301
|
Mikocka-Walus A, Knowles SR. Editorial: anxiety and depression in inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:686-687. [PMID: 30132938 DOI: 10.1111/apt.14912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Mikocka-Walus
- School of Psychology, Deakin University Geelong, Melbourne, Vic., Australia
| | - S R Knowles
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Vic., Australia
| |
Collapse
|
302
|
Seifi M, Rodaway S, Rudolph U, Swinny JD. GABA A Receptor Subtypes Regulate Stress-Induced Colon Inflammation in Mice. Gastroenterology 2018; 155:852-864.e3. [PMID: 29802853 DOI: 10.1053/j.gastro.2018.05.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 04/30/2018] [Accepted: 05/18/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Psychological stress, in early life or adulthood, is a significant risk factor for inflammatory disorders, including inflammatory bowel diseases. However, little is known about the mechanisms by which emotional factors affect the immune system. γ-Aminobutyric acid type A receptors (GABAARs) regulate stress and inflammation, but it is not clear whether specific subtypes of GABAARs mediate stress-induced gastrointestinal inflammation. We investigated the roles of different GABAAR subtypes in mouse colon inflammation induced by 2 different forms of psychological stress. METHODS C57BL/6J mice were exposed to early-life stress, and adult mice were exposed to acute-restraint stress; control mice were not exposed to either form of stress. We collected colon tissues and measured contractility using isometric tension recordings; colon inflammation, based on levels of cluster of differentiation 163 and tumor necrosis factor messenger RNA (mRNA) and protein and myeloperoxidase activity; and permeability, based on levels of tight junction protein 1 and occludin mRNA and protein. Mice were given fluorescently labeled dextran orally and systemic absorption was measured. We also performed studies of mice with disruption of the GABAAR subunit α3 gene (Gabra3-/- mice). RESULTS Mice exposed to early-life stress had significantly altered GABAAR-mediated colonic contractility and impaired barrier function, and their colon tissue had increased levels of Gabra3 mRNA compared with control mice. Restraint stress led to colon inflammation in C57/BL6J mice but not Gabra3-/- mice. Colonic inflammation was induced in vitro by an α3-GABAAR agonist, showing a proinflammatory role for this receptor subtype. In contrast, α1/4/5-GABAAR ligands decreased the expression of colonic inflammatory markers. CONCLUSIONS We found stress to increase expression of Gabra3 and induce inflammation in mouse colon, together with impaired barrier function. The in vitro pharmacologic activation of α3-GABAARs recapitulated colonic inflammation, whereas α1/4/5-GABAAR ligands were anti-inflammatory. These proteins might serve as therapeutic targets for treatment of colon inflammation or inflammatory bowel diseases.
Collapse
Affiliation(s)
- Mohsen Seifi
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Scott Rodaway
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Uwe Rudolph
- Laboratory of Genetic Neuropharmacology, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jerome D Swinny
- Institute of Biomedical and Biomolecular Sciences, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
| |
Collapse
|
303
|
Stapersma L, van den Brink G, Szigethy EM, Escher JC, Utens EMWJ. Systematic review with meta-analysis: anxiety and depression in children and adolescents with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:496-506. [PMID: 29984495 DOI: 10.1111/apt.14865] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/02/2018] [Accepted: 06/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The co-existence of psychological problems and paediatric inflammatory bowel disease (IBD) is receiving increasing attention. Most studies investigated anxiety and depression, with prevalence rates varying from 0% to 50%. A systematic review is necessary to provide clear insight into the prevalence of anxiety and depression in paediatric IBD. AIM To systematically evaluate available data on the prevalence of anxiety and depressive symptoms and disorders in paediatric IBD (aged 6-18 years). METHODS Comprehensive searches were performed in Embase, Medline Ovid, Web of Science, Cochrane, PubMed, PsychInfo Ovid, and Google scholar for studies published from 1994 to 2017. Pooled prevalence rates were calculated using inverse variance heterogeneity models. Meta-regression was used to study if disease type, disease activity and gender influence prevalence. RESULTS Twenty-eight studies (N = 8107, mean age: 14.3) were identified. Pooled prevalence estimates were 16.4% (95% confidence interval [CI] 6.8%-27.3%) for anxiety symptoms and 4.2% (95% CI 3.6%-4.8%) for anxiety disorders. Pooled prevalence estimates were 15.0% (95% CI 6.4%-24.8%) for depressive symptoms and 3.4% (95% CI 0%-9.3%) for depressive disorders. Meta-regression showed no influence of disease type or gender on these prevalence rates, but studies with a higher percentage of active disease had a higher rate of depressive symptoms. CONCLUSIONS The described pooled prevalence of anxiety and depressive symptoms is lower than in adult IBD. However, due to varying instruments/cut-offs for measuring symptoms and few studies investigating disorders, the results should be interpreted with caution. Cross-cultural use of the same instruments is needed to gain better insight into prevalence rates.
Collapse
Affiliation(s)
- L Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - G van den Brink
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E M Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J C Escher
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
304
|
Abstract
AIM To explore the demands for different disease-related information and the acceptance of various information sources in patients with Crohn's disease (CD). METHODS This study included 159 patients with CD and was conducted from April 2017 to December 2017 in our hospital. We obtained the demographic characteristics of the patients and used the modified information demands questionnaire to assess patients' disease information demands, covering 4 aspects which include general knowledge, fertility, clinical treatment, and daily management. Then, we analyzed the factors associated with the information demand. In addition, we studied the patients' acceptance of different information sources. RESULTS The disease-related information demands of patients with CD are generally high. Female patients, young patients, and patients with plans to have children have significantly higher information demands concerning fertility. The information demands in clinical treatment are higher in young patients. Patients living in the countryside and patients with a short disease duration have high information demands concerning life management. The patients' acceptance of different information sources is variable. Doctor-mediated guidance, brochures, and videos are the top 3 patient choices for information sources. CONCLUSION Patients' information demands concerning many aspects of CD are generally high. Certain demands are significantly associated with the demographic characteristics of the patients. Doctor-mediated guidance, brochures, and videos are the top 3 patient choices for information sources. Therefore, corresponding education programs can be developed to improve the physical and psychological health of CD patients in the future.
Collapse
Affiliation(s)
- Qiangqiang Wu
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China,
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China,
| |
Collapse
|
305
|
Hanlon I, Hewitt C, Bell K, Phillips A, Mikocka-Walus A. Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:244-259. [PMID: 29901820 DOI: 10.1111/apt.14840] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/08/2018] [Accepted: 05/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. AIMS To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. METHODS We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis. RESULTS We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. CONCLUSION There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases.
Collapse
Affiliation(s)
- I Hanlon
- Department of Health Sciences, University of York, York, UK
| | - C Hewitt
- Department of Health Sciences, University of York, York, UK
| | - K Bell
- Department of Health Sciences, University of York, York, UK
| | - A Phillips
- Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Mikocka-Walus
- Department of Health Sciences, University of York, York, UK.,School of Psychology, Deakin University Geelong, Melbourne, Vic., Australia
| |
Collapse
|
306
|
van den Brink G, Stapersma L, Vlug LE, Rizopolous D, Bodelier AG, van Wering H, Hurkmans PCWM, Stuyt RJL, Hendriks DM, van der Burg JAT, Utens EMWJ, Escher JC. Clinical disease activity is associated with anxiety and depressive symptoms in adolescents and young adults with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:358-369. [PMID: 29897134 DOI: 10.1111/apt.14832] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/22/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Youths with inflammatory bowel disease (IBD) are at risk for developing anxiety and depressive symptoms with a reported 20%-50% prevalence rate. AIMS This prospective study aimed to: (1) describe the prevalence and severity of anxiety and depressive symptoms in a large Dutch cohort of young IBD patients, and (2) identify demographic and clinical risk factors for anxiety and depression. METHODS IBD patients (n = 374; 10-25 years) were screened for anxiety, depression and quality of life using validated age-specific questionnaires. Patients with elevated scores for anxiety and/or depressive symptoms received a diagnostic interview assessing psychiatric disorders. Demographic and clinical characteristics were retrieved from medical charts. Multiple logistic regression analysis was performed to identify risk factors for anxiety and/or depression. RESULTS Patients (mean age 18.9 years, 44.1% male, Crohn's disease 60.4%) had disease in remission (75.4%), or mild, moderate and severe clinical disease activity in, respectively, 19.8%, 2.7% and 2.1%. Mild anxiety/depressive symptoms were present in 35.2% and severe symptoms in 12.4% of patients. Elevated symptoms of either anxiety (28.3%), depression (2.9%) or both (15.8%) were found and did not differ between adolescents (10-17 years) and young adults (18-25 years). Active disease significantly predicted depressive symptoms (odds ratio (OR): 4.6 [95% confidence interval [CI]: 2.4-8.8], P < 0.001). Female gender (OR: 1.7 [95% CI: 1.1-2.7]), active disease (OR: 1.9 [95% CI: 1.1-3.2]) and a shorter disease duration (OR: 1.3 [95% CI: 0.6-1.0) (all P < 0.025) significantly predicted anxiety and/or depressive symptoms. CONCLUSIONS Considering the high prevalence of anxiety and depressive symptoms, psychological screening is recommended in young IBD patients. Screening facilitates early recognition and psychological treatment. Female patients and patients with active disease are the most vulnerable.
