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Singh MM. Integrative Approaches to Managing Gut Health. Curr Gastroenterol Rep 2024; 26:181-189. [PMID: 38472695 DOI: 10.1007/s11894-024-00927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW To summarize key integrative approaches to managing common gastrointestinal conditions. RECENT FINDINGS Lifestyle interventions like diet, exercise, and stress reduction impact the gut microbiome and gastrointestinal symptoms. Evidence supports mind-body therapies, herbs, certain supplements, and other modalities as complimentary approaches, when appropriate, for common conditions like irritable bowel syndrome or gastroesophageal reflux disease. An integrative approach optimizes both conventional treatments and incorporates lifestyle modifications, complimentary modalities, and the doctor-patient relationship.
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Affiliation(s)
- Marvin M Singh
- Rochester Gastroenterology Associates, Rochester, United States.
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Christodoulou E, Mpali T, Dimitriadou ME, Koutelidakis AE. Mindfulness, Gut-Brain Axis, and Health-Related Quality of Life: The Paradigm of IBD Patients. Healthcare (Basel) 2024; 12:1209. [PMID: 38921323 PMCID: PMC11202893 DOI: 10.3390/healthcare12121209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
Health-related quality of life (HRQoL) is a comprehensive measure that evaluates an individual's well-being across physical, mental, and social dimensions. Enhancing HRQoL, particularly in individuals with chronic conditions like inflammatory bowel diseases (IBD), necessitates a holistic approach. Mindfulness, a scientifically supported strategy for managing anxiety, has shown promise in improving both physical and mental health. Its benefits may be partly explained through its effects on the gut-brain axis (GBA), a bidirectional communication link between the gastrointestinal system and the central nervous system. By exploring the interplay between mindfulness and the GBA, this study aims to uncover how these elements collectively influence HRQoL in both healthy individuals and those with IBD, offering insights into potential therapeutic pathways. A cross-sectional investigation involved 338 adults, including 50 IBD patients, utilizing validated Greek scales for Mindfulness (MAAS-15), Mediterranean Diet (14-MEDAS), and HRQoL (EQ-5D-5L). The questionnaire gathered demographic, anthropometric, and lifestyle data. Among healthy participants, EQ-5D-5L showed a moderate correlation with the MAAS-15 scale (r = 0.389, p < 0.05) and a low correlation with 14-MEDAS (r = 0.131, p < 0.05). IBD patients exhibited significantly lower mean EQ-5D-5L scores than healthy individuals (0.75 vs. 0.85, p < 0.05). MAAS-15 demonstrated a robust correlation (r = 0.414, p < 0.001) with EQ-5D-5L in IBD patients. Elevated mindfulness levels emerged as predictive factors for higher HRQoL in IBD patients (OR: 1.101, 95% CI: 1.008, 1.202, p < 0.05, compared to low mindfulness). In summary, factors influencing the GBA, including mindfulness and the Mediterranean diet, exhibit positive associations with HRQoL. Increased mindfulness levels predict better HRQoL in IBD patients, emphasizing the potential for clinical trials to validate these cross-sectional study findings.
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Affiliation(s)
| | | | | | - Antonios E. Koutelidakis
- Laboratory of Nutritional and Public Health, Department of Food Science and Nutrition, University of the Aegean, 81400 Myrina, Greece; (E.C.)
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Belei O, Basaca DG, Olariu L, Pantea M, Bozgan D, Nanu A, Sîrbu I, Mărginean O, Enătescu I. The Interaction between Stress and Inflammatory Bowel Disease in Pediatric and Adult Patients. J Clin Med 2024; 13:1361. [PMID: 38592680 PMCID: PMC10932475 DOI: 10.3390/jcm13051361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Inflammatory bowel diseases (IBDs) have seen an exponential increase in incidence, particularly among pediatric patients. Psychological stress is a significant risk factor influencing the disease course. This review assesses the interaction between stress and disease progression, focusing on articles that quantified inflammatory markers in IBD patients exposed to varying degrees of psychological stress. Methods: A systematic narrative literature review was conducted, focusing on the interaction between IBD and stress among adult and pediatric patients, as well as animal subjects. The research involved searching PubMed, Scopus, Medline, and Cochrane Library databases from 2000 to December 2023. Results: The interplay between the intestinal immunity response, the nervous system, and psychological disorders, known as the gut-brain axis, plays a major role in IBD pathophysiology. Various types of stressors alter gut mucosal integrity through different pathways, increasing gut mucosa permeability and promoting bacterial translocation. A denser microbial load in the gut wall emphasizes cytokine production, worsening the disease course. The risk of developing depression and anxiety is higher in IBD patients compared with the general population, and stress is a significant trigger for inducing acute flares of the disease. Conclusions: Further large studies should be conducted to assess the relationship between stressors, psychological disorders, and their impact on the course of IBD. Clinicians involved in the medical care of IBD patients should aim to implement stress reduction practices in addition to pharmacological therapies.
