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Norouzkhani N, Faramarzi M, Ghodousi Moghadam S, Karimi MA, Shokri Shirvani J, Bahari A, ShojaeiBaghini M, Eslami S, Tabesh H. Identification of the informational and supportive needs of patients diagnosed with inflammatory bowel disease: a scoping review. Front Psychol 2023; 14:1055449. [PMID: 37251032 PMCID: PMC10211349 DOI: 10.3389/fpsyg.2023.1055449] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Inflammatory Bowel Disease (IBD) affects the quality of life. Patient education and support needs are crucial components of comprehensive chronic illness care. The main purposes of this review were to (i) explore the informational and supportive needs of these patients to improve the quality of life in the existing literature and (ii) identify the gaps related to the needs of the patients in articles. Methods The scoping review is based on the Daudt methodological framework, a modified version of Arksey and O'Malley. Electronic databases were extensively searched from January 01, 2000 to April 30, 2022. Four electronic databases (PubMed/Medline, CINAHL, APA PsycInfo, Psychology and Behavioral Sciences Collection, APA PsycArticles, and ProQuest) were searched using controlled vocabulary, and specific keywords. The searched terms were matched to each database. We manually searched two key journals, namely the Journal of Inflammatory Bowel Disease and the Journal of Crohn's and Colitis. Results In the review, 75 studies on the assessment of the information and support needs of patients with IBD were reviewed. In this regard, 62 and 53 studies were regarding information needs and support needs, respectively. Most of the information needs of patients with IBD reported in the studies were related to diet needs, and educational needs were the most essential support needs. Conclusions Health policymakers and managers can develop care and educational programs related to this disease in health centers according to the needs of the patients. Health professionals, especially gastroenterologists, are the primary referral sources for information on patients. Therefore, gastroenterologists can take the lead in planning and educating the patients and sharing their decisions. Systematic review registration OSF, https://doi.org/10.17605/OSF.IO/3MWGJ.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahbobeh Faramarzi
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Sara Ghodousi Moghadam
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Amin Karimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdie ShojaeiBaghini
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Chen PH, Patel R, Miller SD, Jasper R, Chander G, Hutfless S. Substance Use Among Patients With Incident Crohn's Disease in the United States, 2010 to 2019: A Medicaid Observational Study. GASTRO HEP ADVANCES 2023; 2:747-754. [PMID: 37712010 PMCID: PMC10500958 DOI: 10.1016/j.gastha.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIMS Substance use among persons with Crohn's disease (CD) is associated with symptomatic exacerbation and poorer quality of life. However, data on the prevalence of substance use among individuals with CD are limited. Therefore, our study aimed to estimate the burden of alcohol and drug use among individuals with incident CD in the United States. We also assessed the associations between CD-related interventions and substance use after CD diagnosis. METHODS Our retrospective cohort study of the national Medicaid databases from 2010 to 2019 identified participants with newly diagnosed CD and defined substance use (ie, alcohol, opioids, cocaine, amphetamine, and cannabis) using diagnosis codes. Multivariable logistic regression models assessed the associations between CD-related interventions and substance use after CD diagnosis. RESULTS Overall, 16.3% of Medicaid enrollees with incident CD had substance ever-use, most commonly alcohol or opioids (each 8.0%). Any substance use saw an absolute decrease of 3.8% after CD diagnosis, but changes were less than 1% in either direction for each substance. CD-related hospitalization was associated with increased alcohol or opioid use post-CD diagnosis. Surgery was associated with lower use post-CD of opioids but not alcohol. CD medications (except steroids) were generally associated with decreased post-CD alcohol or opioid use. CONCLUSION Among Medicaid enrollees with incident CD, alcohol and opioid use were more frequent than previously published estimates for the general US population (6% and 4%, respectively, in 2019). Consequently, medical communities must be more aware of substance use by patients with CD to provide quality patient-centered care.
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Affiliation(s)
- Po-Hung Chen
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reeha Patel
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Steven D. Miller
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Jasper
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Geetanjali Chander
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Susan Hutfless
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
Several environmental factors have been implicated in the pathogenesis of inflammatory bowel diseases (IBD); however, the evidence for alcohol is sparse, as is its implications on disease activity and overall management. Here, we examine the available evidence for the effect of alcohol on IBD, including its association with the development of IBD, role in exacerbations, and potential medication interactions. Several mechanisms have been demonstrated to mediate the effects of ethanol in the gastrointestinal tract. Alcohol has been shown to alter the gut microbiome, disrupt intestinal barrier, and increase intestinal permeability, directly and indirectly promoting immune activation. Conversely, specific alcoholic beverages, notably red wine, may have anti-inflammatory properties capable of assisting in disease control and affecting disease monitoring. Nonetheless, most alcohol-mediated effects seem to facilitate intestinal inflammation and consequently impact disease onset, recurrence, and symptom control. Furthermore, alcohol use interferes with the metabolism of several medications leading to increased side effect profiles or even loss of effect. Notably, mesalamine, azathioprine, methotrexate, and biologic medications can all be affected by concomitant alcohol intake via a variety of mechanisms.
