Lifestyle Factors and Silent Inflammatory Bowel Disease

Introduction: Hypoalgesic, or “silent”, inflammatory bowel disease (IBD) is a poorly understood condition that has been associated with poor clinical outcomes. There is evidence that lifestyle factors, including diet, exercise and substance use can influence inflammatory activity and symptoms in IBD. It is unclear, though, whether these issues impact pain experience in IBD. We performed this study to evaluate the potential relationship between several key lifestyle factors and silent IBD. Methods: We performed a retrospective analysis using an IBD natural history registry based in a single tertiary care referral center. We compared demographic and clinical features in two patient cohorts defined using data from simultaneous pain surveys and ileocolonoscopy: a) active IBD without pain (silent IBD), and b) active IBD with pain. We also evaluated the relative incidence of characteristics related to diet, exercise, sexual activity and substance abuse. Results: One hundred eighty IBD patients had active disease and 69 (38.3%) exhibited silent IBD. Silent IBD patients exhibited incidences of disease type, location, and severity as pain-perceiving IBD patients. Silent IBD patients were more likely to be male and less likely to exhibit anxiety and/or depression or to use cannabis, analgesic medication or corticosteroids. There were no significant differences in dietary, exercise-related or sexual activities between silent and pain-perceiving IBD patients. Conclusions: Silent IBD was associated with reduced incidence of substance and analgesic medication use. No relationships were found between silent IBD and diet, exercise or sexual activity, though specific elements of each require further dedicated study.