Editorial: Understanding Factors Associated With Abdominal Pain in Ulcerative Colitis—No Surprises but the Usual Suspects Need Greater Attention. Authors' Reply

We thank Dr. Gao and Professor Segal for their interest in our paper on abdominal pain and associated factors in patients with ulcerative colitis (UC) [1, 2]. We agree with them regarding the importance of being aware of abdominal pain in patients with UC, including factors associated with gut-brain interaction, in particular anxiety and depression. Additionally, we agree with the suggestion that predictive factors for abdominal pain in UC need to be studied more. Despite these agreements, we would like to clarify why we think that the abdominal pain question of the Gastrointestinal Symptom Rating Scale (GSRS) [3, 4] has an advantage compared to most other questionnaires assessing abdominal pain, despite the fact that the GSRS has a focus on upper rather than lower abdominal pain and discomfort, as we discussed [1].

Importantly, it is difficult to measure the different aspects of chronic abdominal pain that can influence how it is perceived due to interacting peripheral and central mechanisms [5]. The authors of an international guideline on chronic pancreatitis, a disease in which abdominal pain is the most common symptom, stated that the one-dimensional pain intensity ratings alone are insufficient to evaluate chronic abdominal pain [6]. Instead, they suggested using a multidimensional approach including, among others, physical functioning, in combination with abdominal pain intensity scales. With this in mind, we think that rating the bothersomeness of abdominal pain or discomfort, as done in the GSRS, is a more comprehensive approach to assess the multidimensionality of abdominal pain compared to assessing only the severity (i.e. intensity) of the pain, as in most questionnaires including the Ulcerative Colitis Patient-Reported Outcomes Signs and Symptoms [7] referred to by Drs. Gao and Segal.

Future studies are required to investigate gut-brain interaction targeting medical, dietary and psychological therapies in the subgroup of patients with UC and irritable bowel syndrome (IBS)-like symptoms. This is based on the evidence for the role of gut–brain interaction in those with persisting abdominal pain and (quiescent) UC, the impact of IBS-like symptoms, including abdominal pain, on quality of life and the lack of trials investigating treatment strategies targeting gut–brain interaction in patients with UC [1, 8, 9].

Tom van Gils: writing – original draft. Hans Törnblom: writing – review and editing. Jóhann P. Hreinsson: writing – review and editing. Börje Jonefjäll: writing – review and editing. Hans Strid: writing – review and editing. Magnus Simrén: writing – review and editing.

This article is linked to Van Gils et al papers. To view these articles, visit https://doi.org/10.1111/apt.18344 and https://doi.org/10.1111/apt.18353.