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Affiliation(s)
- Bradley A White
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Guilherme Piovezani Ramos
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Kuźnicki P, Neubauer K. Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse. J Clin Med 2021; 10:4623. [PMID: 34640641 PMCID: PMC8509435 DOI: 10.3390/jcm10194623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and potentially devastating condition of the digestive tract which is exemplified by increasing prevalence worldwide, byzantine pathogenesis with a poorly defined role of the environmental factors, and complex clinical demonstration. As a systemic disease, IBD may progress with a wide spectrum of extraintestinal manifestations (EMs) and comorbidities affecting different organs and systems, from anaemia, undernutrition, and cancer to those which are often neglected like anxiety and depression. Evolving IBD epidemiology and changing environment are reflected by an expanding list of IBD-related comorbidities. In contrast to the well-established role of smoking the connection between alcohol and IBD is still debatable on many levels, from pathogenesis to complications. Furthermore, little is known about narcotics use in IBD patients, even if there are obvious factors that may predispose them to narcotics as well as alcohol misuse. Last but not least, the question arises what is the prevalence of eating disorders in IBD. In our paper, we aimed to discuss the current knowledge on alcohol and drugs misuse and eating disorders as emerging extraintestinal comorbidities in IBD.
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Affiliation(s)
- Paweł Kuźnicki
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Division of Dietetics, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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5
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Inflammatory Bowel Disease: Are Symptoms and Diet Linked? Nutrients 2020; 12:nu12102975. [PMID: 33003341 PMCID: PMC7650696 DOI: 10.3390/nu12102975] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
New Zealand (NZ) has one of the world’s highest incidence rates of Inflammatory Bowel Disease (IBD), a group of chronic inflammatory conditions that affect the gastrointestinal tract. Patients with IBD often believe certain foods influence their disease symptoms and consequently may alter their diet considerably. The objective of this study was to determine foods, additives, and cooking methods (dietary elements) that NZ IBD patients identify in the onset, exacerbation, or reduction of their symptoms. A total of 233 participants completed a self-administered questionnaire concerning symptom behaviour in association with 142 dietary elements. Symptom onset and symptom exacerbation were associated with dietary elements by 55% (128) and 70% (164) of all IBD participants, respectively. Fruit and vegetables were most frequently identified, with dairy products, gluten-containing bread, and foods with a high fat content also considered deleterious. Of all IBD participants, 35% (82) associated symptom reduction with dietary elements. The identified foods were typically low in fibre, saturated fatty acids, and easily digestible. No statistically significant differences were seen between the type or number of dietary elements and disease subtype or recent disease activity. The association between diet and symptoms in patients with IBD and the mechanism(s) involved warrant further research and may lead to the development of IBD specific dietary guidelines.
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Chuong KH, Haw J, Stintzi A, Mack DR, O'Doherty KC. Dietary strategies and food practices of pediatric patients, and their parents, living with inflammatory bowel disease: a qualitative interview study. Int J Qual Stud Health Well-being 2020; 14:1648945. [PMID: 31382870 PMCID: PMC6713182 DOI: 10.1080/17482631.2019.1648945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: A growing body of scientific evidence supports the role of food and diet in the pathogenesis and management of inflammatory bowel diseases (IBD). However, little is known about the role of food and diet from the perspectives of pediatric patients and their parents. This study aimed to explore how children and adolescents with IBD and their parents coped with the illness through food and diet in their daily lives. Methods: We conducted semi-structured interviews with 28 children and adolescents with IBD, 26 parents and one grandparent. Results: Two major themes, dietary strategies and family food practices, were identified through thematic analysis. There were three types of dietary strategies: food avoidance and moderation; following a specific diet; and healthy eating. For family food practices, two subthemes were identified: impact on grocery shopping, meal planning, and cooking; and maintaining routine and normality. Conclusions: Our findings have important implications for the clinical care of pediatric IBD. Notably, IBD not only influenced the food practices of the pediatric patients, but also their parents and other family members. Healthcare professionals should consider the family unit when giving nutritional advice or developing nutritional guidelines. Personalized nutritional counselling and ongoing nutritional assessment are also warranted.
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Affiliation(s)
- Kim H Chuong
- a Department of Psychology, University of Guelph , Guelph , ON , Canada
| | - Jennie Haw
- a Department of Psychology, University of Guelph , Guelph , ON , Canada
| | - Alain Stintzi
- b Ottawa Institute of Systems Biology and Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
| | - David R Mack
- c Children's Hospital of Eastern Ontario (CHEO) IBD Centre and Department of Pediatrics, University of Ottawa , Ottawa , ON , Canada
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Mantzouranis G, Fafliora E, Saridi M, Tatsioni A, Glanztounis G, Albani E, Katsanos KH, Christodoulou DK. Alcohol and narcotics use in inflammatory bowel disease. Ann Gastroenterol 2018; 31:649-658. [PMID: 30386114 PMCID: PMC6191867 DOI: 10.20524/aog.2018.0302] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to evaluate alcohol consumption and narcotics use among patients with inflammatory bowel diseases (IBD). A comprehensive literature search was conducted in Medline using relevant keywords. The references of the retrieved articles were also searched to identify additional articles. Only English-language studies that provided evidence on alcohol consumption and/or narcotics use among non-hospitalized IBD patients were included in the present review. Twelve studies were included that examined the use of alcohol among IBD patients. The prevalence of alcohol consumption among IBD patients appeared to be similar to that of the general population. The majority of the studies reported worsening of IBD symptoms among patients who consumed alcoholic beverages. Four studies were identified that evaluated narcotics use as analgesia among IBD patients. Narcotics use was prevalent among IBD patients and correlated with a longer disease duration and comorbid mental illnesses. The available evidence suggests that alcohol consumption may have a deleterious effect on IBD symptoms. Furthermore, a considerable proportion of IBD patients are reported to use a narcotic as analgesia and this was correlated with their mental health status. Further studies are needed to address these important facets of IBD.