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Affiliation(s)
- Oana Belei
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Diana-Georgiana Basaca
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Laura Olariu
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Manuela Pantea
- Twelfth Department, Neonatology Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (M.P.); (I.E.)
| | - Daiana Bozgan
- Clinic of Neonatology, “Pius Brânzeu” County Emergency Clinical Hospital, 300723 Timișoara, Romania;
| | - Anda Nanu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Children Hospital, 300011 Timișoara, Romania; (A.N.); (I.S.)
| | - Iuliana Sîrbu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Children Hospital, 300011 Timișoara, Romania; (A.N.); (I.S.)
| | - Otilia Mărginean
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Ileana Enătescu
- Twelfth Department, Neonatology Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (M.P.); (I.E.)
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S.A. R, C.S. S, Ganesh P, Vasu HV. Job Search during COVID-19: How Online Mindfulness Intervention helped to Reduce Stress and Enhance the Self-esteem of the Job Seeker. F1000Res 2022; 11:955. [PMID: 36531265 PMCID: PMC9732500 DOI: 10.12688/f1000research.109523.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Immediately after graduation from university, college students need to make significant decisions about starting their careers or pursuing higher studies. They are also pressured to meet the expectations and demands of self, others, and the environment. Owing to the impact of the COVID-19 pandemic, the aforementioned challenging decisions may become hazardous stressors for college students. Hence, the researchers intended to assist and assess the college students involved in student placements. The research goal was to investigate the impact of mindfulness-based intervention (MBI) on the stress and self-esteem of college students involved in student placements. Methods: One hundred college students participating in the campus placements were selected using purposive sampling from Amrita Vishwa Vidyapeetham University in Coimbatore, India. For evaluation purposes, college students were administered the perceived stress, Rosenberg self-esteem, and Kuppuswamy socio-economic scales. Seventy-five college students were selected for the MBI process and were administered with a pre-intervention and post-intervention without a control group research design. Results: Statistical analysis including analysis of variance (ANOVA) and the Bonferroni post hoc test showed a significant increase in self-esteem and a decrease in the stress of the college students involved in placements. Conclusions: Thus, the researchers recommend that policymakers create awareness, include MBI in the curriculum, and allocate funds for training ventures in educational institutions to assist college students in their challenging life journeys.
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Affiliation(s)
- Rajalakshmi S.A.
- Department of Language and Humanities, Amrita School of Engineering, Amrita Vishwa Vidhyapeetham, Coimbatore, Tamilnadu, 641112, India,
| | - Sowndaram C.S.
