Cognitive-Behavioral Factors Drive IBS-Like Symptoms in IBD
Patients with inflammatory bowel disease (IBD) often experience debilitating symptoms that persist despite low levels of inflammation, raising critical questions about the factors driving symptom burden. A recent latent profile analysis of baseline data from the UK IBD-BOOST trial examined how fatigue, pain, and fecal incontinence cluster together and whether psychological and behavioral variables are associated with these patterns independent of inflammatory activity.
The study included 780 adults with IBD, predominantly in clinical remission, who completed validated measures of fatigue, pain, and fecal incontinence. Three distinct symptom profiles emerged: Moderate (50%), High (40%), and Severe (10%).
Contrary to expectation, neither IBD subtype (Crohn’s disease vs ulcerative colitis) nor fecal calprotectin concentration predicted symptom profile. Instead, participants in the High and Severe groups were more likely to be female, have multimorbidity, longer disease duration, prior IBD surgery, and coexistent irritable bowel syndrome (IBS)–type symptoms. Notably, Rome IV–defined IBS-type symptoms increased the relative risk of belonging to the High profile more than 4-fold and to the Severe profile nearly 8-fold.
Psychological and behavioral factors were strongly linked to greater symptom burden. Depression, anxiety, negative illness perceptions, catastrophic symptom beliefs, all-or-nothing behavior, and avoidance patterns were significantly associated with membership in the High and Severe profiles, while higher self-efficacy exerted a protective effect.
These findings highlight that symptom clustering in IBD cannot be explained by inflammation alone. Instead, cognitive, affective, and behavioral responses play a pivotal role in shaping patient experience, offering potential therapeutic targets. The study underscores the importance of comprehensive, biopsychosocial management strategies that extend beyond anti-inflammatory therapy.
“Recognizing the potential impact of cognitive behavioral factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely,” the authors stated. Integrating psychological interventions, such as cognitive-behavioral approaches, with standard medical care may help mitigate fatigue, pain, and incontinence, ultimately improving quality of life for individuals with IBD, they concluded.
Reference:
Wileman V, Chilcot J, Norton C, et al. Modifiable psychological factors are associated with clusters of pain, fatigue, fecal incontinence, and irritable bowel syndrome–type symptoms in inflammatory bowel disease: a latent profile analysis. J Crohns Colitis. 2024;19(5):jjae183. doi:10.1093/ecco-jcc/jjae183