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Affiliation(s)
- George Mantzouranis
- Department of Gastroenterology, University of Ioannina, Medical School (George Mantzouranis, Eleftheria Fafliora, Athina Tatsioni, George Glantzounis, Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - Eleftheria Fafliora
- Department of Gastroenterology, University of Ioannina, Medical School (George Mantzouranis, Eleftheria Fafliora, Athina Tatsioni, George Glantzounis, Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - Maria Saridi
- Department of Social Sciences, University of Peloponnese, Corinth, Academic Tutor at Hellenic Open University (Maria Saridi), Greece
- Correspondence to: Maria Saridi, PhD, Research Fellow, Faculty of Social Sciences, University of Peloponnese, Corinth, Greece, Academic Tutor at Hellenic Open University, Greece, Sina 33, 20131 Corinth, Greece, e-mail:
| | - Athina Tatsioni
- Department of Gastroenterology, University of Ioannina, Medical School (George Mantzouranis, Eleftheria Fafliora, Athina Tatsioni, George Glantzounis, Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - George Glanztounis
- Department of Gastroenterology, University of Ioannina, Medical School (George Mantzouranis, Eleftheria Fafliora, Athina Tatsioni, George Glantzounis, Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - Eleni Albani
- Department of Nursing, TEI of Western Greece (Eleni Albani), Greece
| | - Konstantinos H. Katsanos
- Department of Gastroenterology, University of Ioannina, Medical School (George Mantzouranis, Eleftheria Fafliora, Athina Tatsioni, George Glantzounis, Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - Dimitrios K. Christodoulou
- Department of Gastroenterology, University of Ioannina, Medical School (George Mantzouranis, Eleftheria Fafliora, Athina Tatsioni, George Glantzounis, Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
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8
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Casanova MJ, Chaparro M, Molina B, Merino O, Batanero R, Dueñas-Sadornil C, Robledo P, Garcia-Albert AM, Gómez-Sánchez MB, Calvet X, Trallero MDR, Montoro M, Vázquez I, Charro M, Barragán A, Martínez-Cerezo F, Megias-Rangil I, Huguet JM, Marti-Bonmati E, Calvo M, Campderá M, Muñoz-Vicente M, Merchante A, Ávila AD, Serrano-Aguayo P, De Francisco R, Hervías D, Bujanda L, Rodriguez GE, Castro-Laria L, Barreiro-de Acosta M, Van Domselaar M, Ramirez de la Piscina P, Santos-Fernández J, Algaba A, Torra S, Pozzati L, López-Serrano P, Arribas MDR, Rincón ML, Peláez AC, Castro E, García-Herola A, Santander C, Hernández-Alonso M, Martín-Noguerol E, Gómez-Lozano M, Monedero T, Villoria A, Figuerola A, Castaño-García A, Banales JM, Díaz-Hernández L, Argüelles-Arias F, López-Díaz J, Pérez-Martínez I, García-Talavera N, Nuevo-Siguairo OK, Riestra S, Gisbert JP. Prevalence of Malnutrition and Nutritional Characteristics of Patients With Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:1430-1439. [PMID: 28981652 DOI: 10.1093/ecco-jcc/jjx102] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS This study sought to determine the prevalence of malnutrition in patients with inflammatory bowel disease, to analyse the dietary beliefs and behaviours of these patients, to study their body composition, to evaluate their muscular strength and to identify the factors associated with malnutrition in these patients. METHODS This was a prospective, multicentre study. Crohn's disease and ulcerative colitis patients from 30 Spanish centres, from the outpatient clinics, were included. A questionnaire of 11 items was applied to obtain data from patients' dietary behaviour and beliefs. Patients who accepted were evaluated to assess their nutritional status using Subjective Global Assessment and body mass index. Body composition was evaluated through bioelectrical impedance. RESULTS A total of 1271 patients were included [51% women, median age 45 years, 60% Crohn's disease]. Of these, 333 patients underwent the nutritional evaluation. A total of 77% of patients declared that they avoided some foods to prevent disease relapse. Eighty-six per cent of patients avoided some foods when they had disease activity because of fear of worsening the flare. Sixty-seven per cent of patients modified their dietary habits after disease diagnosis. The prevalence of malnutrition was 16% [95% confidence interval = 12-20%]. In the multivariate analysis, history of abdominal surgery, active disease and avoidance of some foods during flares were associated with higher risk of malnutrition. CONCLUSIONS The prevalence of malnutrition in inflammatory bowel disease patients was high. We identified some predictive factors of malnutrition. Most of the patients had self-imposed food restrictions, based on their beliefs.