Collapse
Affiliation(s)
- G van den Brink
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L E Vlug
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - D Rizopolous
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - A G Bodelier
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - H van Wering
- Department of Paediatrics, Amphia Hospital, Breda, The Netherlands
| | - P C W M Hurkmans
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - R J L Stuyt
- Department of Gastroenterology, Haga Hospital, Den Haag, The Netherlands
| | - D M Hendriks
- Department of Paediatrics, Juliana Children's Hospital, Den Haag, The Netherlands
| | - J A T van der Burg
- Department of Paediatrics, Juliana Children's Hospital, Den Haag, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - J C Escher
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
307
|
Sofia MA, Ciorba MA, Meckel K, Lim CK, Guillemin GJ, Weber CR, Bissonnette M, Pekow JR. Tryptophan Metabolism through the Kynurenine Pathway is Associated with Endoscopic Inflammation in Ulcerative Colitis. Inflamm Bowel Dis 2018; 24:1471-1480. [PMID: 29796641 PMCID: PMC6196764 DOI: 10.1093/ibd/izy103] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Mucosal appearance on endoscopy is an important indicator of inflammatory burden and determines prognosis in ulcerative colitis (UC). Inflammation induces tryptophan metabolism along the kynurenine pathway (KP) and yields immunologically relevant metabolites. We sought to examine whether changes in serum tryptophan metabolites and tissue expression of KP enzymes are associated with UC endoscopic and histologic disease severity. METHODS Serum and mucosal samples were prospectively obtained at colonoscopy in patients with UC. Mayo disease activity scores, demographics, smoking status, medications, and outcomes were collected. Serum tryptophan metabolites were analyzed using ultra-high performance liquid chromatography (uHPLC), and gas chromatography-mass spectrometry (GC-MS), and enzyme expression was determined by quantitative real-time polymerase chain reaction. Metabolite and enzyme levels were compared by endoscopic subscore, clinical disease activity, time to surgery, and hospitalization. RESULTS This study included 99 patients with Mayo endoscopic subscores 0-3. Kynurenic acid/tryptophan ratio (KYNA/T) and expression of indolamine 2,3-dioxygenase 1 (IDO1), tryptophan 2,3-dioxygenase, kynurinase, and kynurenine monooxygenase correlated positively with endoscopic subscore. Adjusting for age of diagnosis, smoking status, disease extent, and medications yielded significant odds of endoscopic inflammation with increasing KYNA/T (OR 1.0015, P = 0.0186) and IDO1 expression (OR 1.0635, P = 0.0215). The highest tertile ratio of KYNA/T had shorter time to surgery (P = 0.009) and hospitalization (P = 0.01) than the lowest. CONCLUSIONS Increasing KYNA/T is closely associated with endoscopic inflammation and predictive of disease outcomes in patients with UC. These findings identify this novel metabolic association and further support the role of the KP in regulating mucosal inflammation in UC. 10.1093/ibd/izy103_video1izy103.video15788135676001.
Collapse
Affiliation(s)
- M Anthony Sofia
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL, United States
- Address correspondence to: M. Anthony Sofia, MD, Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, 5841 S. Maryland Ave, MC 4076, Chicago, IL, USA 60637. E-mail:
| | - Matthew A Ciorba
- Division of Gastroenterology, Washington University in St. Louis, St. Louis, MO, United States
| | - Katherine Meckel
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL, United States
| | - Chai K Lim
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gilles J Guillemin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Christopher R Weber
- Department of Pathology, University of Chicago Medicine, Chicago, IL, United States
| | - Marc Bissonnette
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL, United States
| | - Joel R Pekow
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL, United States
| |
Collapse
|
308
|
Psychiatric comorbidities in patients with inflammatory bowel disease. Indian J Gastroenterol 2018; 37:307-312. [PMID: 30196516 DOI: 10.1007/s12664-018-0870-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Psychiatric comorbidities are associated with inflammatory bowel disease (IBD). We conducted an observational study to evaluate the prevalence of depression and anxiety in patients with IBD. METHODS Seventy consecutive consenting patients with IBD (62 ulcerative colitis [UC], 8 Crohn's disease [CD]; 40 males, mean age [SD] 36.2 [11.3] years) and 100 healthy volunteers (44 males, age 31.22 [SD] [10.5] years) as controls were enrolled. All participants were directed to take self-assessment tests, Patient Health Questionnaire -9 (PHQ-9) and Symptom Checklist Anxiety Scale (SCL-A20). Participants having a score ≥ 10 on PHQ-9, or ≥ 29 on SCL-A20 were administered the Hamilton Depression Rating Scale (HAM-D) or Hamilton Anxiety (HAM-A) scales, respectively. The severity of depression and anxiety was graded with HAM-D and HAM-A scales, respectively. The protocol was approved by the Institutional Ethics Committee. RESULTS The prevalence of depression (34.3% vs. 5%, p < 0.0001, OR 9.7) and anxiety (18.6% vs. 2%, p = 0.0002, OR 11.17) was higher in patients with IBD as compared to controls. The severity of depression was higher in patients compared to controls (mean rank 17 vs. 7, p = 0.04). The prevalence of depression was not different between UC and CD; all IBD patients with anxiety had UC. The mean duration of disease and history of corticosteroid treatment or surgery for IBD were not associated with the presence of depression or anxiety. Patients with severe CD (Crohn's disease activity index, CDAI > 450) had more severe depression. The severity of UC did not correlate with severity of anxiety or depression in UC. CONCLUSIONS Anxiety and depression are more prevalent in IBD patients as compared to healthy individuals.
Collapse
|
309
|
Mikocka-Walus A, Andrews JM. It is high time to examine the psyche while treating IBD. Nat Rev Gastroenterol Hepatol 2018; 15:329-330. [PMID: 29636536 DOI: 10.1038/s41575-018-0004-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology and School of Medicine, University of Adelaide, Royal Adelaide Hospital, South Australia, Australia.
| |
Collapse
|
310
|
Gracie DJ, Guthrie EA, Hamlin PJ, Ford AC. Bi-directionality of Brain-Gut Interactions in Patients With Inflammatory Bowel Disease. Gastroenterology 2018; 154:1635-1646.e3. [PMID: 29366841 DOI: 10.1053/j.gastro.2018.01.027] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBD) are associated with mood disorders, such as anxiety or depression, but it is not clear whether one contributes to development of the other, or if the interaction is bi-directional (anxiety or depression contributes to the progression of IBD, and IBD affects psychological health). We performed a 2-year longitudinal prospective study of patients in secondary to care investigate the bi-directionality of IBD and mood disorders. METHODS We collected data from 405 adult patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) from November 2012 through June 2017. Demographic features, subtypes of IBD, treatments, symptoms, somatization, and fecal level of calprotectin were recorded at baseline. IBD activity was determined at baseline and after the follow-up period (2 years or more) using the Harvey-Bradshaw Index for CD and the Simple Clinical Colitis Activity Index for UC (scores ≥5 used to define disease activity). Anxiety and depression data were collected using the Hospital Anxiety and Depression Scale (HADS), at baseline and after the follow-up period. Objective markers of disease activity, including glucocorticosteroid prescription or flare of disease activity, escalation of therapy, hospitalization secondary to IBD activity, and intestinal resection during follow-up were assessed via case note review. A brain-gut direction of disease activity was defined as development of new IBD activity in patients with quiescent IBD and abnormal HADS scores at baseline. A gut-brain direction of disease activity was defined by subsequent development of abnormal HADS scores in patients with active IBD and normal HADS scores at baseline. We performed multivariate Cox regression controlling for patient characteristics and follow-up duration. RESULTS Baseline CD or UC disease activity were associated with an almost 6-fold increase in risk for a later abnormal anxiety score (hazard ratio [HR], 5.77; 95% CI, 1.89-17.7). In patients with quiescent IBD at baseline, baseline abnormal anxiety scores were associated with later need for glucocorticosteroid prescription or flare of IBD activity (HR, 2.08; 95% CI, 1.31-3.30) and escalation of therapy (HR, 1.82; 95% CI, 1.19-2.80). These associations persisted when normal IBD activity index scores and fecal level of calprotectin <250 μg/g were used to define quiescent disease at baseline. CONCLUSIONS In a 2-year study of patients with CD or UC, we found evidence for bi-directional effects of IBD activity and psychological disorders. Patients with IBD should be monitored for psychological well-being.
Collapse
Affiliation(s)
- David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
| | - Elspeth A Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - P John Hamlin
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
311
|
Yarlas A, Rubin DT, Panés J, Lindsay JO, Vermeire S, Bayliss M, Cappelleri JC, Maher S, Bushmakin AG, Chen LA, DiBonaventura M. Burden of Ulcerative Colitis on Functioning and Well-being: A Systematic Literature Review of the SF-36® Health Survey. J Crohns Colitis 2018; 12:600-609. [PMID: 29718244 DOI: 10.1093/ecco-jcc/jjy024] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS This review is the first to evaluate the burden of ulcerative colitis [UC] on patients' quality of life by synthesizing data from studies comparing scores from the SF-36® Health Survey, a generic measure assessing eight quality-of-life domains, between UC patients and matched reference samples. METHODS A systematic review of the published literature identified articles reporting SF-36 domains or physical and mental component summary scores [PCS, MCS] from UC and reference samples. Burden of disease for each SF-36 domain was then summarized across studies by comparing weighted mean differences in scores between patient and reference samples with minimally important difference thresholds. RESULTS Thirty articles met pre-specified inclusion criteria. SF-36 scores were extracted from five samples of patients with active disease, 11 samples with a mixture of disease activity, five samples of patients in clinical remission, and 13 samples of patients following proctocolectomy with ileostomy or ileal pouch-anal anastomosis, along with respective reference samples. Clinically meaningful burden was observed in samples with active or mixed disease activity [deficits: PCS = 5.6, MCS = 5.5] on all SF-36 domains except Physical Functioning. No burden was observed in samples in remission or post-surgical patients [deficits: PCS = 0.8, MCS = 0.4] except for the General Health perception domain. CONCLUSIONS Patients with active UC experience a clinically meaningful burden of disease across most aspects of quality of life. Patients with inactive UC exhibit negligible disease burden and are comparable to the general population on most quality-of-life outcomes. Thus, treatments which effectively induce and maintain remission may restore physical and mental health status.
Collapse
Affiliation(s)
| | - David T Rubin
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Julian Panés
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - James O Lindsay
- Centre for Immunobiology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | - Lea Ann Chen
- New York University School of Medicine, New York, NY, USA
| | | |
Collapse
|
312
|
Knowles SR, Keefer L, Wilding H, Hewitt C, Graff LA, Mikocka-Walus A. Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part II. Inflamm Bowel Dis 2018; 24:966-976. [PMID: 29688466 DOI: 10.1093/ibd/izy015] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There has been burgeoning interest in quality of life (QoL) in inflammatory bowel disease (IBD) in recent decades, with hundreds of studies each year now assessing this outcome. This paper is part 2 of a systematic review evaluating 5 key QoL comparisons within IBD states and relative to others without IBD. Part 1 examined QoL comparing IBD and a healthy/general population and other medically ill groups. Part 2, presented here, examines within-disease comparisons of active/inactive disease, Ulcerative colitis (UC) / Crohn's disease (CD), and change in QoL over time. Outcomes using generic versus IBD-specific QoL measures were also examined. METHODS Adult and pediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015. RESULTS Of 6173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement, of which 83 unique studies (75 adult, 8 pediatric) addressed the within-disease comparisons. The pooled mean QoL scores were significantly lower in active versus inactive IBD (n = 26) and for those with CD versus UC (n = 37), consistent across IBD-specific and generic QoL measures, for almost all comparisons. There was significant improvement in QoL over time (n = 37). Study quality was generally low to moderate. The most common measures of QoL were the disease-specific Inflammatory Bowel Disease Questionnaire and generic 36-Item Short Form Survey (SF-36) (adults) and the IBD-specific IMPACT (children). CONCLUSIONS For adults in particular, there was strong confirmation that QoL is poorer during active disease and may be poorer for those with CD. The finding that QoL can improve over time may be encouraging for individuals with this chronic disease.
