitive C-reactive peptide were determined. RESULTS: The criteria for deep remission was fulfilled by 132 patients (44%) and 24 of these fulfilled the Rome III criteria for IBS (18%). Patients with UC in deep remission with IBS-like symptoms had comparable levels of GI symptoms, non-GI somatic symptoms, and quality of life as patients with active UC. The patients with UC in deep remission with IBS-like symptoms had similar levels of fecal calprotectin as patients in deep remission without IBS-like symptoms (18 versus 31 μg/g, P = 0.11), but higher levels of serum cytokines (interleukin [IL]-1β, IL-6, IL-13, IL-10 and IL-8, P < 0.05) and higher levels of anxiety (P < 0.001), depression (P = 0.02) and perceived stress (P = 0.03). CONCLUSIONS: IBS-like symptoms in patients with UC in deep remission are common, but not as prevalent as previously reported. Poor psychological well-being and increased serum cytokine levels, but not colonic low-grade inflammation, were associated with IBS-like symptoms.
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“Symptom self‐reporting may be higher in those with co‐morbidities, such as IBS 69 , 70 and mood disorders, 71”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [69]
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Metadata
- Authors
- Jonefjäll, B., Öhman, L., Simrén, M., & Strid, H.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Skövde (SE)
- Södra Älvsborg Hospital (SE)
- Corresponding author
- Jonefjäll, Börje
- Venue
- Inflammatory Bowel Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-11
- Volume
- 22
- Issue
- 11
- Pages
- 2630-2640
- ISSN
- 1078-0998 (ISSN-L)
- OpenAlex
- W2519572380
- Cited by
- 90
- References
- 41
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 10 · 2021: 10 · 2020: 11 · 2019: 12 · 2018: 12 · 2017: 12 · 2016: 3
- FWCI
- 10.50
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Inflammatory Bowel Diseases (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- AstraZeneca
- Danone
- Södra Älvsborgs Sjukhus
- Göteborgs Läkaresällskap
- Sahlgrenska Universitetssjukhuset
- Göteborgs Universitet
- Svenska Läkaresällskapet (SLS-329111)
- Allergan
- Medical Research Council
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Gastroenterology › Microscopic Colitis
- Keywords
- ulcerative colitis, deep remission
- MeSH terms
- Symptom Flare Up, Adolescent, Adult, Aged, Anxiety, Colitis, Ulcerative, Depression, Female, Humans, Male, Middle Aged, Remission Induction, Severity of Illness Index, Stress, Psychological, Cytokines, Young Adult
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