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Affiliation(s)
- María José Casanova
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Maria Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Begoña Molina
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | - Ricardo Batanero
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario de Cruces, Spain
| | | | | | | | | | - Xavier Calvet
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | - Maria Del Roser Trallero
- Departments of Gastroenterology, Endocrinology and Nutrition.,Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | | | - Iria Vázquez
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital San Jorge de Huesca, Spain
| | | | - Amaya Barragán
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Royo Villanova, Spain
| | | | - Isabel Megias-Rangil
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Sant Joan de Reus, Spain
| | | | | | - Marta Calvo
- Hospital Universitario Puerta de Hierro,Spain
| | - Mariana Campderá
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Puerta de Hierro,Spain
| | | | - Angel Merchante
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital General Universitario de Castellón, Spain
| | | | - Pilar Serrano-Aguayo
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Virgen del Rocío, Spain
| | | | | | - Luis Bujanda
- Hospital de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cecilio Santander
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | | | | | - Tamara Monedero
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Reina Sofía, Spain
| | - Albert Villoria
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | | | | | - Jesús M Banales
- Hospital de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Spain
| | | | | | | | | | - Noelia García-Talavera
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Reina Sofía, Spain
| | | | | | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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No association of alcohol use and the risk of ulcerative colitis or Crohn's disease: data from a European Prospective cohort study (EPIC). Eur J Clin Nutr 2017; 71:512-518. [PMID: 28120853 DOI: 10.1038/ejcn.2016.271] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/18/2016] [Accepted: 12/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES The role of long-term alcohol consumption for the risk of developing ulcerative colitis (UC) and Crohn's disease (CD) is unclear. For the first time, to prospectively assess the role of pre-disease alcohol consumption on the risk of developing UC or CD. SUBJECTS/METHODS Nested within the European Prospective Investigation into Cancer and Nutrition (EPIC-IBD), incident UC and CD cases and matched controls where included. At recruitment, participants completed validated food frequency and lifestyle questionnaires. Alcohol consumption was classified as either: non-use, former, light (⩽0.5 and 1 drink per week), below the recommended limits (BRL) (⩽1 and 2 drinks per day), moderate (⩽2.5 and 5 drinks per day), or heavy use (>2.5 and >5 drinks per day) for women and men, respectively; and was expressed as consumption at enrolment and during lifetime. Conditional logistic regression was applied adjusting for smoking and education, taking light users as the reference. RESULTS Out of 262 451 participants in six countries, 198 UC incident cases/792 controls and 84 CD cases/336 controls were included. At enrolment, 8%/27%/32%/23%/11% UC cases and 7%/29%/40%/19%/5% CD cases were: non-users, light, BRL, moderate and heavy users, respectively. The corresponding figures for lifetime non-use, former, light, BRL, moderate and heavy use were: 3%/5%/23%/44%/19%/6% and 5%/2%/25%/44%/23%/1% for UC and CD cases, respectively. There were no associations between any categories of alcohol consumption and risk of UC or CD in the unadjusted and adjusted odds ratios. CONCLUSION There was no evidence of associations between alcohol use and the odds of developing either UC or CD.
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10
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Hsu TY, Shih HM, Wang YC, Lin LC, He GY, Chen CY, Kao CH, Chen CH, Chen WK, Yang TY. Effect of Alcoholic Intoxication on the Risk of Inflammatory Bowel Disease: A Nationwide Retrospective Cohort Study. PLoS One 2016; 11:e0165411. [PMID: 27802288 PMCID: PMC5089729 DOI: 10.1371/journal.pone.0165411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/20/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study investigated whether alcoholic intoxication (AI) increases the risk of inflammatory bowel disease (IBD) by using a population-based database in Taiwan. METHODS This retrospective matched-cohort study included 57 611 inpatients with new-onset AI (AI cohort) and 230 444 randomly selected controls (non-AI cohort). Each patient was monitored for 10 years to individually identify those who were subsequently diagnosed with Crohn disease (CD) and ulcerative colitis (UC) during the follow-up period. Cox proportional hazard regression analysis was conducted to determine the risk of IBD in patients with AI compared with controls without AI. RESULTS The incidence rate of IBD during the 10-year follow-up period was 2.69 per 1 000 person-years and 0.49 per 1 000 person-years in the AI and non-AI cohorts, respectively. After adjustment for age, sex, and comorbidity, the AI cohort exhibited a 3.17-fold increased risk of IBD compared with the non-AI cohort (hazard ratio [HR] = 3.17, 95% confidence interval [CI] = 2.19-4.58). Compared with the non-AI cohort, the HRs of CD and UC were 4.40 and 2.33 for the AI cohort, respectively. After stratification for the severity of AI according to the duration of hospital stay, the adjusted HRs exhibited a significant correlation with the severity; the HRs of IBD were 1.76, 6.83, and 19.9 for patients with mild, moderate, and severe AI, respectively (p for the trend < .0001). CONCLUSION The risk of IBD was higher in patients with AI and increased with the length of hospital stay.
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Affiliation(s)
- Tai-Yi Hsu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hong-Mo Shih
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Chiao Wang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Guan-Yi He
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
| | - Chih-Yu Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chao-Hsien Chen
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * E-mail:
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Vaucher C, Maillard MH, Froehlich F, Burnand B, Michetti P, Pittet V. Patients and gastroenterologists' perceptions of treatments for inflammatory bowel diseases: do their perspectives match? Scand J Gastroenterol 2016; 51:1056-61. [PMID: 26891800 DOI: 10.3109/00365521.2016.1147065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Perceptions of appropriateness of treatments may differ between gastroenterologists (GIs) and inflammatory bowel disease (IBD) patients. The aim of this study was to explore and compare GIs' and patients' perceptions of risks and benefits of treatments and prioritization of expected outcomes. METHODS Four vignette cases were drawn from clinical situations and used in three independent focus groups with GIs (n = 7), ulcerative colitis (UC-p, n = 8) and Crohn's disease patients (CD-p, n = 6). Content analysis was performed based on the conversation transcripts. RESULTS UC-p agreed more often with GIs' treatment choices than CD-p. CD-p often considered 5-ASA as a placebo. UC-p saw topical 5-ASA as a temporary solution, neither comfortable nor practical when professionally active. Azathioprine was considered as the treatment for which the risks versus benefits were perceived as the highest. The main risk perceived by patients on anti-TNFs was a potential loss of response. Divergences were observed on 1) stop of treatment: UC-p did not easily concur with stopping a treatment, which differed from GIs' expectation of patients' perceptions; CD-p were more prone to consider stopping treatment than GIs, 2) perception of outcomes: physicians had a focus on long-term objective goals. Patients' expectations were of shorter term and mainly concerned stress management, nutritional advice, and information on the treatments effects. CONCLUSIONS Overall, patients and GIs agreed on perceptions of IBD treatments. GIs seemed more concerned about objective and scientific measures of remission whereas patients focused on quality of life and social outcomes when it came to evaluating a therapy.