Collapse
Affiliation(s)
- Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helen Wilding
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Library Service, St Vincent's Hospital, Melbourne, Australia
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, United Kingdom
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Antonina Mikocka-Walus
- Department of Health Sciences, University of York, York, United Kingdom.,School of Psychology, University of Adelaide, Adelaide, Australia.,School of Psychology, Deakin University, Burwood, Australia
| |
Collapse
|
313
|
Abstract
PURPOSE OF REVIEW Patients with inflammatory bowel disease (IBD) are not receiving preventative care services at the same rate as the general population. IBD patients are at increased risk for infections, osteoporosis, and certain malignancies secondary to their disease and as they are on immunosuppressive therapy. They are a younger population and often times consider their gastroenterologist as their primary care physician. In this review, we discuss up-to-date evidence pertaining to vaccine-preventable illnesses in the immunosuppressed IBD patient, screening for bone health, cervical cancer, skin malignancies, psychological wellbeing, and smoking cessation. RECENT FINDINGS Vaccinations are recommended in the IBD population as they are immunosuppressed and at increased risk for acquiring influenza and pneumonia. Not only are they at greater risk to acquire it but they also have a much severe complicated course. Ideally, IBD patients should be vaccinated prior to initiating immunosuppression and most inactive vaccines can be administered to them while they are on therapy. All IBD patients should be encouraged to stop smoking and have adequate vitamin D intake along with appropriate applicable cancer screenings. Gastroenterologists must work in collaboration with primary care providers along with other specialists to help provide our patients well-rounded care for their IBD.
Collapse
Affiliation(s)
- Fazia A Mir
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| |
Collapse
|
314
|
Knowles SR, Graff LA, Wilding H, Hewitt C, Keefer L, Mikocka-Walus A. Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part I. Inflamm Bowel Dis 2018; 24:742-751. [PMID: 29562277 DOI: 10.1093/ibd/izx100] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Quality of life (QoL) is commonly assessed in inflammatory bowel disease (IBD); the relationship of QoL within IBD states and relative to others has not been comprehensively evaluated. This systematic review, published across 2 papers, evaluates 5 key QoL comparisons. Part I, presented here, examines between-disease comparisons: (1) IBD/healthy(general) population and (2) IBD/other medically ill groups. Part II examines within-disease comparisons: (3) active/inactive disease, (4) ulcerative colitis/Crohn's disease, and (5) change over time. Outcomes using generic vs IBD-specific QoL measures were also examined. METHODS Adult and pediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015. RESULTS Of 6173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement; 30 unique studies (23 adult, 7 pediatric) addressed the between-disease comparisons. The pooled mean QoL scores were (1) lower in adult and pediatric IBD samples compared with healthy controls (n = 19), and for both mental and physical QoL, where measured; and (2) higher but not significant for those with IBD compared with various medically ill controls (n = 15). Findings were consistent across IBD-specific and generic QoL measures. Study quality was generally low to moderate. The most common measures of QoL were the disease-specific Inflammatory Bowel Disease Questionnaire and generic SF-36 (adults), and the generic PedsQL (children). CONCLUSIONS There was robust confirmation that QoL for individuals with IBD was poorer than for healthy individuals, for both adults and children. QoL in IBD may be better relative to some other gastrointestinal (GI) and non-GI medical conditions for children.
Collapse
Affiliation(s)
- Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Department of Library Service, St Vincent's Hospital, Melbourne, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Wilding
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, United Kingdom
| | - Laurie Keefer
- Division of Gastroenterology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Antonina Mikocka-Walus
- Department of Health Sciences, University of York, York, United Kingdom.,School of Psychology, University of Adelaide, Adelaide, Australia.,School of Psychology, Deakin University, Burwood, Australia
| |
Collapse
|
315
|
Gray MA, Chao CY, Staudacher HM, Kolosky NA, Talley NJ, Holtmann G. Anti-TNFα therapy in IBD alters brain activity reflecting visceral sensory function and cognitive-affective biases. PLoS One 2018. [PMID: 29518097 PMCID: PMC5843226 DOI: 10.1371/journal.pone.0193542] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background In inflammatory bowel disease (IBD), immune activation with increased circulating TNF-α is linked to the intensity of gastrointestinal symptoms and depression or anxiety. A central feature of depression is cognitive biases linked to negative attributions about self, the world and the future. We aimed to assess the effects of anti-TNFα therapy on the central processing of self-attribution biases and visceral afferent information in patients with Crohn’s disease. Methods We examined 9 patients with Crohn’s disease (age 26.1±10.6. yrs, 5 female, 5 ileocolonic, 2 colonic and 2 ileal disease) during chronic anti-TNFα therapy (5 adalimumab, 4 infliximab). Patients were studied twice in randomized order before and after anti-TNFα administration. On each occasion patients underwent functional magnetic resonance imaging (fMRI) of the brain during a test of implicit attribution biases regarding sickness/health and undertook a standardized nutrient challenge. Results Following anti-TNFα treatment, ratings of ‘fullness’ following nutrient challenge reduced compared to pre-treatment ratings (p<0.05). Reaction times revealed improved processing of self-related and positive health words, consistent with improved implicit sense of wellbeing that correlated with improvements in sensory function after treatment (r = 0.67, p<0.05). Treatment-associated improvements in implicit processing were mirrored by alterations of prefrontal, amygdala, posterior cingulate and visual regions. Between patients, the degree of functional amygdala change was additionally explained by individual differences in attention regulation and body awareness rankings. Conclusion In patients with Crohn’s disease, anti-TNFα administration reduces visceral sensitivity and improves implicit cognitive-affective biases linked to alterations in limbic (amygdala) function.
Collapse
Affiliation(s)
- Marcus A. Gray
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Faculty of Health and Behavioral Science, University of Queensland, St. Lucia, Brisbane, Queensland, Australia
- * E-mail:
| | - Che-yung Chao
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital Brisbane, Queensland, Australia
| | - Heidi M. Staudacher
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Natasha A. Kolosky
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas J. Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Faculty of Health and Behavioral Science, University of Queensland, St. Lucia, Brisbane, Queensland, Australia
| |
Collapse
|
316
|
Marrie RA, Walld R, Bolton JM, Sareen J, Walker JR, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Physical comorbidities increase the risk of psychiatric comorbidity in immune-mediated inflammatory disease. Gen Hosp Psychiatry 2018; 51:71-78. [PMID: 29353127 DOI: 10.1016/j.genhosppsych.2018.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We tested the association between physical comorbidity and incident depression, anxiety disorder and bipolar disorder in three immune-mediated inflammatory diseases (IMID): inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus age-, sex- and geographically-matched controls. METHODS Using population-based administrative data we identified 6119 persons with IBD, 3514 persons with MS, 10,206 persons with RA and 97,727 matched controls. We identified incident cases of depression, anxiety disorder and bipolar disorder in these populations. We evaluated the association of physical comorbidities with incident psychiatric comorbidity using Cox regression, adjusting for sociodemographic factors and index year. RESULTS The risk of incident depression, anxiety disorders and bipolar disorder was higher in each IMID cohort versus their matched cohorts. The risk of incident psychiatric comorbidity increased with an increasing number of physical comorbidities for each psychiatric comorbidity evaluated, across all IMID. Adjustment for physical comorbidity did not attenuate the increased risk of psychiatric comorbidity in the IMID cohorts versus their matched cohorts. CONCLUSION The increased incidence of psychiatric comorbidity in IMID versus matched general population cohorts is not accounted for by their increased prevalence of physical comorbidities. However, within IMID cohorts, physical comorbidity increases the risk of psychiatric comorbidity.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John R Walker
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | |
Collapse
|
317
|
de la Fuente-Nunez C, Meneguetti BT, Franco OL, Lu TK. Neuromicrobiology: How Microbes Influence the Brain. ACS Chem Neurosci 2018; 9:141-150. [PMID: 29220570 DOI: 10.1021/acschemneuro.7b00373] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We review here recent discoveries in the exciting new field of neuromicrobiology. This field encompasses the interactions between the microbiome and the central nervous system. The microbiome has a tremendous impact on human health. In particular, the gut microbiota may play a key role in many essential processes in health and disease via the activity of the gut-brain axis, possibly contributing to autism spectrum disorders, Alzheimer's disease, Parkinson's disease, depression, and anxiety disorder. Gut microbes may also be involved in nociception, complex host behaviors, and brain development. Future efforts will be needed to determine whether the observed associations correspond to causative mechanisms, as well as to engineer effective interventions to modulate the effects of the microbiome on the central nervous system.
