T1171 Concomitant Symptoms of Functional Gastrointestinal Disorders (FGIDs) in Patients with Inflammatory Bowel Disease (IBD) Are Associated with Decreased Quality of Life (Qol)

Abstract

Background: Quality of life (QoL) is impaired in patients with Inflammatory Bowel Disease (IBD) or functional gastrointestinal disorders (FGIDs). There is an increasing recognition that FGIDs, including Irritable Bowel Syndrome (IBS), may coexist in IBD patients. In addition, psychological factors are thought to be important in FGIDs. We therefore studied psychological co-morbidities, disease activity and QoL in IBD outpatients with and without features of FGIDs. Methods: Consecutive IBD outpatients were invited to participate over 8 months. Participants completed the Hospital Anxiety and Depression Scale (HADS), SF12 and Bowel Disease Questionnaire (BDQ-6). Diagnoses, disease activity & therapy were recorded. Psychological co-morbidities and QoL were compared between those with & without FGIDs using non-parametric tests. Results: Sixty-one subjects participated (29 Crohn's disease [CD], 32 Ulcerative Colitis [UC]). CD and UC did not differ in the prevalence of any symptom of FGID, age, disease duration, SF12 or HADS. However, more UC than CD patients had active disease when surveyed (p=0.007). Subjects with active disease did not differ from those in remission with respect to anxiety, depression, mental QoL or prevalence of FGIDs. However, those with active disease had decreased physical QoL (p<0.05). There were no gender differences for the prevalence or type of FGIDs. 54 subjects (89%) fulfilled Rome III criteria for any FGID, 7 had no FGID, 26 had 1, 15 had 2, & 13>2 FGIDs; with 19(31%) meeting criteria for IBS; 14(23%) functional dyspepsia (FD); 11(18%) unspecified functional bowel disorder; 10(16%) functional constipation; 8(13%); functional bloating; 7(11%) functional heartburn & 6(10%) functional dysphagia. 24(39%) met criteria for anxiety & 7(11%) for depression. ANOVA showed no relationship amongst the number of FGIDs per subject & anxiety or depression. IBD patients without FGID had significantly better physical QoL than those with >2 FGIDs (p=0.005), those with one or 2 FGIDs had better mental QoL than those with >2, and those with IBS had poorer physical QoL than those without IBS (p=0.028). FD was associated with anxiety (p=0.047 vs. those without FD) and functional defecation disorders (n=8) with both anxiety & depression (p=0.015 & 0.02 respectively vs. those without). Conclusion: Symptoms of FGIDs are highly prevalent in patients with both CD & UC, and are associated with significantly decreased QoL. Symptoms consistent with specific FGIDs, (IBS & FD) are associated with greater psychological co-morbidity. This effect is not simply due to active disease nor simply explained by the presence of anxiety or depression.