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Affiliation(s)
- Carla Vaucher
- a Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland
| | - Michel H Maillard
- b Division of Gastroenterology & Hepatology , Lausanne University Hospital , Lausanne , Switzerland
| | - Florian Froehlich
- b Division of Gastroenterology & Hepatology , Lausanne University Hospital , Lausanne , Switzerland ;,c Division of Gastroenterology & Hepatology , Basel University Hospital , Basel , Switzerland
| | - Bernard Burnand
- a Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland
| | - Pierre Michetti
- d Clinique La Source-Beaulieu , Crohn and Colitis Center , Lausanne , Switzerland
| | - Valérie Pittet
- a Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland
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12
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Holt DQ, Strauss BJ, Moore GT. Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet 2016; 30:66-72. [DOI: 10.1111/jhn.12400] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D. Q. Holt
- Clinical Nutrition and Metabolism Unit; Monash Health; Clayton VIC Australia
- School of Clinical Sciences; Monash University; Clayton VIC Australia
- Department of Gastroenterology & Hepatology; Monash Health; Clayton VIC Australia
| | - B. J. Strauss
- School of Clinical Sciences; Monash University; Clayton VIC Australia
| | - G. T. Moore
- School of Clinical Sciences; Monash University; Clayton VIC Australia
- Department of Gastroenterology & Hepatology; Monash Health; Clayton VIC Australia
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13
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Pittet V, Vaucher C, Maillard MH, Girardin M, de Saussure P, Burnand B, Rogler G, Michetti P. Information Needs and Concerns of Patients with Inflammatory Bowel Disease: What Can We Learn from Participants in a Bilingual Clinical Cohort? PLoS One 2016; 11:e0150620. [PMID: 26939069 PMCID: PMC4777374 DOI: 10.1371/journal.pone.0150620] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/17/2016] [Indexed: 12/16/2022] Open
Abstract
Background Inflammatory Bowel Disease (IBD) patients are confronted with needs and concerns related to their disease. Aim To explore information expectations of patients included in a national bilingual IBD cohort in Switzerland (SIBDC). Methods This is a mixed-methods study, comprising 1) a semi-narrative survey sent to 1506 patients from the SIBDC and 2) two focus groups conducted with 14 patients to explore and assess the relevance of the survey’s findings. Data collected within the framework of the SIBDC was used to characterize survey’s responders. Results 728 patients (48%) replied to the survey: 52.5% females, 56% Crohn’s disease (CD), 87% secondary/tertiary level educated, 70% full/part-time employed. On average, 47% of patients sought for information, regardless of the disease stage; 27% of them were dissatisfied with information received at the time of first symptoms. During flares, 43% were concerned about drugs and therapies; in remission, 57% had concerns on research and developments; 27% searched for information linked to daily disease management. Information-seeking increased when active disease, for CD with high levels of perceived stress (OR = 2.47; p = 0.003), and for all with higher posttraumatic stress symptoms. The focus groups confirmed a perceived lack of information about general functioning, disease course, treatments and their risks, extra-intestinal symptoms and manifestations. Conclusions Information remains insufficient for IBD patients. Lack of information in specific domains can potentially cause stress and hinder detection of symptoms. Better information should be considered as a potentially important component in improving patients’ outcomes in IBD.