Collapse
Affiliation(s)
- Cesar de la Fuente-Nunez
- Synthetic
Biology Group, MIT Synthetic Biology Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department
of Biological Engineering, and Department of Electrical Engineering
and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Research
Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- The Center for Microbiome Informatics and Therapeutics, Cambridge, Massachusetts 02139, United States
| | - Beatriz Torres Meneguetti
- S-Inova Biotech,
Programa de Pós-Graduação stricto sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande - MS, 79117-900, Brazil
| | - Octávio Luiz Franco
- S-Inova Biotech,
Programa de Pós-Graduação stricto sensu em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande - MS, 79117-900, Brazil
- Centro
de Análises Proteômicas e Bioquímicas, Pós-Graduação
em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília - DF, 71966-700, Brazil
| | - Timothy K. Lu
- Synthetic
Biology Group, MIT Synthetic Biology Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department
of Biological Engineering, and Department of Electrical Engineering
and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Research
Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- The Center for Microbiome Informatics and Therapeutics, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
318
|
Greuter T, Franc Y, Kaelin M, Schoepfer AM, Schreiner P, Zeitz J, Scharl M, Misselwitz B, Straumann A, Vavricka SR, Rogler G, von Känel R, Biedermann L. Low serum zinc levels predict presence of depression symptoms, but not overall disease outcome, regardless of ATG16L1 genotype in Crohn's disease patients. Therap Adv Gastroenterol 2018; 11:1756283X18757715. [PMID: 29487628 PMCID: PMC5821298 DOI: 10.1177/1756283x18757715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/13/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Zinc deficiency (ZD) in Crohn's disease (CD) is considered a frequent finding and may exacerbate CD activity. ZD is associated with depression in non-CD patients. We aimed to assess the prevalence of ZD in CD patients in clinical remission, its association with mood disturbances and to analyze a potential impact on future disease course. METHODS Zinc levels from CD patients in clinical remission at baseline and an uncomplicated disease course within the next 3 years (n = 47) were compared with those from patients developing complications (n = 50). Baseline symptoms of depression and anxiety were measured with the Hospital Anxiety and Depression scale. RESULTS Mean zinc level in the 97 patients (40.4 ± 15.7 years, 44.3% males) was 18.0 ± 4.7 μmol/l. While no ZD (<11 μmol/l) was observed, we found low zinc levels (<15.1 μmol/l) in 28 patients (28.9%). Males had higher zinc levels compared with females (19.4 ± 5.7 versus 16.8 ± 3.3, p = 0.006). Patients with low zinc levels more often reported depression symptoms compared with patients with higher levels (27.3 versus 9.4%, p = 0.047). In a multivariate analysis, zinc levels were an independent negative predictor for depression symptoms [odds ratio (OR) 0.727, 95% confidence interval (CI) 0.532-0.993, p = 0.045]. Zinc levels of patients with a complicated disease course were not different from those of patients without (17.7 ± 4.3 versus 18.3 ± 5.1, n.s.). Baseline zinc levels did not predict disease outcome regardless of ATG16L1 genotype. CONCLUSION Low-normal zinc levels were an independent predictor for the presence of depression symptoms in CD patients. Zinc levels at baseline did not predict a complicated disease course, neither in CD patients overall, nor ATG16L1T300A carriers.
Collapse
Affiliation(s)
- Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Yannick Franc
- Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
| | | | - Alain M. Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital Lausanne – CHUV, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Jonas Zeitz
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Benjamin Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | | | - Stephan R. Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Roland von Känel
- Department of Psychosomatic Medicine, Clinic Barmelweid, Switzerland
| | | |
Collapse
|
319
|
Marrie RA, Graff L, Walker JR, Fisk JD, Patten SB, Hitchon CA, Lix LM, Bolton J, Sareen J, Katz A, Berrigan LI, Marriott JJ, Singer A, El-Gabalawy R, Peschken CA, Zarychanski R, Bernstein CN. Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study. JMIR Res Protoc 2018; 7:e15. [PMID: 29343461 PMCID: PMC5792704 DOI: 10.2196/resprot.8794] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood. OBJECTIVE The objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants. METHODS Between November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations. RESULTS The final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001). CONCLUSIONS This paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Lisa M Lix
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | | | | | | | | | | |
Collapse
|
320
|
Zangenberg MS, El-Hussuna A. Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review. World J Gastroenterol 2017; 23:8651-8659. [PMID: 29358872 PMCID: PMC5752724 DOI: 10.3748/wjg.v23.i48.8651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/14/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the evidence about psychiatric morbidity after inflammatory bowel disease (IBD)-related surgery.
METHODS PRISMA guidelines were followed and a protocol was published at PROSPERO (CRD42016037600). Inclusion criteria were studies describing patients with inflammatory bowel disease undergoing surgery and their risk of developing psychiatric disorder.
RESULTS Twelve studies (including 4340 patients) were eligible. All studies were non-randomized and most had high risk of bias. Patients operated for inflammatory bowel disease had an increased risk of developing depression, compared with surgical patients with diverticulitis or inguinal hernia, but not cancer. In addition, patients with Crohn’s disease had higher risk of depression after surgery compared with non-surgical patients. Patients with ulcerative colitis had higher risk of anxiety after surgery compared with surgical colorectal cancer patients. Charlson comorbidity score more than three and female gender were independent predictors for depression and anxiety following surgery.
CONCLUSION The review cannot give any clear answer to the risks of psychiatric morbidity after surgery for IBD studies with the lowest risk of bias indicated an increased risk of depression among surgical patients with Crohn’s disease and increased risk of anxiety among patients with ulcerative colitis.
Collapse
Affiliation(s)
- Marie Strøm Zangenberg
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge 4600, Denmark
| | - Alaa El-Hussuna
- Department of Surgery, Aalborg University Hospital, Aalborg 9100, Denmark
| |
Collapse
|
321
|
Marchioni Beery RM, Barnes EL, Nadkarni A, Korzenik JR. Suicidal Behavior Among Hospitalized Adults With Inflammatory Bowel Disease: A United States Nationwide Analysis. Inflamm Bowel Dis 2017; 24:25-34. [PMID: 29272476 DOI: 10.1093/ibd/izx005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicidal behavior in inflammatory bowel disease (IBD) has been minimally explored. We aimed to determine United States (US) nationally representative prevalence estimates of suicidal ideation (SI) and suicide/self-inflicted injury (S/SII) among hospitalized adults with IBD and to examine trends in suicidal behavior over time. METHODS A retrospective cross-sectional study using National (Nationwide) Inpatient Sample data (2006-2011) identified adults with Crohn's disease (CD) or ulcerative colitis (UC), SI or S/SII, and multiple comorbid risk factors for suicidal behavior. RESULTS We identified 331,777 (estimated 1.64 million) IBD-related hospitalizations (64% CD, 36% UC) and 39,787,239 (estimated 196.08 million) hospitalizations among the general US population. Among IBD-related hospitalizations, 2502 discharges were associated with SI (prevalence 0.76%) and 1104 with S/SII (prevalence 0.33%). Both were significantly greater in CD versus UC (P < 0.001). Relative to the general US population, IBD patients were significantly less likely to demonstrate suicidal behavior: (SI:0.33% versus 0.59%, P < 0.001) (S/SII:0.75% versus 1.04%, P < 0.001). Multivariable logistic regression revealed that IBD was associated with decreased odds of SI (adjusted odds ratio [aOR] 0.62, 95%CI 0.60-0.65) and S/SII (aOR 0.43, 95%CI 0.40-0.45) relative to the general population, and suicidal behavior was lower in IBD compared to disease-related controls with rheumatoid arthritis and systemic lupus erythematosus. Similar increasing trends in suicidal behavior were observed in IBD and non-IBD populations (2006-2011). CONCLUSION In this large US database, SI or S/SII occurred in over 1% of the IBD population and was increased in CD versus UC.
Collapse
Affiliation(s)
- Renée M Marchioni Beery
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA.,Division of Digestive Diseases & Nutrition, Department of Medicine, University of South Florida, USA
| | - Edward L Barnes
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | - Joshua R Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| |
Collapse
|
322
|
Mählmann L, Gerber M, Furlano RI, Legeret C, Kalak N, Holsboer-Trachsler E, Brand S. Psychological wellbeing and physical activity in children and adolescents with inflammatory bowel disease compared to healthy controls. BMC Gastroenterol 2017; 17:160. [PMID: 29233119 PMCID: PMC5727963 DOI: 10.1186/s12876-017-0721-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Children and adolescents with inflammatory bowel disease (IBD) report impairments in daily activities, social interactions and coping. Findings regarding psychological functioning are inconsistent, while limited information is available on objectively assessed physical activity (PA). The aims of the present study were therefore to compare anthropometric dimensions, blood values, psychological functioning and PA of children and adolescents with IBD with healthy controls. METHODS Forty-seven children and adolescents took part in the study. Of these, 23 were diagnosed with IBD (mean age: 13.88 years, 44% females). The IBD group was divided into a medically well adjusted "remission-group" (n = 14; IBD-RE) and a group with an "active state" of disease (n = 8; IBD-AD). Healthy controls (n = 24; HC) were age- and gender-matched. Participants' anthropometric data, blood values and objective PA were assessed. Further, participants completed questionnaires covering socio-demographic data and psychological functioning. RESULTS Participants with IBD-AD showed higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values, haemoglobin, and leukocyte values. IBD-AD had poorer psychological functioning and lower PA (average steps per day) compared to IBD-RE and HC. No mean differences were found between IBD-RE and HC. CONCLUSIONS The pattern of results suggests that effective medical treatment of IBD in children and adolescents is associated with favorable physiological parameters, psychological dimensions and PA. Psychological counselling of children and adolescents in an active state of IBD seem to be advised in addition to standard treatment schedules. TRIAL REGISTRATION NCT NCT02264275 ; Registered 8 October 2014.
Collapse
Affiliation(s)
- Laura Mählmann
- Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Wilhelm Klein-Strasse 27, Ch-4012 Basel, Switzerland
- United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), Maastricht University, Maastricht, The Netherlands
| | - Markus Gerber
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Raoul I. Furlano
- Pediatric Gastroenterology & Nutrition, University Children’s Hospital Basel, Basel, Switzerland
| | - Corinne Legeret
- Pediatric Gastroenterology & Nutrition, University Children’s Hospital Basel, Basel, Switzerland
| | - Nadeem Kalak
- Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Wilhelm Klein-Strasse 27, Ch-4012 Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Wilhelm Klein-Strasse 27, Ch-4012 Basel, Switzerland
| | - Serge Brand
- Psychiatric Clinics of the University of Basel, Centre for Affective, Stress and Sleep Disorders, University of Basel, Wilhelm Klein-Strasse 27, Ch-4012 Basel, Switzerland
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
- Substance Abuse Prevention Research Center; Sleep Disorders Research Center, Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
323
|
Barnes EL, Kochar B, Long MD, Martin CF, Crockett SD, Korzenik JR, Kappelman MD. The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease. J Pediatr 2017; 191:184-189.e1. [PMID: 29037795 PMCID: PMC5792080 DOI: 10.1016/j.jpeds.2017.08.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/06/2017] [Accepted: 08/16/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the burden and predictors of hospital readmissions among pediatric patients with inflammatory bowel disease using the Nationwide Readmissions Database. STUDY DESIGN We performed a retrospective cohort study using 2013 Nationwide Readmissions Database. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients <18 years with diagnoses of ulcerative colitis (UC) or Crohn's disease (CD). Demographic factors and details of hospitalizations were evaluated using survey procedures in SAS v 9.4 (SAS Institute, Cary, North Carolina). Multivariable logistic regression was used to estimate ORs and 95% CIs of readmission. RESULTS Among 2733 hospitalizations (63% CD, 37% UC), 611 (22%) patients were readmitted within 90 days of the index hospitalization. Readmission resulted in weighted estimates of 11 440 excess days of hospitalization and total charges of over $107 million. For CD, male sex (aOR 1.36, 95% CI 1.03-1.81) and co-existing anxiety or depression (aOR 1.89, 95% CI 1.06-3.40) were associated with increased readmissions, while patients who underwent surgery had decreased readmissions (aOR 0.40, 95% CI 0.24-0.65). In patients with UC, an index admission of >7 days was associated with increased readmissions (aOR 1.69, 95% CI 1.09-2.62). CONCLUSIONS Readmission occurs frequently in children with inflammatory bowel disease and is associated with significant cost and resource burdens. Among patients with CD, psychiatric comorbidities such as anxiety and depression are apparent drivers of readmission.