- Department of Language and Humanities, Amrita School of Engineering, Amrita Vishwa Vidhyapeetham, Coimbatore, Tamilnadu, 641112, India
| | - Preetham Ganesh
- Department of Computer Science and Engineering, Amrita School of Engineering, Amrita Vishwa Vidhyapeetham, Coimbatore, Tamilnadu, 641112, India
| | - Harsha Vardhini Vasu
- Department of Computer Science and Engineering, Amrita School of Engineering, Amrita Vishwa Vidhyapeetham, Coimbatore, Tamilnadu, 641112, India
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Ge L, Liu S, Li S, Yang J, Hu G, Xu C, Song W. Psychological stress in inflammatory bowel disease: Psychoneuroimmunological insights into bidirectional gut–brain communications. Front Immunol 2022; 13:1016578. [PMID: 36275694 PMCID: PMC9583867 DOI: 10.3389/fimmu.2022.1016578] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammatory bowel disease (IBD), mainly including ulcerative colitis (UC) and Crohn’s disease (CD), is an autoimmune gastrointestinal disease characterized by chronic inflammation and frequent recurrence. Accumulating evidence has confirmed that chronic psychological stress is considered to trigger IBD deterioration and relapse. Moreover, studies have demonstrated that patients with IBD have a higher risk of developing symptoms of anxiety and depression than healthy individuals. However, the underlying mechanism of the link between psychological stress and IBD remains poorly understood. This review used a psychoneuroimmunology perspective to assess possible neuro-visceral integration, immune modulation, and crucial intestinal microbiome changes in IBD. Furthermore, the bidirectionality of the brain–gut axis was emphasized in the context, indicating that IBD pathophysiology increases the inflammatory response in the central nervous system and further contributes to anxiety- and depression-like behavioral comorbidities. This information will help accurately characterize the link between psychological stress and IBD disease activity. Additionally, the clinical application of functional brain imaging, microbiota-targeted treatment, psychotherapy and antidepressants should be considered during the treatment and diagnosis of IBD with behavioral comorbidities. This review elucidates the significance of more high-quality research combined with large clinical sample sizes and multiple diagnostic methods and psychotherapy, which may help to achieve personalized therapeutic strategies for IBD patients based on stress relief.
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Affiliation(s)
- Li Ge
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Shuman Liu
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Sha Li
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jing Yang
- Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guangran Hu
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Changqing Xu
- Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wengang Song
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Wengang Song,
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Peerani F, Watt M, Ismond KP, Whitlock R, Ambrosio L, Hotte N, Mitchell N, Bailey RJ, Kroeker K, Dieleman LA, Siffledeen J, Lim A, Wong K, Halloran BP, Baumgart DC, Taylor L, Raman M, Madsen KL, Tandon P. A randomized controlled trial of a multicomponent online stress reduction intervention in inflammatory bowel disease. Therap Adv Gastroenterol 2022; 15:17562848221127238. [PMID: 36187365 PMCID: PMC9520184 DOI: 10.1177/17562848221127238] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Psychological stress negatively impacts inflammatory bowel disease (IBD) outcomes. Patients have prioritized access to online interventions; yet, the data on these have been limited by mixed in-person/online interventions, low adherence, and non-randomized controlled trial (RCT) design. OBJECTIVES We assessed the efficacy of and adherence to a 12-week online multicomponent stress reduction intervention in IBD. DESIGN This is a RCT. METHODS Adult participants on stable IBD medical therapy with elevated stress levels from four centers were randomized to intervention or control groups. Intervention participants received a 12-week online program including a weekly yoga, breathwork and meditation video (target 2-3 times/week), a weekly cognitive behavioral therapy/positive psychology informed video activity, and weekly 10-min check-ins by a study team member. Control participants received weekly motivational messages by email. All patients received standard of care IBD therapy. The primary outcome was Cohen's Perceived Stress Scale (PSS). Secondary outcomes evaluated mental health, resilience, health-related quality of life (HRQoL), symptom indices, acceptability, adherence, and inflammatory biomarkers. Analysis of covariance was used to determine between-group differences. RESULTS Of 150 screened patients, 101 were randomized to the intervention (n = 49) and control (n = 52) groups (mean age: 42.5 ± 14.1 years; M:F 1:3, 48% with ulcerative colitis and 52% with Crohn's disease). The between-group PSS improved by 22.4% (95% confidence interval, 10.5-34.3, p < 0.001). Significant improvements were seen in mental health, resilience, and HRQoL measures, with a median satisfaction score of 89/100 at the end of the 12 weeks. In the 44/49 patients who completed the intervention, 91% achieved program adherence targets. CONCLUSION This 12-week online intervention improved perceived stress, mental health, and HRQoL, but did not impact IBD symptom indices or inflammatory biomarkers. The program was readily adopted and adhered to by participants with high retention rates. After iterative refinement based on participant feedback, future studies will evaluate the impact of a longer/more intense intervention on disease course. REGISTRATION ClinicalTrials.gov Identifier NCT03831750. PLAIN LANGUAGE SUMMARY An online stress reduction intervention in inflammatory bowel disease patients improves stress, mental health, and quality of life People with inflammatory bowel disease (IBD) have high levels of stress, anxiety, and depression. Although IBD patients have expressed the need for online mental wellness interventions, the existing data to support these interventions in IBD are limited. In this trial, 101 IBD patients had the chance to participate in a 12-week online stress reduction intervention. In those patients randomly selected to participate in the online intervention, each week they received the following: a 20- to 30-min yoga, breathwork, and meditation video that they were asked to do 2-3 times a week, a 10- to 20-min mental wellness activity they were asked to do once during the week, and a 10-min telephone check-in with a study team member. Participants who were not selected to use the online intervention received a weekly motivational message by email. In all, 90 of the 101 participants (89%) completed the study with the mean age of participants being 43 years and the majority being females (75%). Ninety-one percent of participants who completed the intervention met the program target of doing the yoga, breathwork, and meditation video at least 2 times per week. Significant improvements were seen in perceived stress (by 22.4%), depression (by 29.5%), anxiety (by 23.7%), resilience (by 10.6%), and quality of life (by 8.9%). No changes were seen in IBD severity or in blood markers of inflammation. In conclusion, this study demonstrates evidence that a 12-week online stress reduction intervention had low dropout rates, high adherence and beneficial effects on stress, mental health, and quality of life measures. Continued feedback will be sought from study participants and our IBD patient partners to refine the intervention and assess the impact in future studies of patients with active IBD, as well as the impact of a longer/more intense intervention.
