Abdominal Pain Common in Both Active and Quiescent UC

TOPLINE: 

Abdominal pain is prevalent in patients with active and quiescent ulcerative colitis (UC), affects a higher proportion of patients during active disease, and is worse among women, patients with anxiety, and those with active disease.

METHODOLOGY:

• Researchers analyzed the data from three existing cohorts of adult patients with UC from Sweden to investigate the prevalence of abdominal pain and factors associated with it in active and quiescent UC.
• Cross-sectional cohort I (2002-2003) included 130 patients (mean age, 45 years; 46% women), of whom 46 had active disease. Cross-sectional cohort II (2012-2014) included 288 patients (mean age, 42 years; 40% women), of whom 156 had active disease. Longitudinal cohort III (2004-2007) included 83 patients (mean age, 36 years; 34% women) with active disease at diagnosis that reached deep remission during follow-up.
• Disease activity assessments were based on the clinician’s overall assessment based on symptoms, lab tests, and recent endoscopic investigations in cohort I and on Mayo scores and fecal calprotectin levels in cohorts II and III. Deep remission was defined as a total Mayo score ≤ 2, and all patients who were not in deep remission were categorized as having active disease.
• Researchers assessed abdominal pain using the Gastrointestinal Symptom Rating Scale (GSRS), psychological symptoms using the Hospital Anxiety and Depression Scale, and physical and mental quality of life (QOL) and fatigue using validated questionnaires and scales, respectively.
• Follow-up was conducted at 3-4 months and 1, 2, 3, and 10 years.

TAKEAWAY:

• In cross-sectional cohorts I and II, 63% and 58% of patients with active UC vs 54% and 33% of patients in remission had abdominal pain (both P ≤ .02). In longitudinal cohort III, 71% had abdominal pain at diagnosis vs 46% when in remission (P
• Abdominal pain levels were higher in patients with active UC than in those in remission in cross-sectional cohort I (P = .02) and II (P P
• Higher levels of anxiety were associated with higher levels of abdominal pain in cross-sectional cohort I (adjusted odds ratio [aOR], 1.75) and II (aOR, 1.99).
• In cohort II, female sex (aOR, 2.03) and having active disease (aOR, 2.68) were independently associated with higher levels of abdominal pain.
• A significant correlation was observed between increased levels of abdominal pain and reduced QOL in patients with both active and quiescent UC.

IN PRACTICE:

“Our findings suggest to combine medical treatments focusing on reducing inflammation with medical, dietary, and/or psychological treatment focusing on pain relief when treating UC patients with abdominal pain,” the authors wrote.

SOURCE:

The study, led by Tom van Gils, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, was published online in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

The definition of disease activity in cohort I was not as precise as that in the more recent cohorts. The GSRS for abdominal pain referred to pain or discomfort in the upper abdomen or the pit of the stomach, potentially underestimating the prevalence of lower abdominal pain or discomfort. Histological remission was not evaluated, which could have affected the interpretation of what role low-grade inflammation played in abdominal pain.

DISCLOSURES:

This study was supported by the Health & Medical Care Committee of the Regional Executive Board Region in Västra Götaland, Gothenburg Medical Society, Foundation of Elin and Carl Linder, and others. Some authors reported serving as consultants or advisory board members, being part of a speaker’s bureau, or receiving unrestricted research grants from pharmaceutical, medical device, or research firms.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.