Collapse
Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Bharati Kochar
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC
| | - Christopher F Martin
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC
| | - Joshua R Korzenik
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA
| | - Michael D Kappelman
- Center for Gastrointestinal Biology and Disease, Chapel Hill, NC; Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
324
|
Holzer P, Farzi A, Hassan AM, Zenz G, Jačan A, Reichmann F. Visceral Inflammation and Immune Activation Stress the Brain. Front Immunol 2017; 8:1613. [PMID: 29213271 PMCID: PMC5702648 DOI: 10.3389/fimmu.2017.01613] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022] Open
Abstract
Stress refers to a dynamic process in which the homeostasis of an organism is challenged, the outcome depending on the type, severity, and duration of stressors involved, the stress responses triggered, and the stress resilience of the organism. Importantly, the relationship between stress and the immune system is bidirectional, as not only stressors have an impact on immune function, but alterations in immune function themselves can elicit stress responses. Such bidirectional interactions have been prominently identified to occur in the gastrointestinal tract in which there is a close cross-talk between the gut microbiota and the local immune system, governed by the permeability of the intestinal mucosa. External stressors disturb the homeostasis between microbiota and gut, these disturbances being signaled to the brain via multiple communication pathways constituting the gut-brain axis, ultimately eliciting stress responses and perturbations of brain function. In view of these relationships, the present article sets out to highlight some of the interactions between peripheral immune activation, especially in the visceral system, and brain function, behavior, and stress coping. These issues are exemplified by the way through which the intestinal microbiota as well as microbe-associated molecular patterns including lipopolysaccharide communicate with the immune system and brain, and the mechanisms whereby overt inflammation in the GI tract impacts on emotional-affective behavior, pain sensitivity, and stress coping. The interactions between the peripheral immune system and the brain take place along the gut-brain axis, the major communication pathways of which comprise microbial metabolites, gut hormones, immune mediators, and sensory neurons. Through these signaling systems, several transmitter and neuropeptide systems within the brain are altered under conditions of peripheral immune stress, enabling adaptive processes related to stress coping and resilience to take place. These aspects of the impact of immune stress on molecular and behavioral processes in the brain have a bearing on several disturbances of mental health and highlight novel opportunities of therapeutic intervention.
Collapse
Affiliation(s)
- Peter Holzer
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Aitak Farzi
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Ahmed M Hassan
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Geraldine Zenz
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Angela Jačan
- CBmed GmbH-Center for Biomarker Research in Medicine, Graz, Austria
| | - Florian Reichmann
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| |
Collapse
|
325
|
Iturralde E, Adams RN, Barley RC, Bensen R, Christofferson M, Hanes SJ, Maahs DM, Milla C, Naranjo D, Shah AC, Tanenbaum ML, Veeravalli S, Park KT, Hood KK. Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics. J Adolesc Health 2017; 61:591-598. [PMID: 28830798 PMCID: PMC7162556 DOI: 10.1016/j.jadohealth.2017.05.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/10/2017] [Accepted: 05/24/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics. METHODS A total of 109 patients aged 12-22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care. RESULTS Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening. CONCLUSIONS A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.
Collapse
Affiliation(s)
- Esti Iturralde
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca N Adams
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Regan C Barley
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rachel Bensen
- Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California
| | - Megan Christofferson
- Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California
| | - Sarah J Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David M Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Carlos Milla
- Division of Pulmonary Medicine, Stanford Children's CysticFibrosis Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Diana Naranjo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Avni C Shah
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sruthi Veeravalli
- Division of Pulmonary Medicine, Stanford Children's CysticFibrosis Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - K T Park
- Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
326
|
Römkens TEH, Te Morsche R, Peters W, Burger DM, Hoentjen F, Drenth JPH. Urinalysis of MMX-mesalazine as a tool to monitor 5-ASA adherence in daily IBD practice. Br J Clin Pharmacol 2017; 84:477-481. [PMID: 29073323 DOI: 10.1111/bcp.13462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/26/2017] [Accepted: 10/18/2017] [Indexed: 12/12/2022] Open
Abstract
Adherence is pivotal but challenging in ulcerative colitis (UC) treatment. Many methods to assess adherence are subjective or have limitations. (Nac-)5-aminosalicylic acid (5-ASA) urinalysis by high-performance liquid chromatography (HPLC) seems feasible and reproducible in healthy volunteers. We performed a prospective study in adult quiescent UC patients to evaluate the feasibility of spot (Nac-)5-ASA urinalysis by HPLC to assess adherence in daily inflammatory bowel disease (IBD) care. Twenty-nine patients (51.7% male, mean age 52 ± 11 years) were included (median FU 9 months) and weekly spot urine samples were collected. We found large variation in spot (Nac-)5-ASA urinary excretion that was unrelated to brand, dosing schedule or dosage of 5-ASA. In conclusion, spot (Nac-)5-ASA urinalysis is not applicable to assess 5-ASA adherence in daily IBD care.
Collapse
Affiliation(s)
- Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Rene Te Morsche
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilbert Peters
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
327
|
Abstract
Inflammatory bowel disease (IBD) includes 2 chronic idiopathic inflammatory diseases: ulcerative colitis and Crohn disease. The incidence and prevalence of IBD is increasing worldwide. It can affect people of all ages, including children and geriatric populations, and can impact all aspects of life. In this article, diagnosis and treatment of IBD in adults, pediatric, pregnant, and elderly populations are explored from the perspective of a primary care physician.
Collapse
Affiliation(s)
- Tomoko Sairenji
- Department of Family Medicine, University of Washington, 1959 Northeast Pacific Street E-304, Seattle, WA 98195-6390, USA.
| | - Kimberly L Collins
- Department of Family Medicine, University of Washington, 331 NE Thornton Place, Seattle, WA 98125, USA
| | - David V Evans
- Department of Family Medicine, University of Washington, 1959 Northeast Pacific Street E-304, Seattle, WA 98195-6390, USA
| |
Collapse
|
328
|
Reigada LC, Moore MT, Martin CF, Kappelman MD. Psychometric Evaluation of the IBD-Specific Anxiety Scale: A Novel Measure of Disease-Related Anxiety for Adolescents With IBD. J Pediatr Psychol 2017; 43:413-422. [DOI: 10.1093/jpepsy/jsx121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/05/2017] [Indexed: 12/24/2022] Open
Affiliation(s)
- Laura C Reigada
- Department of Psychology, City University of New York at Brooklyn College
| | | | - Christopher F Martin
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill
| | - Michael D Kappelman
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill
| |
Collapse
|
329
|
Conley S, Proctor DD, Jeon S, Sandler RS, Redeker NS. Symptom clusters in adults with inflammatory bowel disease. Res Nurs Health 2017; 40:424-434. [PMID: 28833284 PMCID: PMC5597486 DOI: 10.1002/nur.21813] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/21/2017] [Indexed: 12/11/2022]
Abstract
Symptoms (pain, fatigue, sleep disturbance, depression, and anxiety) in inflammatory bowel disease (IBD) are associated with reduced quality of life. Understanding how IBD symptoms cluster and the clinical and demographic factors associated with symptom clusters will enable focused development of symptom management interventions. The study purposes were to (i) identify symptom cluster membership among adults with IBD and (ii) examine associations between demographic (age, gender, race/ethnicity, and education) and clinical factors (smoking status, time since diagnosis, medication type, IBD type, disease activity), and membership in specific symptom cluster groups. We conducted a retrospective study of data from the Crohn's and Colitis Foundation of America's (CCFA) Partners Cohort and used Patient Reported Outcome Measurement Information System (PROMIS) measures to measure pain interference, fatigue, sleep disturbance, anxiety, and depression. The sample included 5,296 participants with IBD (mean age 44, 72% female). In latent class analysis (LCA), four groups of participants were identified based on symptoms: "low symptom burden" (26% of sample), "high symptom burden" (38%), "physical symptoms" (22%), and "psychological symptoms" (14%). In multinomial regression, female gender, smoking, corticosteroids, Crohn's disease, and active disease state were associated with membership in the high symptom burden group. Additional research is needed to test interventions that may be effective at reducing symptom burden for individuals with IBD.
Collapse
Affiliation(s)
| | - Deborah D Proctor
- Department of Medicine, Section of Digestive Diseases, Yale University, New Haven, CT
| | | | - Robert S. Sandler
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC
| | | |
Collapse
|
330
|
Bandoli G, Chambers CD. Autoimmune conditions and comorbid depression in pregnancy: examining the risk of preterm birth and preeclampsia. J Perinatol 2017; 37:1082-1087. [PMID: 28749487 PMCID: PMC5630484 DOI: 10.1038/jp.2017.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether prenatal depression interacts with autoimmune conditions to further increase the risk of preterm birth or preeclampsia. STUDY DESIGN Our sample included 3034 pregnant women with rheumatoid arthritis (RA), Crohn's disease (CD) or psoriasis, or controls that were prospectively enrolled into MothertoBaby pregnancy studies. We estimated the independent and joint effects of the three autoimmune conditions and depression on the select outcomes. RESULTS We found an increased risk of preterm birth among women with RA (2.10; 95% confidence interval (CI) 1.54, 2.87), CD (1.87; 95% CI 1.25, 2.81) or psoriasis (1.88; 95% CI 1.27, 2.79) independent of depression status. RA was also independently associated with preeclampsia. Prenatal depression was not independently associated with preterm birth or preeclampsia, nor was there any synergism with autoimmune conditions. CONCLUSION If these findings are confirmed, the absence of synergism should be encouraging news to the many women with select autoimmune conditions and depression in pregnancy.