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Affiliation(s)
- Valérie Pittet
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Carla Vaucher
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Michel H. Maillard
- Division of Gastroenterology & Hepatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc Girardin
- Division of Gastroenterology & Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Philippe de Saussure
- Division of Gastroenterology & Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Bernard Burnand
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology & Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pierre Michetti
- Crohn and Colitis Center, Clinique La Source-Beaulieu, Lausanne, Switzerland
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Gater A, Kitchen H, Heron L, Pollard C, Håkan-Bloch J, Højbjerre L, Hansen BB, Strandberg-Larsen M. Development of a conceptual model evaluating the humanistic and economic burden of Crohn's disease: implications for patient-reported outcomes measurement and economic evaluation. Expert Rev Pharmacoecon Outcomes Res 2015; 15:643-56. [PMID: 25985850 DOI: 10.1586/14737167.2015.1045883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary objective of this review is to develop a conceptual model for Crohn's disease (CD) outlining the disease burden for patients, healthcare systems and wider society, as reported in the scientific literature. A search was conducted using MEDLINE, PsycINFO, EconLit, Health Economic Evaluation Database and Centre for Reviews and Dissemination databases. Patient-reported outcome (PRO) measures widely used in CD were reviewed according to the US FDA PRO Guidance for Industry. The resulting conceptual model highlights the characterization of CD by gastrointestinal disturbances, extra-intestinal and systemic symptoms. These symptoms impact physical functioning, ability to complete daily activities, emotional wellbeing, social functioning, sexual functioning and ability to work. Gaps in conceptual coverage and evidence of reliability and validity for some PRO measures were noted. Review findings also highlight the substantial direct and indirect costs associated with CD. Evidence from the literature confirms the substantial burden of CD to patients and wider society; however, future research is still needed to further understand burden from the perspective of patients and to accurately understand the economic burden of disease. Challenges with existing PRO measures also suggest the need for future research to refine or develop new measures.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, UK
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15
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Dietary fiber information for individuals with Crohn disease: reports of gastrointestinal effects. Gastroenterol Nurs 2014; 36:320-7. [PMID: 24084130 DOI: 10.1097/sga.0b013e3182a67a9a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The experiences of individuals with Crohn disease before and after receiving dietary fiber information have not been described in the literature. This article offers findings from a study that used four semistructured audiorecorded interviews during a 4-week time period for the purpose of exploring the experiences of 11 individuals before and after receiving dietary fiber information from a healthcare professional. The first and second interviews occurred immediately before and after the presentation of information. Follow-up interviews occurred at 2-week intervals. Thematic analysis of the baseline interviews revealed 2 themes: (a) accepting a redefined (lower expectations) definition of normal quality of life and (b) continuing to look for answers. Three themes emerged from the follow-up interviews at Week 4: (a) reevaluating old diet-related concepts, (b) enjoying a healthier lifestyle at a self-set pace, and (c) enjoying positive physical effects of wheat bran consumption. This article examines the 3rd postintervention theme, "enjoying physical effects of wheat bran consumption." The relevance of this research is that nurses equipped with dietary fiber information may be better able to help some individuals with Crohn disease to explore the potential benefits of a well-rounded nutritious pattern of eating that includes wheat bran cereal.
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16
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Prince AC, Moosa A, Lomer MCE, Reidlinger DP, Whelan K. Variable access to quality nutrition information regarding inflammatory bowel disease: a survey of patients and health professionals and objective examination of written information. Health Expect 2014; 18:2501-12. [PMID: 24934409 DOI: 10.1111/hex.12219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) report a range of nutritional and dietary problems and high-quality written information should be available on these. There is little research investigating the availability and quality of such information for patients with IBD. OBJECTIVE This study assessed the type and quality of written information on nutrition and diet available to patients with IBD and the opinions of patients and health professionals. SETTING AND PARTICIPANTS Seventy-two patients with IBD were recruited from a large gastroenterology outpatient centre in England. One hundred dietitians from across the United Kingdom were also recruited. METHODS Face-to-face surveys were conducted with patients with IBD. Questions regarding the use, format and usefulness of dietary information received were probed. Dietitians were surveyed regarding written dietary information used in clinical practice. Samples of IBD-specific dietary information used across the UK were objectively assessed using two validated tools. MAIN RESULTS The majority of patients rated written information as 'good' or 'very good', with the most useful information relating to 'general diet and IBD'. Forty-nine (49%) dietitians reported gaps in written information available for patients with IBD. Fifty-three different samples of IBD-specific information sheets were returned, with widely variable objective quality ratings. Commercially produced written information scored greater than locally produced information (BMA tool, P < 0.05). CONCLUSIONS Patient access to high-quality, written, IBD-specific dietary information is variable. IBD-specific written nutrition information needs to be developed in accordance with validated tools to empower patients, encourage self-management and overcome nutritional implications of IBD.
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Affiliation(s)
- Alexis C Prince
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
| | - Arifa Moosa
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
| | - Miranda C E Lomer
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, UK
| | - Dianne P Reidlinger
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
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17
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The burden of inflammatory bowel disease: a patient-reported qualitative analysis and development of a conceptual model. Inflamm Bowel Dis 2014; 20:545-52. [PMID: 24407484 PMCID: PMC3932523 DOI: 10.1097/01.mib.0000440983.86659.81] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to describe the impacts of inflammatory bowel disease (IBD) from the patients' perspective and to inform the development of a conceptual model. METHODS Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between themes, assisted by qualitative data software MaxQDA. Themes from the qualitative research were supplemented with those reported in the literature and concepts included in IBD-specific patient-reported outcome measures. RESULTS Twenty-seven patients participated. Key physical symptoms included pain, bowel-related symptoms such as frequency, urgency, incontinence, diarrhea, passing blood, and systemic symptoms such as weight loss and fatigue. Participants described continuing and variable symptom experiences. IBD symptoms caused immediate disruption of activities but also had ongoing impacts on daily activities, including dietary restrictions, lifestyle changes, and maintaining close proximity to a toilet. More distal impacts included interference with work, school, parenting, social and leisure activities, relationships, and psychological well-being. The inconvenience of rectal medications, refrigerated biologics, and medication refills emerged as novel burdens not identified in existing patient-reported outcome measures. CONCLUSIONS IBD symptoms cause immediate disruption in activities, but patients may continue to experience some symptoms on a chronic basis. The conceptual model presented here may be useful for identifying target concepts for measurement in future studies in IBD.
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18
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El-Tawil AM. Epidemiology and inflammatory bowel diseases. World J Gastroenterol 2013; 19:1505-7. [PMID: 23539486 PMCID: PMC3602465 DOI: 10.3748/wjg.v19.i10.1505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/11/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
The role of alcohol in causing or aggravating the pathogenesis of inflammatory bowel disease is unclear. For finding a conclusive answer for this valuable question we conducted this review. Only two studies were identified that successfully fulfilled our inclusive criteria. Usual consumption of alcohol reduced the risk compared with less frequent use (odds ratio = 0.57, 95%CI: 0.37-0.86). Light alcoholic drinking has protective effects against development of ulcerative colitis. But this inverse association disappeared when smoking was included.
