Background
Chronic abdominal pain is highly prevalent in inflammatory bowel disease (IBD) patients in remission. The aetiology is incompletely understood, although persistent histologic inflammation, post-inflammatory visceral hypersensitivity and altered gut-brain interaction are believed to contribute. Data on the characteristics of IBD patients suffering from chronic abdominal pain are sparse. We investigated clinical, lifestyle and psychosocial factors associated with chronic abdominal pain in a real-world cohort of IBD patients in remission.

Methods
A prospective multicentre study was performed enrolling consecutive IBD patients, between Jan 1, 2020 and Jul 1, 2021, using myIBDcoach. Patient reported outcome measures on disease activity, lifestyle and psychosocial factors (i.e. depressive symptoms, anxiety, stress, and life events) were assessed in three-monthly intervals. Chronic abdominal pain in IBD in remission (IBDremissionPain+) was defined as an abdominal pain score ≥3 (1-10 numeric rating scale (NRS)) at ≥1/3 of all assessments combined with faecal calprotectin <150 µg/g in 90 days around periodic assessments. Multivariable logistic regression was performed to identify risk factors for IBDremissionPain+ compared to patients in remission without chronic abdominal pain (IBDremissionPain-).

Results
In total, 559 patients were followed prospectively, of which 429 (76.7%) were in biochemical remission. Of these, 198 (46.2%) fulfilled the criteria for chronic abdominal pain. IBDremissionPain+ patients were predominantly females, had higher BMI, and shorter disease duration compared to IBDremissionPain-. IBDremissionPain+ patients reported higher levels of stress, fatigue, depressive and anxiety symptoms, and occurrence of life events. On multivariable logistic regression, female sex (aOR 2.58), shorter disease duration (<10years, aOR 2.31), higher BMI (aOR 1.06), higher levels of stress (aOR 1.19), fatigue (aOR 4.73) and life events (aOR 1.65) were all significantly associated with the presence of chronic abdominal pain. 

Conclusion
In this real-world population of IBD patients in remission, 46.2% experienced chronic abdominal pain, characterized by female sex, shorter disease duration, higher BMI, fatigue and psychosocial factors.