Collapse
Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego. 7910 Frost Street, Suite 370. San Diego, CA 92123
| | - Christina D. Chambers
- Department of Pediatrics, University of California, San Diego. 7910 Frost Street, Suite 370. San Diego, CA 92123
| |
Collapse
|
331
|
Marrie RA, Walld R, Bolton JM, Sareen J, Walker JR, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Increased incidence of psychiatric disorders in immune-mediated inflammatory disease. J Psychosom Res 2017; 101:17-23. [PMID: 28867419 DOI: 10.1016/j.jpsychores.2017.07.015] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/29/2017] [Accepted: 07/31/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Although psychiatric comorbidity is known to be more prevalent in immune-mediated inflammatory diseases (IMID) than in the general population, the incidence of psychiatric comorbidity in IMID is less understood, yet incidence is more relevant for understanding etiology. METHODS Using population-based administrative (health) data, we conducted a retrospective cohort study over the period 1989-2012 in Manitoba, Canada. We identified 19,572 incident cases of IMID including 6119 persons with inflammatory bowel disease (IBD), 3514 persons with multiple sclerosis (MS), 10,206 persons with rheumatoid arthritis (RA), and 97,727 age-, sex- and geographically-matched controls. After applying validated case definitions, we estimated the incidence of depression, anxiety disorder, bipolar disorder and schizophrenia in each of the study cohorts. Using negative binomial regression models, we tested whether the incidence rate of psychiatric comorbidity was elevated in the individual and combined IMID cohorts versus the matched cohorts, adjusting for sex, age, region of residence, socioeconomic status and year. RESULTS The relative incidence of depression (incidence rate ratio [IRR] 1.71; 95%CI: 1.64-1.79), anxiety (IRR 1.34; 95%CI: 1.29-1.40), bipolar disorder (IRR 1.68; 95%CI: 1.52-1.85) and schizophrenia (IRR 1.32; 95%CI: 1.03-1.69) were elevated in the IMID cohort. Depression and anxiety affected the MS population more often than the IBD and RA populations. CONCLUSIONS Individuals with IMID, including IBD, MS and RA are at increased risk of psychiatric comorbidity. This increased risk appears non-specific as it is seen for all three IMIDs and for all psychiatric disorders studied, implying a common underlying biology for psychiatric comorbidity in those with IMID.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - John R Walker
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - John D Fisk
- Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada.
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | | |
Collapse
|
332
|
Tarricone I, Regazzi MG, Bonucci G, Rizzello F, Carini G, Muratori R, Poggioli G, Campieri M. Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review. J Psychosom Res 2017; 101:68-95. [PMID: 28867427 DOI: 10.1016/j.jpsychores.2017.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/23/2017] [Accepted: 07/01/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Higher prevalence of psychiatric disorders, such as anxiety and depression, has been found in people with Crohn's disease and Ulcerative Colitis compared to the general population. Nowadays, international guidelines advocate psychotherapy and psycho-pharmacological treatments as playing an important role in IBD care. The main goal of this systematic literature review was summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD. METHODS A systematic literature review was conducted using three different electronic databases: MEDLINE, PsychINFO, and EMBASE to identify studies reporting the prevalence and efficacy of psycho-pharmacological and psychotherapeutic treatments for IBD. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also performed. RESULTS Forty-three studies were included. Although a high rate of psychoactive drug use was found in people with IBD, a low proportion of IBD patients have access to psychiatric referral. 1/3 of the studies found that psychotherapy was effective for improving the quality of life, perception of stress, anxiety and depression as well as disease. Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression. CONCLUSION Our results suggest that psychiatric treatment should be implemented in IBD care. However, further studies are needed to confirm the findings of our systematic review.
Collapse
Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Department of Psychiatry and Psychological Addictions, Local Health Authority, Bologna, Italy.
| | | | - Giulia Bonucci
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | - Giovanni Carini
- Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | | | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | | |
Collapse
|
333
|
Impaired objective and subjective sleep in children and adolescents with inflammatory bowel disease compared to healthy controls. Sleep Med 2017; 39:25-31. [PMID: 29157584 DOI: 10.1016/j.sleep.2017.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/15/2017] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Poor sleep and higher inflammation markers are associated, and impaired sleep quality is common among patients with inflammatory bowel disease (IBD). However, information on sleep among children and adolescents with IBD is currently lacking. The aims of the present study were to compare subjective and objective sleep of children and adolescents with IBD with healthy controls and to shed more light on the relationship between sleep and inflammation. We expected that poor sleep, as assessed via sleep electroencephalography recordings, would be observed among participants with IBD, but particularly among participants in an active state of disease. Furthermore, we expected that poor sleep and higher inflammatory markers would be associated. METHODS A total of 47 children and adolescents participated in the study; 23 were diagnosed with IBD (mean age: 13.88 years, 44% female). The IBD group was divided into a medically well adjusted "remission-group" (IBD-RE; n = 14) and a group with an "active state of disease" (IBD-AD; n = 8). Healthy controls (HC; n = 24) were age and gender matched. Participants completed self-rating questionnaires for subjective sleep disturbances. Anthropometric data, acute and chronic inflammatory markers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) and objective sleep were considered. RESULTS Compared to HC and IBD-RE, IBD-AD patients showed impaired objective sleep patterns (eg, more awakenings, longer sleep latency, and reduced stage 3 sleep). Linear relationships described the correlation between higher ESR and more stage 4 (minutes, percentage) sleep. Nonlinear relationships described the relation between ESR and subjective sleep quality (inverse U-shaped) and between CRP and sleep latency (U-shaped). CONCLUSION In children and adolescents with an active IBD, objective sleep was impaired and overall sleep quality and inflammation indices were associated in a complex manner. It seems advisable to include assessment of subjective sleep quality in the care of pediatric IBD patients as an additional indicator for objective sleep disturbances and inflammation. TRIAL REGISTRATION NUMBER NCT02264275.
Collapse
|
334
|
Keefer L. Editorial: depression in the setting of inflammatory bowel disease means we have failed to provide early, effective, psychosocial care. Aliment Pharmacol Ther 2017; 46:553-554. [PMID: 28776733 DOI: 10.1111/apt.14212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- L Keefer
- Ichan School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
335
|
Abstract
The term inflammatory bowel disease (IBD) refers principally to two major categories of chronic relapsing inflammatory intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC). In the United States, it is currently estimated that about 1.5 million people suffer from IBD, causing considerable suffering, mortality and economic loss every year. Yet the cause of IBD is unknown, and until we understand more, prevention or cure will not be possible. There is a lot of variation in the incidence and prevalence of CD based on geographic region, environment, immigrant population, and ethnic groups. The annual incidence of CD in North America is reported to be 3.1-20.2 per 100,000 with a prevalence of 201 per 100,000 population. Based on the epidemiological, genetic and immunological data, CD is considered to be a heterogeneous disorder with multifactorial etiology in which genetics and environment interact to manifest the disease. Several genes have been studied so for with respect to CD, but thus far the strong and replicated associations have been identified with NOD2, IL23R and ATG16L1 genes. The risk factors implicated with CD include smoking, low fiber- high carbohydrate diet, altered microbiome and medications such as non-steroidal anti-inflammatory drugs. CD is typically characterized by transmural inflammation of the intestine and could affect any part of the gastrointestinal tract from mouth to perianal area. In terms of distribution of the disease 25% of the patients have colitis only, 25% is ileitis only and 50% have ileocolitis. The Montreal classification is based on the age at diagnosis (<16, 17-40, > 40), disease location (Ileal, colonic, Ileocolonic) and the disease behavior (nonstricturing/nonpenetrating, stricturing, penetrating). The key features for diagnosing CD comprises a combination of radiographic, endoscopic and pathological findings demonstrating focal, asymmetric, transmural or granulomatous features. Abdominal Computed tomography (CT) enterography is the most preferred first-line radiologic study used in the assessment of small bowel CD. The diagnostic accuracy of magnetic resonance enterography/enteroclysis is similar to that of CT scans and also prevents exposure to ionizing radiation. Endoscopic scores are considered to be the gold standard tool to measure the activity of CD and they are used more commonly in the clinical trials to measure the efficacy of various drugs on inducing and maintaining mucosal healing. The most common scoring systems used to measure clinical disease activity include Crohn's Disease Activity Index (CDAI), HBI- Harvey-Bradshaw index (HBI), short inflammatory bowel disease questionnaire (SIBDQ) and Lehmann score. Management of Crohn's disease has been seen as an evolving challenge owing to its widely heterogeneous manifestations, overlapping characteristics with other inflammatory disorders, often elusive extraintestinal manifestations and uncertain etiology. Therapeutic interventions are tailored to address symptomatic response and subsequent tolerance of the intervention. Chronology of treatment should favor treatment dose acute disease or "induction therapy", followed by maintenance of adequate response or remission, i.e. "maintenance therapy". The medications which are highly effective in inducing remission include steroids and Tumor Necrosis Factor (TNF) inhibitors. Medications used to maintain remission include 5-aminosalicyclic acid products, immunomodulators (Azathioprine, 6-mercaptopurine, methotrexate) and TNF inhibitors (infliximab, adalimumab, certolizumab and golimumab). Surgical interventions like bowel resection, stricturoplasty or drainage of abscess is required in up to two thirds of CD patients during their lifetime. The most common indications for surgical resection are medically refractory disease, perforation, persisting or recurrent obstruction, abscess not amenable to percutaneous drainage, intractable hemorrhage, dysplasia or cancer. Endoscopic recurrence in postoperative CD patients, as defined by Rutgeers score i2-i4 occur in 30-90% of the patients at the neoterminal ileum within 12 months of surgery and almost universally by 5 years. Treating CD requires a comprehensive care team including the patient, primary care provider, and gastroenterologist. In summary CD is a chronic inflammatory condition with a remitting and relapsing course primarily affecting relatively younger population with significant socioeconomic effects.