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19
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Norton BA, Thomas R, Lomax KG, Dudley-Brown S. Patient perspectives on the impact of Crohn's disease: results from group interviews. Patient Prefer Adherence 2012; 6:509-20. [PMID: 22879737 PMCID: PMC3413071 DOI: 10.2147/ppa.s32690] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIM To understand the impact of Crohn's disease (CD) on various aspects of daily life from the perspective of patients living with CD. Awareness of the disease and biologic therapies, patient satisfaction and adherence, and physician (provider) relationships were also assessed. BACKGROUND CD is a chronic, inflammatory, autoimmune disorder of the gastrointestinal tract that substantially impacts patients' physical and emotional well-being. For patients eligible for biologic therapy, anti-tumor necrosis factor agents represent an important addition to the available therapies for CD. METHODS The study sample included biologic-naïve and biologic-experienced patients who had self-reported moderate to severe CD, were under the care of a specialist, and agreed to film a video diary and participate in a focus group. Data from the videos and group interviews were collected from May to June of 2009 and summarized qualitatively by grouping similar answers and quotations. RESULTS Of the 44 participants who submitted video diaries, 23 were biologic-experienced and 21 were biologic-naïve. Participants stated that CD caused fear and embarrassment, that they were reluctant to share the full impact of CD with family and providers, and that they relied on their provider for treatment decisions. Many participants accepted a new state of normalcy if their current medication helped their most bothersome symptoms without providing sustained remission. Participants receiving biologic therapy generally were more informed, more satisfied, and more likely to adhere to treatment regimens. CONCLUSION Participants' responses suggest a need for more patient education and more collaborative relationships between patients and providers (physicians) regarding treatment decisions.
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Affiliation(s)
- Beth-Ann Norton
- Massachusetts General Hospital, Boston, MA, USA
- Correspondence: B Norton, Massachusetts General Hospital, 165 Cambridge St, 9th Floor, Boston, MA 01224 USA, Fax +1 212 426 5099, Email
| | | | | | - Sharon Dudley-Brown
- Johns Hopkins University, Schools of Medicine and Nursing, Baltimore, MD, USA
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20
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Nutritional problems in inflammatory bowel disease: the patient perspective. J Crohns Colitis 2011; 5:443-50. [PMID: 21939918 DOI: 10.1016/j.crohns.2011.04.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/27/2011] [Accepted: 04/29/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's Disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD), which may result in nutrition problems that impact on patient health, nutritional status and quality of life. Subjective reports of how IBD patients experience these problems as part of their disease process, including comparisons between patient groups, or the need for tailored nutrition advice as perceived by these patients, have not been widely studied. This survey aimed to identify and explore nutritional problems that are important to CD and UC patients and to investigate their views on the IBD health services provided to help them with these. METHODS Eighty-seven IBD patients were invited to take part in a nutrition survey using face-to-face questionnaire interviews. The survey asked about food and nutrition problems that patients have experienced, identifying which were most significant and the extent to which they had been addressed by the clinical service. RESULTS Seventy-two IBD patients completed the evaluation (47 CD, 25 UC). Of these, 45 (62.5%) felt that food and nutrition were either 'important' or 'extremely important' in their experience of IBD, and 59 (82%) reported problems with food and nutrition. Patients with CD and UC reported similar frequencies of most nutritional problems. However, 44 (94%) CD vs. 16 (64%) UC patients reported problems with weight (p=0.002). Less than half of patients had seen a dietitian for tailored nutritional advice to address these problems. CONCLUSIONS Nutritional problems experienced and reported by IBD patients are numerous and varied. They are considered important by patients with CD and UC, both of whom would generally value specific dietary counselling, highlighting a need for further research in this area and adequate and equal provision of services for both groups.
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Jäghult S, Saboonchi F, Johansson UB, Wredling R, Kapraali M. Identifying predictors of low health-related quality of life among patients with inflammatory bowel disease: comparison between Crohn's disease and ulcerative colitis with disease duration. J Clin Nurs 2011; 20:1578-87. [PMID: 21418363 DOI: 10.1111/j.1365-2702.2010.03614.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To identify predictors of low health-related quality of life among patients with inflammatory bowel disease and make a comparison between Crohn's disease and ulcerative colitis with disease duration. BACKGROUND Studies have shown that patients with inflammatory bowel disease rate their health-related quality of life lower, as compared with a general population. DESIGN Survey. METHODS In this study, 197 patients in remission were included and divided into a Crohn's disease group and an ulcerative colitis group. Each group was also divided into separate groups whether the patients had short disease duration or long disease duration. Generic instruments, combined with disease-specific questionnaires, were used for measuring health-related quality of life. RESULTS The analysis showed a non-significant effect for diagnosis, but a significant effect for disease duration showing that the patients with short disease duration had lower scores of health-related quality of life compared with patients with long disease duration. A significant interaction between diagnosis and disease duration was also revealed. CONCLUSION Patients with longer disease duration experienced a better health-related quality of life than patients with short disease duration. Patients with Crohn's disease and short disease duration have the lowest health-related quality of life and are in greatest need of education and support. RELEVANCE TO CLINICAL PRACTICE It is important to identify which patients' are in the greatest need of education and support.
