Background
Methods
Study design, population, and data collection
Clinical and sociodemographic data
Memorial symptom assessment scale (MSAS)
Statistical analyses
Results
Study population
IBD | CD | UC | |
---|---|---|---|
N = 350
|
n = 119
|
n = 231
| |
Sociodemographic characteristics
| |||
Age (mean, SD) | 39.0 (14.4) | 40.1 (15.4) | 38.5 (13.9) |
Gender, n (%) | |||
Female | 174 (49.7) | 68 (57.1) | 106 (45.9) |
Male | 176 (50.3) | 51 (42.9) | 125 (54.1) |
Education, n (%) | |||
University; ≥2 years | 177 (50.6) | 57 (47.9) | 120 (51.9) |
Elementary/upper secondary | 173 (49.4) | 62 (52.1) | 111 (48.1) |
Marital status, n (%) | |||
Married/co-inhabitant | 236 (67.4) | 75 (63.0) | 161 (69.7) |
Single/widow(ed) | 114 (32.6) | 44 (37.0) | 70 (30.3) |
Work status, n (%) | |||
Working | 297 (84.9) | 96 (80.7) | 201 (87.0) |
Not working | 53 (15.1) | 23 (19.3) | 30 (13.0) |
Clinical characteristics
| |||
Diagnosis, n (%) | |||
Crohn’s disease | 119 (34.0) | ||
Ulcerative colitis | 231 (66.0) | ||
Montreal - location for CD, n (%) | |||
Ileal (L1) | 61 (51.3) | ||
Colonic (L2) | 24 (20.2) | ||
Ileocolonic (L3) | 34 (28.6) | ||
Upper tract only or modifier (L4)a
| 2 (1.7) | ||
Montreal – behavior for CD, n (%) | |||
Non-stricturing, non-penetrating (B1) | 92 (77.3) | ||
Stricturing (B2) | 25 (21.0) | ||
Penetrating (B3) | 2 (1.7) | ||
Perianal disease (B4)a
| 10 (8.4) | ||
Montreal – extent for UC, n (%) | |||
Ulcerative proctitis (E1) | 94 (40.7) | ||
Left-sided UC (E2) | 53 (22.9) | ||
Extensive UC (E3) | 84 (36.4) | ||
Montreal disease severity for UC, n (%) | |||
Clinical remission (S0) | 4 (1.7) | ||
Mild UC (S1) | 92 (39.8) | ||
Moderate UC (S2) | 115 (49.8) | ||
Severe UC (S3) | 20 (8.7) | ||
Calprotectin ≥ 250 µg/g | 158 (52.0) | 56 (54.4) | 102 (50.7) |
Missing, n (%)
|
46 (13.1)
| ||
Elevated HBI/SCCAIb, n (%) | 190 (55.6) | 56 (48.3) | 134 (59.3) |
Missing, n (%)
|
8 (2.3)
| ||
25-OH Vitamin D deficiencyc, n (%)
| 98 (28.2) | 29 (24.6) | 69 (30.1) |
Missing, n (%)
| 3 (0.9) | ||
Anemiad, n (%) | 45 (12.9) | 16 (13.4) | 29 (12.7) |
Missing, n (%)
| 2 (0.6) | ||
Iron deficiencye, n (%)
| 104 (34.4) | 30 (29.4) | 74 (37.0) |
Missing, n (%)
| 48 (13.8) | ||
Current tobacco use, n (%) | 26 (7.4) | 13 (10.9) | 13 (5.6) |
Symptom prevalence
Symptom | Active disease (n = 190) | Inactive disease (n = 152) | ||||||
---|---|---|---|---|---|---|---|---|
n | missing | % | 95% CI | n | missing | % | 95% CI | |