Collapse
Affiliation(s)
- Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University Health Science Center El Paso, 2000B Transmountain Road, El Paso, TX 79911, United States.
| | - Priyadarshini Loganathan
- Department of Internal Medicine, Texas Tech University Health Science Center El Paso, 2000B Transmountain Road, El Paso, TX 79911, United States
| | - Anthony P Catinella
- Department of Family Medicine, Texas Tech University Health Science Center El Paso, 2000B Transmountain Road, El Paso, TX 79911, United States
| | - Jana G Hashash
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, M2, C Wing, 200 Lothrop Street, Pittsburgh, PA 15213, United States
| |
Collapse
|
336
|
Regueiro M, Click B, Holder D, Shrank W, McAnallen S, Szigethy E. Constructing an Inflammatory Bowel Disease Patient-Centered Medical Home. Clin Gastroenterol Hepatol 2017. [PMID: 28624253 DOI: 10.1016/j.cgh.2017.05.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Miguel Regueiro
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Benjamin Click
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane Holder
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - William Shrank
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandra McAnallen
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
337
|
Alexakis C, Kumar S, Saxena S, Pollok R. Systematic review with meta-analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease. Aliment Pharmacol Ther 2017; 46:225-235. [PMID: 28573652 DOI: 10.1111/apt.14171] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/04/2017] [Accepted: 05/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite a higher prevalence of psychosocial morbidity in Inflammatory Bowel Disease (IBD), the association between depressive state and disease course in IBD is poorly understood. AIM To investigate the impact of depressive state on disease course in IBD. METHODS We conducted a systematic review in MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and PsychINFO for prospective studies evaluating the impact of baseline depressive state on subsequent disease course in adult IBD. RESULTS Eleven studies matched our entry criteria, representing 3194 patients with IBD. Three reported on patients with ulcerative colitis (UC), four included patients with Crohn's disease (CD) exclusively, and four studies included both UC and CD. Five studies reported an association between depressive state and disease course. None of the UC-specific studies found any association. In three of four CD-specific studies, a relationship between depressive state and worsening disease course was found. In four of five studies including patients in remission at baseline, no association between depressive state and disease course was found. Pooled analysis of IBD studies with patients in clinical remission at baseline identified no association between depressive state and disease course (HR 1.04, 95%CI: 0.97-1.12). CONCLUSION There is limited evidence to support an association between depressive state and subsequent deterioration in disease course in IBD, but what data that exist are more supportive of an association with CD than UC. Baseline disease activity may be an important factor in this relationship. Further studies are needed to understand the relationship between mental health and outcomes in IBD.
Collapse
Affiliation(s)
- C Alexakis
- Department of Gastroenterology, St George's University Hospital NHS Trust, London, UK
| | - S Kumar
- Department of Gastroenterology, St George's University Hospital NHS Trust, London, UK
| | - S Saxena
- Department of Primary Care and Public Health, Charing Cross Campus, Imperial College London, London, UK
| | - R Pollok
- Department of Gastroenterology, St George's University Hospital NHS Trust, London, UK
| |
Collapse
|
338
|
Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database. Inflamm Bowel Dis 2017; 23:875-881. [PMID: 28426473 PMCID: PMC5512697 DOI: 10.1097/mib.0000000000001121] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies suggest that disease activity alone does not reliably predict hospital readmission among patients with inflammatory bowel diseases (IBDs). Using a national database, we aimed to further describe the burden of readmissions for IBD and identify modifiable risk factors. METHODS We performed a retrospective cohort study using 2013 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9-CM) codes, we identified adult patients with discharge diagnoses of ulcerative colitis or Crohn's disease and ascertained diagnoses of anxiety, depression, chronic pain, tobacco use, and other comorbidities during index admission. Logistic regression was used to estimate factors associated with hospital readmission. RESULTS Among 52,498 hospitalizations of patients with IBD (63% Crohn's disease and 37% ulcerative colitis), 12,407 (24%) were readmitted within 90 days of the index hospitalization, resulting in roughly $576 million in excess charges. In multivariable analysis of patients with Crohn's disease, anxiety (odds ratio [OR] 1.31, 95% confidence interval [CI], 1.21-1.43), depression (OR 1.27, 95% CI, 1.07-1.50), chronic pain (OR 1.31, 95% CI, 1.18-1.46), and tobacco abuse (OR 1.13, 95% CI, 1.06-1.22) were associated with a significant increase in odds of readmission. Among patients with ulcerative colitis, anxiety (OR 1.28, 95% CI, 1.14-1.45), depression (OR 1.35, 95% CI, 1.07-1.70), and chronic pain (OR 1.44, 95% CI, 1.21-1.73) were associated with a significant increase in odds of readmission. CONCLUSIONS Readmission occurs frequently in patients with IBD and is costly. Anxiety, depression, and chronic pain may represent targets for interventions to prevent 90-day hospital readmission in this population.
Collapse
|
339
|
Click BH, Greer JB, Regueiro MD, Hartman DJ, Davis PL, Siegel CA, Herfarth HH, Rosh JR, Shah SA, Koltun WA, Binion DG, Baidoo L, Szigethy E. IBD LIVE Series-Case 7: The Brain-Gut Connection and the Importance of Integrated Care in IBD. Inflamm Bowel Dis 2017; 23:681-694. [PMID: 28426450 DOI: 10.1097/mib.0000000000001101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Benjamin H Click
- 1Gastroenterology Fellow II, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 2Assistant Professor of Medicine, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 3Professor of Medicine, Associate Chief for Education, Co-Director, Inflammatory Bowel Disease Center, Head, IBD Clinical Program, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Associate Professor of Pathology, Associate Director of Pathology Informatics, Department of Pathology, Division of Anatomic Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 5Clinical Associate Professor of Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 6Associate Professor of Medicine and of The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; 7Director of the Inflammatory Bowel Disease Center at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire; 8Professor of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina; 9Director, Division of Gastroenterology and Nutrition, Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey; 10Professor of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York; 11Chief of Gastroenterology, The Miriam Hospital, Providence, Rhode Island; 12Clinical Professor of Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island; 13Chief, Division of Colon and Rectal Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania; 14Director, Hershey Penn State IBD Center, Professor of Surgery, Peter and Marshia Carlino Chair in IBD, Penn State College of Medicine, Hershey, Pennsylvania; 15Professor of Medicine, Clinical and Translational Science, Co-Director of the IBD Center, Director of Translational IBD Research, Director, Nutrition Support Service, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 16Associate Professor of Medicine, Director, Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and 17Associate Professor of Psychiatry, Pediatrics, and Medicine, University of Pittsburgh School of Medicine, Director, Visceral Inflammation and Pain Center, Co-Director Total Care-IBD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
340
|
The Rating Form of IBD Patient Concerns: Translation, Validation, and First Implementation of the Greek Version. Gastroenterol Res Pract 2017; 2017:6267175. [PMID: 28529522 PMCID: PMC5424483 DOI: 10.1155/2017/6267175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/15/2017] [Indexed: 12/15/2022] Open
Abstract
Background. The rating form of IBD patients' concerns (RFIPC) provides a unique assessment of the worries and concerns of inflammatory bowel disease (IBD) patients. Our aims were primarily to validate the Greek version of RFIPC and secondarily to describe the pattern of Greek patients'concerns. Methods. After translating RFIPC, the questionnaire was given to IBD patients at baseline and after 12 weeks. The questionnaire's measuring properties were evaluated based on the consensus-based standards for the selection of health status measurement instruments (COSMIN) recommendations. Premediated factorial structures were tested for goodness of fit with confirmatory factor analysis (CFA). Results. At baseline, 200 patients (94 with Crohn's disease) completed RFIPC. After 12 weeks, the first 100 patients recompleted the questionnaire. CFA results were consistent with a slightly modified than the original factorial structure. Cronbach's α and intraclass correlation coefficients were high. RFIPC scores negatively affected the quality of life. RFIPC was sensitive to detect important changes in patients' condition and was able to discriminate between remission and active disease. Disease activity, full time employment, celibacy, and low education were associated with higher scores. Conclusion. The Greek version of RFIPC is a reliable, valid, and responsive tool to assess Greek IBD patients' concerns.
Collapse
|
341
|
Mind-Body Interventions for Pediatric Inflammatory Bowel Disease. CHILDREN-BASEL 2017; 4:children4040022. [PMID: 28368365 PMCID: PMC5406681 DOI: 10.3390/children4040022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/17/2017] [Accepted: 03/28/2017] [Indexed: 12/15/2022]
Abstract
Pediatric inflammatory bowel disease is an autoimmune disease that causes chronic inflammation of the gastrointestinal mucosa. There is emerging evidence that the brain–gut connection affects inflammatory bowel disease (IBD) patients more than previously thought. This is evidenced by comorbid mood disorders, irritable bowel symptoms concurrent with quiescent IBD, and the potential of psychosocial stressors to trigger IBD flares. Mind–body interventions such as psychotherapy, relaxation, mindfulness, biofeedback, yoga, and clinical hypnosis offer an adjunct to standard medical treatment for IBD. We will review the current evidence base for these mind–body interventions in the treatment of pediatric IBD, illustrate a case study, and offer suggestions for future research for this promising field.
Collapse
|
342
|
Abstract
BACKGROUND Antidepressants are commonly used to treat symptoms of anxiety and depression in inflammatory bowel disease (IBD). Recent studies suggest a link between IBD activity and an individual's emotional state which raises the possibility that antidepressants may potentially modify the disease course of IBD. This systematic review thus primarily aims to evaluate the efficacy of antidepressants on IBD activity, and secondarily, on anxiety and depression. METHODS MEDLINE, EMBASE, Cochrane (IBD Group), CINAHL, AMED, PsycINFO, and OpenGrey were searched from 1990 onward with no restrictions on study design. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also conducted. RESULTS Fifteen eligible studies included in the review (1 randomized controlled trial, 2 cohorts, 1 case-control, 1 cross-sectional survey, 1 qualitative, 2 audits, 1 case series, and 6 case reports) examined a range of antidepressants. Twelve studies suggested that antidepressants have a positive impact on IBD course. Nine studies reported anxiety and depression as an outcome, of these 8 reported beneficial effects of antidepressants. Most of the studies were deemed to be at low risk of bias, apart from the case reports, which were at high risk of bias. CONCLUSIONS This research indicates that antidepressants may have a beneficial effect on IBD course. However, it is currently not possible to determine their efficacy for certain because of the lack of randomized trials. Further trials using objective measures of IBD activity, longer follow-up periods, and larger sample sizes are needed.