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Affiliation(s)
- Susanna Jäghult
- Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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Hoivik ML, Bernklev T, Moum B. Need for standardization in population-based quality of life studies: a review of the current literature. Inflamm Bowel Dis 2010; 16:525-36. [PMID: 19637337 DOI: 10.1002/ibd.21032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this systematic review we focus on the current use of and knowledge on health related quality of life in unselected, population-based IBD cohorts. We made a systematic literature search and included for comprehensive review papers that described a population-based cohort and that used validated HRQoL instruments. We show that even studies defined by the authors as population-based do not always meet the criteria set for being population-based. The heterogeneity of the study populations we have reviewed emphasizes that "population-based" must be defined very meticulously and that study populations need to be scrutinized with regard to all characteristics of the cohort before one can compare their results. Different definitions of study populations as population-based affect outcomes. We also show that use of the same HRQoL questionnaires does not guarantee comparable results as there are several different versions of the questionnaires, the different translations are not always comparable and at last there are several methods of computing and presenting the data. Detailed accumulation of knowledge and thorough meta analyses is therefore difficult hence we find it necessary to raise a discussion on the need of standardization in this field of research and we make some simple recommendations on factors we find important.
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Affiliation(s)
- Marte Lie Hoivik
- Section of Gastroenterology, Medical Department, Oslo University Hospital, Aker, Norway.
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Hyphantis T, Antoniou K, Tomenson B, Tsianos E, Mavreas V, Creed F. Is the personality characteristic "impulsive sensation seeking" correlated to differences in current smoking between ulcerative colitis and Crohn's disease patients? Gen Hosp Psychiatry 2010; 32:57-65. [PMID: 20114129 DOI: 10.1016/j.genhosppsych.2009.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/08/2009] [Accepted: 09/08/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Crohn's disease (CD) is associated with smoking, while ulcerative colitis (UC) is largely a disease of nonsmokers. We aimed to test whether the smoking-linked personality characteristic "impulsive sensation seeking" (ImpSS) is correlated to the differences in smoking in inflammatory bowel disease (IBD). METHODS In 185 IBD patients, the General Health Questionnaire and the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) were administered. The Fagerstrom Test for Nicotine Dependence was used to assess smokers' nicotine dependence. RESULTS CD patients were twice as likely to be active smokers than UC patients. CD patients presented higher ImpSS scores than UC patients, but the differences became nonsignificant after adjustment for age, gender, education and psychological distress. Multivariate analyses, however, showed that the relationship of ImpSS with current smoking was stronger in CD patients. Moderator analysis showed that the relationship of ImpSS with nicotine dependence was also greater in smokers with CD than in those with UC. No other ZKPQ subscale was correlated to disease type, current smoking or nicotine dependence. CONCLUSION ImpSS is associated with current smoking and nicotine dependence in IBD, and these associations are stronger in CD. These findings might be relevant to more effective interventions aiming at smoking cessation in CD patients.
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Affiliation(s)
- Thomas Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina 45110, Greece.
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Health-related quality-of-life evaluation of crohn disease patients after receiving natalizumab therapy. Gastroenterol Nurs 2009; 32:327-39. [PMID: 19820441 DOI: 10.1097/sga.0b013e3181bb1484] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Crohn disease (CD) is a chronic inflammatory condition without a permanent medical cure and commonly requiring a lifetime of care. This article discusses the impact of natalizumab induction and maintenance therapy on the health-related quality of life (HRQoL) of CD patients. Two natalizumab phase III studies were evaluated: the Efficacy of Natalizumab in Crohn's Disease Response and Remission (ENCORE) study evaluated the HRQoL of CD patients during 12 weeks of natalizumab induction therapy, and the Evaluation of Natalizumab As Continuous Therapy (ENACT-2) trial evaluated the effect of natalizumab maintenance therapy on HRQoL for a period of 48 weeks past a 12-week induction period (ENACT-1). HRQoL assessments were made with the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Short Form-36 (SF-36). In the ENCORE study, induction therapy with natalizumab was demonstrated to significantly increase HRQoL scores at 12 weeks when compared with patients on placebo. During the ENACT-2 trial, IBDQ and SF-36 scale scores of patients who responded to natalizumab induction remained stable whereas those on placebo worsened. At week 60, the mean change from baseline on all scales of the IBDQ and the SF-36 were significantly higher for those who continued to receive natalizumab as compared to those who received placebo (p </= .016 for all scales). Natalizumab significantly improved the patient's clinical status and HRQoL shortly after treatment was initiated, and the effect was maintained for 60 weeks.
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Moorthy D, Cappellano KL, Rosenberg IH. Nutrition and Crohn's disease: an update of print and Web-based guidance. Nutr Rev 2008; 66:387-97. [PMID: 18667014 DOI: 10.1111/j.1753-4887.2008.00048.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This article reviews the role of nutrition in Crohn's disease, one of the inflammatory bowel diseases. In addition to presenting a comprehensive review of the state-of-the-evidence on nutritional risks and nutritional therapies in Crohn's disease, and making specific nutrient recommendations, this article includes a list of Web-based resources, including websites, blogs, newsletters, and multimedia podcasts that can be utilized by patients and healthcare providers alike to learn more about the etiology, pathophysiology, and nutritional management of Crohn's disease.
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Affiliation(s)
- Denish Moorthy
- Nutrition and Neurocognition Laboratory, Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
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