Feeling bloated | 164 | 3 | 87.7 | 82.1–92.0 | 118 | 1 | 78.1 | 71.0-84.5 |
Lack of energy | 163 | 3 |
87.2
|
81.5–91.6
| 109 | 3 |
73.2
|
65.3–80.1
|
Feeling drowsy | 157 | 2 | 83.5 | 77.4–88.5 | 116 | 3 | 77.9 | 70.3–84.2 |
Pain | 149 | 1 | 78.8 | 72.3–84.4 | 101 | 4 | 68.2 | 60.1–75.6 |
Diarrhea | 146 | 1 |
77.2
|
70.6–83.0
| 76 | 1 |
50.3
|
42.1–58.6
|
Worrying | 140 | 1 | 74.1 | 67.2–80.2 | 98 | 3 | 64.8 | 57.6–73.3 |
Feeling irritable | 124 | 2 | 66.0 | 58.7–72.7 | 85 | 3 | 57.0 | 48.7–65.1 |
Difficulty sleeping | 119 | 3 | 63.6 | 56.3–70.5 | 74 | 5 | 50.3 | 42.0-58.7 |
Feeling sad | 113 | 1 | 59.8 | 52.4–66.8 | 72 | 3 | 48.3 | 40.1–56.6 |
Difficulty concentrating | 109 | 2 | 58.0 | 50.6–65.1 | 68 | 2 | 45.3 | 37.2–53.7 |
Problems with sexual interest/activity | 100 | 3 |
53.5
|
46.1–60.8
| 47 | 2 |
31.3
|
24.0-39.4
|
Feeling nervous | 101 | 1 | 53.4 | 46.1–60.7 | 72 | 3 | 48.3 | 40.1–56.6 |
Dizziness | 100 | 2 |
53.2
|
45.8–60.5
| 52 | 2 |
34.7
|
27.1–42.9
|
Nausea | 85 | 2 | 45.2 | 38.0-52.6 | 50 | 2 | 33.3 | 25.9–41.5 |
Lack of appetite | 81 | 2 | 43.1 | 36.0-50.5 | 44 | 2 | 29.3 | 22.2–37.3 |
Sweats | 73 | 2 | 38.8 | 31.8–46.2 | 53 | 2 | 35.3 | 27.7–43.5 |
Dry mouth | 71 | 3 | 38.0 | 31.0-45.3 | 46 | 5 | 31.3 | 24.0-39.5 |
Weight loss | 67 | 2 | 35.6 | 28.8–43.0 | 36 | 2 | 24.0 | 17.4–31.6 |
Constipation | 66 | 3 | 35.3 | 28.5–42.6 | 47 | 2 | 31.3 | 24.0-39.4 |
Cough | 54 | 1 | 28.6 | 22.2–35.6 | 34 | 6 | 23.3 | 16.7–31.0 |
Itching | 50 | 2 | 26.6 | 20.4–33.5 | 38 | 2 | 25.3 | 18.6–33.1 |
Shortness of breath | 50 | 2 | 26.6 | 20.4–33.5 | 27 | 2 | 18.0 | 12.2–25.1 |
Numbness and tingling in hands and feet | 47 | 3 | 25.1 | 19.1–32.0 | 40 | 3 | 26.8 | 20.0-34.7 |
Mouth sores | 43 | 5 | 23.2 | 17.4–30.0 | 23 | 2 | 15.3 | 10.0-22.1 |
Changes in skin | 43 | 1 | 22.8 | 17.0-29.4 | 28 | 3 | 18.8 | 12.9–26.0 |
Problems with urination | 38 | 1 | 20.1 | 14.6–26.5 | 14 | 3 | 9.4 | 5.2–15.3 |
Change in the way food tastes | 36 | 2 | 19.1 | 13.8–25.5 | 15 | 2 | 10.0 | 5.7–16.0 |
Hair loss | 36 | 1 | 19.0 | 13.7–25.4 | 24 | 2 | 16.0 | 11.0-22.9 |
“I don`t look like myself” | 35 | 1 | 18.5 | 13.3–24.8 | 23 | 1 | 15.2 | 10.0–22.0 |
Swelling of arms or legs | 31 | 2 | 16.5 | 11.5–22.6 | 13 | 3 | 8.7 | 4.7–14.5 |
Vomiting | 22 | 1 | 11.6 | 7.4–17.1 | 6 | 4 | 4.1 | 1.5–8.6 |
Difficulty swallowing | 21 | 2 | 11.2 | 7.0-16.6 | 9 | 2 | 6.0 | 2.3–11.1 |
Symptom clusters
Cluster I (Psychological) | Cluster II (Impaired energy) | Cluster III (Physical) | |