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Affiliation(s)
- Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Makayla Watt
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kathleen P Ismond
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Lindsy Ambrosio
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naomi Hotte
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Robert J Bailey
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Levinus A Dieleman
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jesse Siffledeen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Allen Lim
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Wong
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Brendan P Halloran
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
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Watt M, Peerani F, Madsen K, Siffledeen J, Kroeker K, Lim A, Tandon P, Hyde A. Exploring Patient Perspectives on a 12-Week Online, Stress Reduction Intervention in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2022; 4:otac036. [PMID: 36777414 PMCID: PMC9802265 DOI: 10.1093/crocol/otac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Online stress reduction interventions may be useful adjuncts to standard medical therapies for inflammatory bowel disease (IBD). As part of the evaluation of a 12-week randomized control trial (RCT) of an online multicomponent stress reduction program, our aim for the current study was to use qualitative methods to more deeply explore the patient experience with the online programming. Methods Upon completion of the 12-week RCT, all intervention participants were invited to participate in semistructured interviews. A qualitative descriptive approach was used. Interviews were analyzed through a theoretical thematic analysis process, whereby transcripts were coded, and codes then grouped into larger categories and themes. Results A total of 56 interviews were analyzed with the emergence of 3 main themes: (1) IBD as a source of stress and uncertainty, (2) understanding the positive impacts of the stress reduction program, and (3) suggested strategies to enhance program desirability. IBD was described as causing uncertainty, significant disruptions to daily activities, and stress, which in turn worsened symptoms. The online program was associated with a perceived reduction in IBD symptom burden, an increased ability to manage daily and disease-associated stressors, and a more positive mindset. Variation in program content and fostering connections with others in the IBD community were identified as potential strategies to enhance future programming. Conclusions This qualitative companion study highlights the power of the patient voice to deepen our understanding of the impact of IBD, and the potential benefit of an online stress reduction program including suggestions for iterative refinement.