Collapse
|
343
|
Berding A, Witte C, Gottschald M, Kaltz B, Weiland R, Gerlich C, Reusch A, Kruis W, Faller H. Beneficial Effects of Education on Emotional Distress, Self-Management, and Coping in Patients with Inflammatory Bowel Disease: A Prospective Randomized Controlled Study. Inflamm Intest Dis 2017; 1:182-190. [PMID: 29922675 DOI: 10.1159/000452989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) suffer from various physical as well as psychological impairments, and patient education may help improve their well-being. Therefore, we developed a manualized education program for IBD patients addressing medical and psychological issues. This study aimed to evaluate it in a large controlled trial. METHODS A total of 181 IBD outpatients participated in a prospective, randomized, waitlist-controlled trial; assessments were made before as well as 2 weeks and 3 months after intervention. Analysis of covariance was used to assess intervention effects on disease-related worries and concerns (primary outcome), fear of progression, coping with anxiety, health competencies, health-related quality of life (HRQoL), perceived disease activity, symptoms of depression and anxiety, disease-related knowledge, and coping strategies. Participants' satisfaction with the program was also evaluated. RESULTS At 2 weeks and 3 months after intervention, we found significant large effects of our education program on skill and technique acquisition, knowledge, and coping with IBD. Moreover, we found significant medium effects on disease-related worries and concerns, fear of progression, coping with anxiety, constructive attitudes and approaches, as well as coping with disease-related negative emotions. The number of coping strategies used was significantly higher at 3 months. We did not find any effects on perceived disease activity, HRQoL, positive and active engagement in life, or symptoms of anxiety and depression. The program was rated very favorably by the attendees. CONCLUSION Our education program contributed to improvements in psychological distress, self-management skills, and coping and was appreciated by its attendees.
Collapse
Affiliation(s)
- Anja Berding
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany.,Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christine Witte
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | | | - Birgit Kaltz
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | - Romy Weiland
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christian Gerlich
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Andrea Reusch
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Wolfgang Kruis
- Department of Internal Medicine, Protestant Hospital Kalk, Cologne, Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| |
Collapse
|
344
|
Abstract
BACKGROUND Early readmissions are important indicators of quality of care. Limited data exist describing hospital readmissions in ulcerative colitis (UC). The aim of this study was to describe unplanned, 30-day readmissions among adult UC patients and to assess readmission predictors. METHODS We analyzed the 2013 United States National Readmission Database and identified UC admissions using administrative codes in patients from 18 to 80 years of age. Our primary outcome was a 30-day, unplanned readmission rate. We used chi-square tests, t tests, and Wilcoxon rank-sum tests for descriptive analyses and survey logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations with readmissions adjusting for confounders. RESULTS Among 26,094 hospitalizations with a primary UC diagnosis, there were 2757 (10.6%) 30-day, unplanned readmissions. The most common readmission diagnoses were reasons related to UC (58%), complications of surgical procedures/medical care (5.5%), Clostridium difficile (4.8%), and septicemia (4.3%). In multivariable analysis, length of stay ≥7 days (aOR 1.54, 95% CI, 1.24-1.90), not having an endoscopy (aOR 1.20, 95% CI, 1.04-1.38), and depression (aOR 1.40, 95% CI, 1.16-1.66) were significantly associated with readmission. 58.2% of readmissions had at least one of these factors. Patients were also less likely to be admitted if they were women or had self-pay payer status. Having a colectomy did not significantly increase readmissions (aOR 1.14, 95% CI, 0.86-1.52). CONCLUSIONS On a national level, 1 in 10 hospitalizations for UC was followed by an unplanned readmission within 30 days. Not having an endoscopy on the index hospitalization and depression were independently associated with readmissions. Further studies should examine if strategies that address these predictors can decrease readmissions.
Collapse
|
345
|
Walker JR. Understanding and management of anxiety and mood disorders in inflammatory bowel disease. Lancet Gastroenterol Hepatol 2017; 2:148-150. [PMID: 28404123 DOI: 10.1016/s2468-1253(16)30218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 06/07/2023]
Affiliation(s)
- John R Walker
- Department of Clinical Health Psychology, University of Manitoba, St Boniface Hospital, Winnipeg, MB R2H 2A6, Canada.
| |
Collapse
|
346
|
Evidence of Bidirectional Associations Between Perceived Stress and Symptom Activity: A Prospective Longitudinal Investigation in Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:473-483. [PMID: 28221251 DOI: 10.1097/mib.0000000000001040] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Our aim was to explore the relationships among perceived stress, intestinal inflammation, and inflammatory bowel disease (IBD) symptoms over time. METHODS Participants were recruited from a population-based registry of persons with IBD and assessed at months 0, 3, and 6. Key dependent measures were the Manitoba IBD Index (symptom activity), Cohen's Perceived Stress Scale, and fecal calprotectin in stool (intestinal inflammation). RESULTS Complete data were available for 417 participants at months 0; 369 provided follow-up data. Active symptoms were reported by 54% of those with Crohn's disease (CD) and 40% of those with ulcerative colitis (UC) and approximately one-third consistently had fecal calprotectin measures ≥250 μg/g, suggestive of active inflammation. A significant proportion of participants had indications of inflammation but no active symptoms over the 6 months. Correlations of month 0 perceived stress and disease activity measures with values at months 3 and 6 for both CD and UC indicated strong temporal stability. In hierarchical multiple regression analyses, month 0 symptom activity was thus a strong predictor of later symptom activity for CD and UC. Perceived stress predicted change in symptom activity from 0 to 3 months for CD, as did use of prednisone for UC. Comparably, month 0 perceived stress was a strong predictor of later perceived stress for CD and UC, while month 0 symptom activity predicted change in perceived stress from 0 to 3 months for both CD and UC. CONCLUSIONS The analysis revealed prospective bidirectional relationships between perceived stress and IBD symptoms but no relationship between perceived stress and change in intestinal inflammation as assessed by fecal calprotectin.
Collapse
|
347
|
Regueiro M, Greer JB, Szigethy E. Etiology and Treatment of Pain and Psychosocial Issues in Patients With Inflammatory Bowel Diseases. Gastroenterology 2017; 152:430-439.e4. [PMID: 27816599 DOI: 10.1053/j.gastro.2016.10.036] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/07/2016] [Accepted: 10/27/2016] [Indexed: 12/15/2022]
Abstract
There is increasing evidence that brain-gut interactions are altered during development of inflammatory bowel diseases (IBDs). Understanding the relationship between the neurobiology, psychological symptoms, and social ramifications of IBD can guide comprehensive care for the whole patient. The most common psychological conditions in patients with IBD are chronic abdominal pain, anxiety, and depression. We review the evidence-based data and rates of these conditions and their respective relationship to IBD and the diagnostic approaches to identify patients with these conditions. Different treatment options for pain and psychosocial conditions are discussed, and new models of team-based IBD care are introduced. Providing the health care provider with tools to diagnose and manage psychological conditions in patients with Crohn's disease or ulcerative colitis is necessary for their total care and should be part of quality-improvement initiatives.
Collapse
Affiliation(s)
- Miguel Regueiro
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia B Greer
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eva Szigethy
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
| |
Collapse
|
348
|
ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. Am J Gastroenterol 2017; 112:241-258. [PMID: 28071656 DOI: 10.1038/ajg.2016.537] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 10/01/2016] [Indexed: 02/06/2023]
Abstract
Recent data suggest that inflammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identification, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identification of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary.
Collapse
|
349
|
Impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, and quality of life. Int J Colorectal Dis 2017; 32:125-130. [PMID: 27757540 DOI: 10.1007/s00384-016-2681-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Inflammatory bowel disease has been associated with neurological symptoms including restless legs syndrome. Here, we investigated the impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, mood, cognition, and quality of life. METHODS Two groups of inflammatory bowel disease patients, with and without restless legs syndrome, were prospectively evaluated for sleep disorders, fatigue, daytime sleepiness, depression, anxiety, and health-related quality of life. Furthermore, global cognitive function, executive function, attention, and concentration were assessed in both groups. Disease activity and duration of inflammatory bowel disease as well as current medication were assessed by interview. Inflammatory bowel disease patients with and without restless legs syndrome were matched for age, education, severity, and duration of their inflammatory bowel disease. RESULTS Patients with inflammatory bowel disease and clinically relevant restless leg syndrome suffered significantly more frequent from sleep disturbances including sleep latency and duration, more fatigue, and worse health-related quality of life as compared to inflammatory bowel disease patients without restless legs syndrome. Affect and cognitive function including cognitive flexibility, attention, and concentration showed no significant differences among groups, indicating to be not related to restless legs syndrome. CONCLUSIONS Sleep disorders including longer sleep latency, shorter sleep duration, and fatigue are characteristic symptoms of restless legs syndrome in inflammatory bowel disease patients, resulting in worse health-related quality of life. Therefore, clinicians treating patients with inflammatory bowel disease should be alert for restless legs syndrome.
Collapse
|
350
|
López-Sanromán A, Carpio D, Calvet X, Romero C, Cea-Calvo L, Juliá B, Argüelles-Arias F. Perceived Emotional and Psychological Impact of Ulcerative Colitis on Outpatients in Spain: UC-LIFE Survey. Dig Dis Sci 2017; 62:207-216. [PMID: 27817123 DOI: 10.1007/s10620-016-4363-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/20/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ulcerative colitis (UC) negatively impacts patients' health-related quality of life (HRQoL). AIM The UC-LIFE survey aimed to evaluate the perceived everyday and emotional impact of UC on patients attending outpatient clinics in Spain and explored patient-physician communication. METHODS Gastroenterologists handed the survey to consecutive unselected UC patients aged ≥18 years. Patients described their perception on the burden of symptoms and disease severity, social and emotional impact of UC on everyday life, disease knowledge and sources of information about the disease, and patient-physician communication. RESULTS A total of 585 patients received the survey, and 436 returned it (74.5% response rate; mean age 46 years, 53% men). Most patients perceived that UC prevented them from leading a normal life (79.3%) and impaired sleep quality (76.1%). Most patients described an emotional impact due to UC, mainly feelings of depression and anxiety, and some 38% perceived that UC decreased their self-confidence. Despite most patients believing that their physician listened/asked about UC symptoms, many perceived that emotional/psychological support was lacking. CONCLUSIONS Findings support the need for a more patient-centered approach to the care of UC patients, to include psychological, emotional, and social aspects. Improved patient-physician communication would be beneficial and may contribute to better HRQoL in UC patients.
Collapse
Affiliation(s)
- Antonio López-Sanromán
- Head Gastroenterology Division, Gastroenterology and Hepatology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Daniel Carpio
- Gastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Biomedica (IBI), SERGAS, Pontevedra, Spain
| | - Xavier Calvet
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Unitat de Malalties Digestives, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain
| | - Cristina Romero
- Medical Affairs Department, Merck Sharp & Dohme Spain, Josefa Valcárcel 38, 28027, Madrid, Spain.
| | - Luis Cea-Calvo
- Medical Affairs Department, Merck Sharp & Dohme Spain, Josefa Valcárcel 38, 28027, Madrid, Spain
| | - Berta Juliá
- Medical Affairs Department, Merck Sharp & Dohme Spain, Josefa Valcárcel 38, 28027, Madrid, Spain
| | | |
Collapse
|