P0502Should abdominal pain be considered an activity parameter in Ulcerative Colitis? A cross-sectional study

Abstract Background Abdominal pain is a frequent complaint in Inflammatory Bowel Disease (IBD). While it is included as an activity parameter in Crohn’s disease clinical indices, it remains an underrecognized symptom in ulcerative colitis (UC). Some studies suggest that it may occur both during active inflammation and in deep remission1. Multiple factors beyond inflammation such as stress, anxiety, depression and fatigue have been linked to pain in UC2. This study aims to assess the intensity and frequency of abdominal pain in UC, and correlate it with extent of disease, clinical, endoscopic, histological and biochemical activity, and ultimately with quality of life, fatigue, anxiety and depressive symptoms. Methods We conducted a cross-sectional study at a tertiary centre, enrolling consecutive consenting patients with UC who completed a questionnaire between March and July 2025, which included a Numeric Rating Scale (NRS) assessing pain intensity, Short Inflammatory Bowel Disease Questionnaire (SIBDQ), where pain frequency is considered, Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) and the Hospital Anxiety and Depression Scale (HADS). Patient electronic clinical reports were assessed to collect disease activity data. Results We included 191 patients with a mean age of 46.1 ± 1.0 years, 101 (52.9%) were female, and 58 (30.4%) reported pain. Forty-two participants (22.0%) had active disease (≥3 bowel movements with blood), 17 of whom (40.5%) reported pain. A higher frequency of pain episodes was correlated positively with clinical (ρ = 0.26; p 0.001), endoscopic (ρ = 0.21; p = 0.004), histological (ρ = 0.21; p = 0.005) and biochemical activity assessed by faecal calprotectin (ρ = 0.16; p = 0.03), but not with C reactive protein (ρ = 0.03; p = 0.70). Female sex was associated with higher pain intensity (p 0.001) and frequency (p 0.001). There was no association between pain (intensity or frequency) and disease extent or medication. Both pain intensity and frequency were strongly correlated with poorer quality of life (ρ=-0.73; p 0.001 and ρ=-0.78; p 0.001, respectively), higher levels of fatigue (ρ = 0.47; p 0.001 and ρ = 0.28; p 0.001), anxiety (ρ = 0.42; p 0.001 and ρ = 0.37; p 0.001) and depressive symptoms (ρ = 0.31; p = 0.001 and ρ = 0.28; p 0.001). In a multiple linear regression analysis, anxiety was the only independent predictor of both greater pain intensity (β = 0.41; p = 0.002) and pain frequency (β = 0.33; p = 0.001). Conclusion Abdominal pain was found to be highly prevalent in our UC cohort, affecting nearly half of patients with clinical disease activity but also occurring significantly in those in remission. Given its association with both inflammation and, critically, psychosocial factors, a holistic assessment and treatment strategy is essential. References: 1. Keefer L., et al., “AGA Clinical Practice Update on Pain Management in Inflammatory Bowel Disease: Commentary,” Gastroenterology 166 (2024): 1182–1189; 2. van Gils T, et al., Factors Associated With Abdominal Pain in Patients With Active and Quiescent Ulcerative Colitis: A Multicohort Study. Aliment Pharmacol Ther. 2025;61(2):268-277. Conflict of interest: Dr. Borges Chaves, Carlos: No conflict of interest Azevedo Silva, Inês: No conflict of interest João, Mafalda: No conflict of interest Sant’Anna, Mariana: No conflict of interest Silva, Andrea: No conflict of interest Ferreira, Margarida: No conflict of interest Lopes, Sandra Maria Fernandes: No conflict of interest Mendes, Sofia: No conflict of interest Ferreira, Manuela: No conflict of interest Figueiredo, Pedro: No conflict of interest Portela, Francisco: No conflict of interest