---|---|---|---|
Worrying |
0.84
| 0.29 | 0.19 |
Feeling sad |
0.82
| 0.34 | 0.17 |
Feeling nervous |
0.81
| 0.26 | 0.28 |
Feeling irritable |
0.64
| 0.53 | 0.23 |
Difficulty concentrating |
0.64
| 0.53 | 0.13 |
Lack of energy | 0.34 |
0.82
| 0.26 |
Feeling drowsy | 0.32 |
0.81
| 0.15 |
Difficulty sleeping | 0.37 |
0.60
| 0.32 |
Diarrhea | 0.19 | 0.10 |
0.79
|
Feeling bloated | 0.20 | 0.28 |
0.65
|
Pain | 0.26 | 0.57 |
0.62
|
Factors associated with symptom cluster membership
Psychological cluster vs. physical cluster | Impaired energy cluster vs. physical cluster | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multinomial | Univariate | Multinomial | ||||||||||
Variable | OR | 95% CI |
p-value | OR | 95% CI |
p-value | OR | 95% CI |
p-value | OR | 95% CI |
p-value | |
Gender | |||||||||||||
Male (ref) | 1 | 1 | |||||||||||
Female | 0.75 | 0.41–1.38 | 0.35 | 0.91 | 0.46–1.81 | 0.79 | 1.07 | 0.55–2.09 | 0.85 | 1.22 | 0.57–2.61 | 0.62 | |
Age | 1.0 | 0.98–1.02 | 0.89 | 0.99 | 0.97–1.02 | 0.63 | 1.00 | 0.98–1.02 | 0.98 | 0.99 | 0.96–1.02 | 0.38 | |
Diagnosis | |||||||||||||
UC (ref) | 1 | 1 | |||||||||||
CD | 0.81 | 0.42–1.55 | 0.52 | - | 1.14 | 0.55–2.36 | 0.72 | - | |||||
Marital status | |||||||||||||
Married/co-habitant (ref) | 1 | 1 | |||||||||||
Single/widowed | 1.22 | 0.64–2.31 | 0.54 | - | 1.00 | 0.50–2.02 | 0.99 | - | |||||
Education level | |||||||||||||
>12 years (ref) | 1 | 1 | |||||||||||
<12 years | 0.93 | 0.51–1.70 | 0.81 | - | 1.61 | 0.82–3.17 | 0.17 | 1.57 | 0.74–3.35 | 0.24 | |||
Work status | |||||||||||||
Working (ref) | 1 | 1 | |||||||||||
Not working | 0.65 | 0.25–1.64 | 0.36 | - | 0.78 | 0.28–2.18 | 0.64 | - | |||||
Calprotectin | |||||||||||||
< 250 µg/g (ref) | 1 | 1 | |||||||||||
≥ 250 µg/g | 1.76 | 0.89–3.48 | 0.10 | 1.80 | 0.88–3.69 | 0.11 | 2.07 | 0.98–4.36 | 0.06 | 1.69 | 0.76–3.75 | 0.20 | |
HBI/SCCAI* | |||||||||||||
Remission (ref) | 1 | 1 | |||||||||||
Disease activity | 1.38 | 0.73–2.59 | 0.32 | - | 1.84 | 0.92–3.68 | 0.08 | 1.46 | 0.66–3.21 | 0.35 | |||
25(OH) vitamin D** | |||||||||||||
Normal(ref) | 1 | 1 | |||||||||||
Deficiency | 1.11 | 0.58–2.13 | 0.74 | - | - | 2.06 | 0.96–4.42 | 0.07 |
2.49
|
1.00-6.20
|
0.05
| ||
Ferritin*** | |||||||||||||
Normal (ref) | 1 | 1 | |||||||||||
Iron deficiency | 0.85 | 0.42–1.71 | 0.65 | - | 0.87 | 0.43–1.87 | 0.72 |
-
| |||||
Hemoglobin*** | |||||||||||||
Normal (ref) | 1 | 1 | |||||||||||
Anemia | 1.09 | 0.46–2.57 | 0.85 | - | 1.47 | 0.54-4.00 | 0.45 |
-
|