Low-Grade Inflammation Is Likely Cause of IBS Symptoms in IBD Patients

[David in Seattle]

Am J Gastroenterol 2010.

When patients with inflammatory bowel disease (IBD) in remission have irritable bowel symptoms, the cause is more likely to be low-grade inflammation rather than true irritable bowel syndrome (IBS), according to a new study.

To identify the cause of IBS-like symptoms in IBD patients, the researchers measured fecal calprotectin, a marker for colonic inflammation. Calprotectin levels were higher in IBD patients with IBS-like symptoms than in other IBD patients and control groups.

"This study provides convincing evidence that (IBS) symptoms reflect ongoing IBD activity," the researchers write in their paper, which appeared online April 13 in the American Journal of Gastroenterology.

In the two-part study, Dr. Fergus Shanahan from Cork University Hospital, Ireland, and colleagues first evaluated 62 patients with Crohn's disease and 44 with ulcerative colitis. They defined remission of each condition according to the appropriate clinical criteria, activity indices, and C-reactive protein levels.

On that basis, all of their subjects were in remission. Even so, 37 Crohn's disease patients (59.7%) and 17 ulcerative colitis patients (38.6%) met Rome II criteria for IBS.

To evaluate the likely cause of IBS symptoms, the researchers stratified patients according to IBD etiology and IBS symptom status. They also analyzed two control groups: 34 healthy women without gastrointestinal symptoms and 41 women with confirmed IBS.

Fecal calprotectin levels were higher in Crohn's patients with IBS symptoms than in those without (415 vs. 175 mg/kg, p=0.009). The levels were similarly higher in ulcerative colitis patients with IBS symptoms compared to those without (591 vs. 230 mg/kg, p = 0.004).

Calprotectin levels in the inflammatory bowel disease patients - regardless of IBS symptom status - "greatly exceeded" levels in controls, the authors said.

"This study confirms the validity of calprotectin in distinguishing IBD from both IBS and control subjects and again illustrates that calprotectin levels are within the normal range in IBS," the researchers write.

While some IBD patients might technically qualify for an IBS diagnosis as well, the presence of IBS-like symptoms should always be interpreted as subclinical activity of their primary disease, according to the investigators.

Their conclusion: "Bottom line, IBD is IBD unless proven otherwise!"

 

[Crohn's 35]

IBS is a condition, and IBD is a disease. If the inflammation is there in existance I would think the IBS has been possibly misdiagnosed which we all have seen some people been told they have IBS only later to find out they have IBD.

 

[D Bergy]

So in a more practical sense, it stands to reason that controlling what I call Chronic low grade inflammation is a good idea.

It is not necessarily only in the intestinal tract, but even if it is, it affects our body as a whole.

Since I do have an early warning indicator of inflammation in the form of depression, I know it is a factor in my case. It was not constant, but came and went in cycles.

Interesting study. Thanks for posting it here.

Dan

 

[David in Seattle]

IBS is a condition, and IBD is a disease. If the inflammation is there in existance I would think the IBS has been possibly misdiagnosed which we all have seen some people been told they have IBS only later to find out they have IBD.

Unfortunately for the sufferers, I'm afraid the science (not to mention the definitions & diagnoses) behind all these conditions is far from exact

 

[David in Seattle]

So in a more practical sense, it stands to reason that controlling what I call Chronic low grade inflammation is a good idea.

It is not necessarily only in the intestinal tract, but even if it is, it affects our body as a whole.

Since I do have an early warning indicator of inflammation in the form of depression, I know it is a factor in my case. It was not constant, but came and went in cycles.

Interesting study. Thanks for posting it here.

Dan

I think we're only beginning to appreciate the ramification of chronic inflammation, as in cancer.

Glad you found it interesting!

 

[Cookie]

I think we're only beginning to appreciate the ramification of chronic inflammation, as in cancer.

Agreed. Kinda makes you feel like a Guinea pig, doesn't it?

 

[Mazen]

A good book on this subject is "The Inflammation Syndrome". It suggests diet (high in fish, vegetables and fruits), supplements (fish oil, Vitamines E&C, anti-inflammtory herbs and spices), and testing for any allergies.

