Burden and Impact of Abdominal Pain in Moderate to Severe Crohn’s Disease and Ulcerative Colitis: Results from the Communicating Needs and Features of IBD Experiences (CONFIDE) Survey

Background:
Abdominal pain (AP) is a common symptom of Crohn’s disease (CD) and ulcerative colitis (UC), affecting up to 70% of patients. The Communicating Needs and Features of IBD Experiences (CONFIDE) survey explored the experience and impact of CD and UC-related symptoms among patients in the United States (US), Europe (France, Germany, Italy, Spain, and UK), and Japan. We investigated the impact of AP among US and European patients with CD or UC.
Methods:
Online, quantitative, cross-sectional surveys were conducted among patients with moderate to severe CD or UC (defined by previous treatment, steroid use, and/or hospitalization). Patients were asked about the impact and severity of AP (‘AP before bowel movement (BM)’ and ‘persistent AP’); patients recorded AP severity over the past 3 days using the 11-point AP Numeric Rating Scale (NRS; 0=no pain; 10=worst possible pain). Data are presented as descriptive statistics.
Results:
Surveys were completed by 215 US (54.9% male, mean age: 40.9 years) and 547 European (55.4% male, 38.0 years) patients with CD and 200 US (61.5% male, 40.4 years) and 556 European (57.4% male, 38.9 years) patients with UC. More than 20% of all patients reported currently experiencing (in the past month) ‘AP before BM’ (CD, US: 34.9%, Europe: 25.0%; UC, US: 31.0%, Europe: 20.7%) and/or ‘persistent AP’ (CD, US: 22.3%, Europe: 20.3%; UC, US: 22.0%, Europe: 20.1%). Overall, 9.8% US and 11.0% European patients with CD and 12.0% US and 5.6% European patients with UC reported currently experiencing both symptoms. Among patients who had ever experienced ‘AP before BM’ (CD, US: 48.8%, Europe: 41.3%; UC, US: 45.5%, Europe: 32.0%) or ‘persistent AP’ (CD, US: 43.7%, Europe: 36.6%; UC, US: 38.0%, Europe: 31.3%), more than one-third ranked them among top 5 symptoms with greatest impact on them (‘AP before BM’: CD, US: 53.3%, Europe: 34.1%; UC, US: 49.5%, Europe: 44.4%; ‘persistent AP’: CD, US: 54.3%, Europe: 47.0%; UC, US: 53.9%, Europe: 66.1%). Additionally, of those who ever experienced either symptom, most reported experiencing them at least once a week during the past 3 months (‘AP before BM’: CD, US: 65.7%, Europe: 56.2%; UC, US: 70.3%, Europe: 60.7%; ‘persistent AP’: CD, US: 59.6%, Europe: 60.0%; UC, US: 67.1%, Europe: 59.2%). Mean (SD) AP NRS scores in the overall population were 6.4 (2.7) and 5.7 (2.7) for US and European patients with CD, and 6.4 (2.4) and 6.1 (2.3) for US and European patients with UC, respectively. Approximately 20% of all patients reported ‘AP before BM’ and/or ‘persistent AP’ as a reason for declining participation in work/school, social activities, and sports/physical exercise in the past 3 months. Among patients who reported decreased sexual activity due to CD or UC (CD, US: n=148, Europe: n=305; UC, US: n=126, Europe: n=292), 22.6–38.5% cited disease-related AP as the reason and 14.0–27.8% indicated that their AP worsened during intercourse.
Conclusions:
Abdominal pain, both persistent and before bowel movement, is a frequent and severe symptom among patients with moderate to severe CD or UC. While literature more often links abdominal pain to CD, our findings indicated a similar impact of abdominal pain among patients with CD and UC, across US and European populations. Assessing and addressing abdominal pain in clinical practice is crucial for effective management of both CD and UC.