Gastrointestinal hypoalgesia in inflammatory bowel disease
Gastrointestinal hypoalgesia in inflammatory bowel disease
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DOI：
10.20524/aog.2019.0442
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发表时间：
2020-01-01
影响因子：
2.2
通讯作者：
Williams, Emmanuelle D.
中科院分区：
文献类型：
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作者：
Coates, Matthew D.;Soriano, Christopher;Williams, Emmanuelle D.
疼痛感知是检测有害身体伤害的关键。炎症性肠病（IBD）的胃肠道痛觉减退是一种鲜为人知的现象，以前与患者预后不良有关。我们的目的是评估与这种情况相关的危险因素，并辨别可能将这些患者与无痛静息患者区分开来的特征。方法：我们使用基于单一三级保健转诊中心的IBD自然病史登记处进行回顾性分析。我们比较了3个患者队列的人口统计学和临床特征，这些患者队列使用了同时进行的疼痛调查和回肠结肠镜检查的数据：a)无疼痛的活动性IBD（低痛觉性IBD）；b)伴有疼痛的活动性IBD；c)无疼痛的非活动性IBD。结果53例IBD患者存在活动性疾病，43例（28.1%）出现痛觉减退。低痛觉性IBD患者更容易发生非肛周瘘（P=0.03）。logistic回归分析显示，低痛觉性IBD与男性、高龄和美沙胺使用独立相关，与焦虑/抑郁状态和阿片类药物使用负相关。低痛觉性IBD患者在人口学和临床上与无痛性静止IBD队列相似（n=59）。低痛觉性IBD患者血小板计数和c反应蛋白更有可能在病理上升高（P=0.03），尽管>25%未表现出炎症标志物升高。结论：痛觉减退在IBD中很常见，尤其是在男性和老年人中，并且与瘘和皮质类固醇使用的发生率增加有关。需要新的无创诊断工具来筛查这一人群，因为炎症标志物并不总是升高。
Background Pain perception is critical for detection of noxious bodily insults. Gastrointestinal hypoalgesia in inflammatory bowel disease (IBD) is a poorly understood phenomenon previously linked to poor patient outcomes. We aimed to evaluate the risk factors associated with this condition and to discern characteristics that might differentiate these patients from pain-free quiescent counterparts.Methods We performed a retrospective analysis using an IBD natural history registry based in a single tertiary care referral center. We compared demographic and clinical features in 3 patient cohorts defined using data from simultaneous pain surveys and ileocolonoscopy: a) active IBD without pain (hypoalgesic IBD); b) active IBD with pain; and c) inactive IBD without pain.Results One hundred fifty-three IBD patients had active disease and 43 (28.1%) exhibited hypoalgesia. Hypoalgesic IBD patients were more likely to develop non-perianal fistulae (P=0.03). On logistic regression analysis, hypoalgesic IBD was independently associated with male sex, advancing age and mesalamine use, and inversely associated with anxious/depressed state and opiate use. Hypoalgesic IBD patients were demographically and clinically similar to the pain-free quiescent IBD cohort (n=59). Platelet count and C-reactive protein were more likely to be pathologically elevated in hypoalgesic IBD (P=0.03), though >25% did not exhibit elevated inflammatory markers.Conclusions Hypoalgesia is common in IBD, particularly in male and older individuals, and is associated with an increased incidence of fistulae and corticosteroid use. Novel noninvasive diagnostic tools are needed to screen for this population, as inflammatory markers are not always elevated.