I guess all these books point to the same thing: a healthy nutritious natural diet high in Omega3 plus identifying any food allergies or intolerances you have

 

[Hedgehog]

Ha! My gastro said I must have IBS as well as Crohn's because I have pain and bloating symptoms in my colon. But I KNOW it's not IBS, it's inflammation because it went away completely on higher doses of Pred. Once I tapered, back it came. There's no visible sign of inflammation in my colon and my weight is stable but it hurts like hell and I'm depressed!
Just started Azathiaprine and hoping it helps. Meantime, I'm on Elemental because I can't bear the pain of eating. Grrrrrr.....
Gail

 

[Hedgehog]

David, I forgot say, big thanks for this. I'm going to mention it to my gastro when I see him.
Gail

 

[David in Seattle]

David, I forgot say, big thanks for this. I'm going to mention it to my gastro when I see him.
Gail

Glad I could help, and best of luck, Gail!

 

[doylep]

Hi
My first posting apart from my intro message a few weeks back..
This string rang true to my findings.........

I was diagnosed (loose term for when GP ran out of tests, sidmodoscopy,ultrasound,barum enema, blood etc etc) with IBS in Feb 2010....
In a very depressed and now on citalopram... I sought other answers for my 24/7 pain in abdomen and lower back etc... No bowel issues as in D or C by the way....

BUPA private med tests in UK finally has found two small erosions in my small intesine.. Now I am classed as having Subclinical Chrons and treated with Budenofalk 9mg .... I am +3 weeks into meds but not clear if things improving.... seems slow at the moment..how long do these meds take? My life is on hold and I am not working now..... Hope the meds work......

So my feeling is its likely as u indicate that many people like me with an IBS diagnosis are likely walking around with subclinical Crohns.. its just not detected by the tests run.....

Oh by the way Fecal calprotectin levels was <19 .... I don't have exact figure so by this test alone I would not have IBD.. Only the capsule pillcam picked the IBD up....

Hope this interesting to someone?

Peter

 

[henryalcat]

Inflammation Symptoms

As per some reports IBS is a type of low-grade IBD. No one really understands what would cause IBS symptoms to resolve. There seems to be a low-grade inflammation after pathogen clearing or resolution of the stress event in a subset of individuals which may be related to inability to down regulate the inflammatory response.

 

[tracycat79]

Wow! I am showing my new GI doc this! She thinks my current symptoms are ibs. They may be, but she was making it sound like my original diagnosis of crohns might be wrong. Too bad my old gi doc retired bc I would have just went back to him. But one good thing is that she wants to do another colonoscopy. I am still unclear about what the biopsy will show if I am in remission. I keep getting different answers, but that just may be how it is. Seems like there are not many clear answers for this disease.

 

[Tummyache]

So why isn't this test done routinely to check for intestinal inflammation instead of "guessing" that patients have IBS in stead of IBD? Or, maybe I am behind the times, and this is a REALLY new diagnostic test and doctors are just beginning to utilize it. 90% accuracy seems pretty good!

 

[BBACK12]

In my Phlebotomy class I took, we recently just did CBC's and we did Sed Rates, my Sed Rate was the highest out of 30 people in my class, and my teacher asked if I had anything inflammed that I knew about, so I told her I had Crohns and she said " That explains it, we have a few patients that have Crohns that always have high sed rates". I guess inflammation is chronic for some!

 

[mainekitty]

@Tummyache I don't think this test is that new, because I had it done when I lived in the UK in 2007. At the time I was feeling really good, but the test came back positive for fecal calprotectin (unfortunately for me, I had felt so good I'd come off the Pentasa for a few weeks... bad move, as it turned out).

What my GI there told me was that it was a new test (at that time) that was good for picking up lower-levels of inflammation, which seems to be my thing. Weirdly enough, I don't think I've had this test since moving to the U.S. Maybe it's "new" here?

 

[mainekitty]

Thanks for bringing attention to this article, btw. I have access to a university library and have downloaded it. If anyone wants me to email them the pdf just message me (I think that's legal... right?).