{
  "abstract": "Introduction Patient-reported outcome measures are increasingly used to assess disease control in ulcerative colitis (UC). However, the relationship between patient-reported disease control and objective markers of inflammation remains incompletely understood.Methods We performed a cross-sectional analysis of adults with UC who had contemporaneous faecal calprotectin (FCP) and IBD-Control-8 data available. The study aimed to examine the correlation between FCP and patient-reported disease control, quantify symptom–biomarker discordance, and identify factors associated with poor disease control in patients with biochemically inactive UC. Correlation between FCP and IBD-Control-8 scores was assessed using Spearman’s rank correlation. Biochemical disease activity was defined using FCP thresholds of >250 µg/g (primary) and >100 µg/g (sensitivity analysis). Poor disease control was defined a priori as an IBD-Control-8 score ≤13. Discordance was defined as poor disease control despite biochemically inactive disease. Bowel and anorectal disorders of gut-brain interaction (DGBI) were assessed using the Rome IV diagnostic questionnaire. Associations between Biochemical disease activity, Rome IV DGBI criteria status, and patient reported symptoms using IBD control questionnaire were examined using univariable and multivariable regression analyses.Results Among 154 patients (55% female; median age 53 years, IQR 41–62) with paired faecal calprotectin (FCP) and IBD-Control-8 data, FCP correlated moderately with IBD-Control-8 scores (Spearman’s ρ = −0.38, p < 0.001). Using an FCP threshold of ≤250 µg/g, 100 patients (65%) had biochemically inactive disease, of whom 60 (61%) were classified as having poor disease control on the self-reported IBD control questionnaire, representing 39% of the overall cohort. Similar findings were observed using an FCP threshold of ≤100 µg/g.In patients with biochemically inactive disease, poor disease control was significantly associated with urgency (67% vs 38%, p = 0.01), Rome IV irritable bowel syndrome (35% vs 14%, p = 0.04), and the presence of other Rome IV DGBI (61% vs 24%, p < 0.001). In multivariable analyses restricted to this subgroup, Rome IV DGBI were independently associated with worse IBD-Control-8 scores (−3.6 points, p < 0.001) and higher odds of poor disease control (IBD-Control-8 ≤13; OR 4.69, 95% CI 1.83–12.99), whereas faecal calprotectin was not independently associated with poor disease control in logistic models.Conclusions Faecal calprotectin correlates only moderately with patient-reported disease control in UC, with substantial symptom–biomarker discordance. Poor bowel symptom control despite biochemically inactive disease is common and is driven predominantly by Rome IV DGBI rather than objective inflammation alone, potentially reflecting gut-brain interaction mechanisms. These findings highlight the importance of addressing DGBI symptoms alongside inflammatory activity when assessing disease control in UC.",
  "authors": [
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Manchester University NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Dipesh Vasant"
    },
    {
      "affiliations": [
        "Oxford University Hospitals, Oxford, United Kingdom"
      ],
      "name": "Gaurav Nigam"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom"
      ],
      "name": "Shaheen Hamdy"
    },
    {
      "affiliations": [
        "Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Anish Kuzhiyanjal"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, United Kingdom",
        "Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom"
      ],
      "name": "Jimmy Limdi"
    }
  ],
  "title": "O54 Discordance between clinical and biochemical disease activity in ulcerative colitis is associated with Rome IV bowel disorders of gut-brain interaction",
  "uid": "664c5126-7869-5c79-8bf2-4048a322e3ac"
}