Ingunn Johansen[1,4], Milada C. Småstuen[2], Stine Løkkeberg[1], Vendel A. Kristensen[3],, Marte L. Høivik[3,4], Charlotte Lund[3,4], Vibeke Strande[4, 5], Bjørn Olsen[4, 6], Gert Huppertz-Hauss[4, 6], Tone B. Aabrekk[4, 7], May-Bente Bengtson[7], Petr Ricanek[8], Trond Espen Detlie[8], Svein Oskar Frigstad[9], Lars-Petter Jelsness-Jørgensen[1, 10], Randi Opheim[3, 11]

Affiliates

[1] Østfold University College, Department of Health Sciences, Fredrikstad, Norway [2] Oslo Metropolitan University, Department of Health Science, Oslo Norway [3] Oslo University Hospital, Department of Gastroenterology, Oslo, Norway [4] University of Oslo, Institute of Clinical Medicine, Oslo, Norway [5] Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway [6] Telemark Hospital Trust, Department of Gastroenterology, Skien, Norway [7] Vestfold Hospital Trust, Department of Gastroenterology, Tønsberg, Norway [8] Akershus University Hospital, Department of Gastroenterology, Lørenskog, Norway [9] Vestre Viken Hospital Trust, Department of Medicine, Bærum Hospital, Norway [10] Østfold Hospital Trust, Department of Gastroenterology, Fredrikstad, Norway [11] University of Oslo, Institute of Health and Society, Oslo, Norway

Abstract

Background: Patients with inflammatory bowel disease (IBD) frequently report multiple symptoms. The complex relationships among co-occurring symptoms are still poorly understood. The aims of this study were to examine prevalence of symptoms at the time of IBD diagnosis, explore symptom clusters, and possible associations between symptom clusters and selected socio-demographic and clinical variables in newly diagnosed IBD patients.

Methods: The IBSEN III study is a prospective population-based inception cohort of patients with inflammatory bowel disease, included from 2017-2019. Data in this study is based on patients included at the three largest hospitals in the study area. Data collection included clinical and sociodemographic data, laboratory tests, faecal samples, ileocolonoscopy reports, and patient reported outcome measures. Memorial Symptom Assessment Scale (MSAS) was used to assess prevalence of symptoms. Symptom clusters were identified using principal component analysis. Possible associations between socio-demographic and clinical variables and symptom cluster membership were estimated using multinomial regression analysis.

Results: Of the 573 patients ≥18 years diagnosed with IBD, 350 patients completed the MSAS questionnaire (61.1%). Of these, 174 (50%) women, 231 (66%) with ulcerative colitis (UC) and 119 (34%) with Crohn’s disease (CD). At the time of diagnosis, 11 symptoms were reported by more than 50% of the IBD patients. The three symptoms most frequently reported were bloating (84%), drowsiness (81%), and lack of energy (81%). Three symptom clusters were identified; a psychological cluster (56% of the patients), impaired energy cluster (28%), and a physical cluster (16%). The clusters comprised 3-5 symptoms. The multinomial regression analysis revealed that vitamin D deficiency was significantly associated with increased odds of being in the impaired energy cluster (OR=2.48, 95% CI [1.00-6.17], p=0.05). No other associations between socio-demographic and clinical variables and cluster membership were found.

Conclusions: Bloating, drowsiness and lack of energy are the three symptoms most frequently reported by newly diagnosed IBD patients. Three distinct symptom clusters are identified. The cluster that comprised psychological symptoms includes more than half of the patients. Vitamin D deficiency is the only factor associated with a cluster membership, namely in the impaired energy cluster.