P0215 Food avoidance and symptom triggers in patients with Ulcerative Colitis while in remission
Authors: Ayton D , Hoque S 
Published: January 2025

Background

In inflammatory bowel disease (IBD) food avoidance is common due to symptom triggers but may lead to nutritional deficiencies, impaired gut microbiota and physical and mental health challenges. This study expands on previous investigations by our team on food avoidance and dietary restrictions1, examining whether patients in clinical remission from ulcerative colitis (UC) continue to avoid certain foods and whether symptoms such as abdominal discomfort, bloating or altered bowel habits worsen due to stress, anxiety or certain foods.

Methods

A survey of 100 randomly selected UC patients at an IBD clinic included those with active disease (34%) and in remission (66%). Remission was defined by faecal calprotectin ≤250µg/g in the past year, CRP within the normal range in the past six months, and a Mayo score of 0 on recent sigmoidoscopy/colonoscopy. IBS questionnaire based on WHO criteria2 was used and data on disease location, year of diagnosis, gender, and current treatment.

Results

In remission group, 61% of patients avoid certain foods all/most the time or sometimes and 70% reported symptoms worsened when consuming foods (table 1). In remission, higher total symptom scores from survey (&gt;15) were significantly associated with increased food avoidance all/most of the time (p=0.016), with these individuals being twice as likely to avoid foods compared to those with scores &lt;15. No significant difference was found between active disease and remission in symptoms worsening with food consumption (p=0.08), though active disease patients reported higher symptom scores. Similarly, while trends suggest active disease influences food avoidance behaviour, the difference between groups was not statistically significant (p=0.068). No significant difference in food avoidance was observed between males and females (p=0.215), and a moderate positive correlation (r=0.36, p=&lt;0.003) was identified between symptoms worsening under stress/anxiety and after eating certain foods, suggesting a symptom cluster driven by psychological and dietary triggers in remission. These findings highlight the need to address psychological and dietary triggers in symptom management for UC patients.

Conclusion

This study shows that food avoidance is common even while the UC patients are in remission. Higher reported symptom scores are strongly linked to increased food avoidance. While trends suggest active disease may influence food-related behaviours, symptom clusters in remission highlight the interplay between psychological and dietary triggers worsening symptoms. These findings emphasise the need for holistic strategies to address stress and food-related sensitivities and close the gaps in patient education on nutrition and symptom management in UC patients.

References

1.Norman E, Hoque S. P185 Food avoidance and dietary restrictions in patients with Inflammatory Bowel Disease. J Crohns Colitis. 2024;18(Suppl 1) doi:10.1093/ecco-jcc/jjad212.0315.

2.World Gastroenterology Organisation. Test for Diagnosing IBS. Published 2009. Available at: https://www.worldgastroenterology.org/UserFiles/file/wdhd-2009-test-for-diagnosing-ibs.pdf