Editorial: symptoms predicting active intestinal inflammation in patients with IBD

Activity of ulcerative colitis (UC) and Crohn's disease (CD) produces symptoms that may tremendously affect patients' quality of life.1 Patientreported symptoms (PRS) are an integral part of current therapeutic strategies and clinical trials in IBD.2,3 However, there is often a disagreement between PRS of ‘active’ or ‘flare’ of disease and symptoms provoked by active intestinal inflammation. This is especially true for CD where different phenotypes are differentially associated with symptoms of active disease, whereas concurrent confounders (e.g., IBS or bacterial overgrowth) can have similar symptoms.4 Serial measurement of faecal calprotectin (FC), an objective biomarker of intestinal inflammation, serves as a reliable proxy for endoscopy in confirming active IBD, but FC may also be elevated in asymptomatic patients.5 Therefore, there is still an unmet need to identify PRS that are strong predictors of active IBD. Kulyk et al performed a prospective remote study encompassing repeated online completion of the IBDSI6 (a validated but subjective tool assessing the symptomatic activity of IBD), report of ‘flares’ (if needed), and serial measurements of FC for 1 year to discriminate by subjective and objective methods those PRS that are associated with active IBD.7 The results were analysed as a whole IBD group and separately by disease type and gender. As expected, a high burden of PRS was recorded during active and inactive disease. Regardless of disease type and gender, fatigue was the most prevalent and bothersome symptom across all three domains of the study— followed by urgency and an increased number of loose or liquid stools; all severely affected patients' quality of life. Unlike fatigue, urgency and diarrhoea were highly predictive symptoms in discriminating active from inactive disease. However, it is important to utilise these three symptoms concurrently during the clinical assessment of IBD patients since fatigue is provoked by urgency whereas its absence was predictive of inactive disease.7– 9