Symptoms in Persons With Either Active or Inactive Crohn's Disease Are Agnostic to Disease Phenotype: The Magic in Imagine Study

Charles N Bernstein; Zoann Nugent; Remo Panaccione; Deborah A Marshall; Gilaad G Kaplan; Levinus A Dieleman; Stephen Vanner; Lesley A Graff; Anthony Otley; Jennifer Jones; Michelle Buresi; Sanjay Murthy; Mark Borgaonkar; Brian Bressler; Alain Bitton; Kenneth Croitoru; Sacha Sidani; Aida Fernandes; Paul Moayyedi

doi:10.1097/MCG.0000000000002137

Symptoms in Persons With Either Active or Inactive Crohn's Disease Are Agnostic to Disease Phenotype: The Magic in Imagine Study

J Clin Gastroenterol. 2025 Jan 22. doi: 10.1097/MCG.0000000000002137. Online ahead of print.

Authors

Charles N Bernstein^{1

2}, Zoann Nugent^{1

2}, Remo Panaccione³, Deborah A Marshall⁴, Gilaad G Kaplan^{3

4}, Levinus A Dieleman⁵, Stephen Vanner⁶, Lesley A Graff^{7

2}, Anthony Otley⁸, Jennifer Jones⁹, Michelle Buresi³, Sanjay Murthy¹⁰, Mark Borgaonkar¹¹, Brian Bressler¹², Alain Bitton¹³, Kenneth Croitoru¹⁴, Sacha Sidani¹⁵, Aida Fernandes¹⁶, Paul Moayyedi¹⁶

Affiliations

¹ Departments of Internal Medicine.
² Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
³ Division of Gastroenterology and Hepatology, Department of Medicine.
⁴ Department of Community Health Sciences, University of Calgary, Calgary.
⁵ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁶ Queens University, Kingston.
⁷ Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences.
⁸ Departments of Pediatrics.
⁹ Internal Medicine, Dalhousie University, Halifax, NS, Canada.
¹⁰ Department of Medicine, University of Ottawa, Ottawa.
¹¹ Department of Medicine, Memorial University, St Johns, NL, Canada.
¹² Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹³ Department of Medicine, McGill University, Montreal.
¹⁴ Department of Medicine, University of Toronto, Toronto.
¹⁵ Department of Medicine, University of Montreal, Montreal, PQ, Canada.
¹⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 39853241
DOI: 10.1097/MCG.0000000000002137

Abstract

Background: We aimed to examine the relationship between disease symptoms and disease phenotype in a large Canadian cohort of persons with Crohn's disease (CD).

Methods: Adults (n=1515) with CD from 14 Canadian centers participated in the Mind And Gut Interactions Cohort (MAGIC) between 2018 and 2023. Disease activity was measured using the 24-item IBD Symptom Inventory-Short-Form (IBDSI-SF). We compared the symptoms commonly associated with active versus inactive disease, and explored symptoms patterns in relation to disease phenotype, based on the Montreal Classification. To assess psychological status the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used.

Results: The mean disease duration was 15.6±11.8 years. The 5 most common symptoms were similar for those with active disease, although at higher prevalence (89% to 98%) versus those with inactive disease (47% to 79%), and included fatigue, diarrhea, gas, bloating, and urgency. The intensity of symptoms was higher in those with active than inactive IBDSI-SF scores. The rank order and relative distribution of the symptoms and intensity of the symptoms reported were similar between those with different disease phenotypes B1, B2, and B3 and L1, L2, and L3. Persons with active IBDSI-SF had a higher prevalence of anxiety (24.6%) and depression (38.2%) versus persons with inactive IBDSI-SF (6.3% and 8%, respectively).

Conclusions: Individuals with CD with active and inactive disease by IBDSI, experience similar symptoms, but the prevalence of symptoms and their intensity is greater in persons with active IBDSI. Persons with inactive IBDSI report many symptoms. There was no difference in symptom reporting by disease behavior or location.