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Affiliation(s)
- Makayla Watt
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Madsen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Siffledeen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Allen Lim
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Address correspondence to: Puneeta Tandon, MD, MSc, FRCPC, University of Alberta, Division of Gastroenterology, 130 University Campus NW, Edmonton, Alberta T6G 2X8, Canada ()
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Tiles-Sar N, Neuser J, de Sordi D, Rücker G, Baltes A, Preiss J, Moser G, Timmer A. Psychological interventions for inflammatory bowel disease: a systematic review and component network meta-analysis protocol. BMJ Open 2022; 12:e056982. [PMID: 35732389 PMCID: PMC9226957 DOI: 10.1136/bmjopen-2021-056982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients with inflammatory bowel diseases (IBD) often report psychological problems, unemployment, disability, sick leave and compromised quality of life. The effect of psychological interventions on health-related outcomes in IBD is controversial as previous reviews faced the obstacle of high heterogeneity among provided multimodular interventions. The heterogeneity can be addressed with network meta-analysis (NMA) and (multi)component NMA (CNMA). We aim to investigate whether psychological interventions can improve quality of life, clinical and social outcomes in IBD using NMA and CNMA. This is the study protocol. METHODS AND ANALYSIS We will consider randomised, quasi-randomised and non-randomised controlled trials, including cluster randomised and cross-over trials with 2 months of minimum follow-up. The conditions to be studied comprise Crohn's disease and ulcerative colitis in children, adolescents and adults. We will include any psychological intervention aiming to change the health status of the study participant.We will search Medline, Embase, Web of Science, CENTRAL, LILACS, Psyndex, PsycINFO, Google Scholar and trial registries from inception (the search will be updated before the review completion). Two authors will independently screen all references based on titles and abstracts. For data extraction, standard forms are developed and tested before extraction. All information will be assessed independently by at least two reviewers, and disagreements solved by consensus discussion or a third rater if necessary.The data synthesis will include a pairwise meta-analysis supported by meta-regression. We will conduct NMA (all treatments will constitute single nodes of the network) and CNMA (we will define all treatments as sums of core components, eg, cognitive +behaviour, or cognitive +behaviour + relaxation, and additionally consider interactions) using the R Package netmeta. ETHICS AND DISSEMINATION No ethical approval is required. Reports will include the final report to the funder, conference presentation, peer-reviewed publication and a patient report. PROSPERO REGISTRATION NUMBER CRD42021250446.
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Affiliation(s)
- Natalia Tiles-Sar
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Johanna Neuser
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Dominik de Sordi
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Medical Informatics, Medical Faculty and Medical Center - University of Freiburg, Freiburg, Germany
| | - Anne Baltes
- German Association for Crohn's Disease and Ulcerative Colitis (DCCV e.V.), Berlin, Germany
| | - Jan Preiss
- Clinic for Internal Medicine - Gastroenterology, Diabetology and Hepatology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Antje Timmer
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Jedel S, Beck T, Swanson G, Hood MM, Voigt RM, Gorenz A, Jakate S, Raeisi S, Hobfoll S, Keshavarzian A. Mindfulness Intervention Decreases Frequency and Severity of Flares in Inactive Ulcerative Colitis Patients: Results of a Phase II, Randomized, Placebo-Controlled Trial. Inflamm Bowel Dis 2022; 28:1872-1892. [PMID: 35661212 PMCID: PMC9713500 DOI: 10.1093/ibd/izac036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ulcerative Colitis (UC) is a chronic, inflammatory disease, characterized by symptomatic periods (flare) interspersed with asymptomatic periods (remission). Evidence suggests that psychological stress can trigger flare. Studies have shown that mindfulness interventions (MI) reduce stress, foster more adaptive coping, and improve quality of life, but have been minimally used for UC patients. The objective of this study was to determine whether participation in an MI results in improvements in UC disease course and inflammatory cascades, mindfulness, perceived stress, and other psychological outcomes in inactive UC patients with limited or no exposure to past MI. METHODS Participants were randomized to an 8-week MI or control group. Biological and psychological assessments were performed at baseline, post 8-week course, and at 6- and 12-months. RESULTS Forty-three participants enrolled. The MI increased the state of mindfulness and mindfulness skills, decreased perceived stress and stress response in patients with inactive UC. The MI intervention significantly decreased the incidence of flare over 12 months (P < .05). None of the UC patients in the MI flared during 12 months, while 5 of 23 (22%) control group participants flared during the same period. CONCLUSIONS MIs could be considered as adjuvant treatment for a subset of UC patients with high perceived stress and low state of mindfulness.The trial was registered at clinicaltrials.gov as NCT01491997.
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Affiliation(s)
- Sharon Jedel
- Address correspondence to: Sharon Jedel, PsyD, 1725 W. Harrison Street, Suite 207, Chicago, IL 60612 ()
| | - Todd Beck
- Bioinformatics and Biostatics Core, Rush University Medical Center, Chicago, IL, USA
| | - Garth Swanson
- Bioinformatics and Biostatics Core, Rush University Medical Center, Chicago, IL, USA
| | - Megan M Hood
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Robin M Voigt
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Annika Gorenz
- Rush University Medical Center, College of Nursing, Chicago, IL, USA
| | - Shriram Jakate
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Shohreh Raeisi
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Stevan Hobfoll
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ali Keshavarzian
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
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10
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Wilson D, Rodrigues de Oliveira D, Palace-Berl F, de Mello Ponteciano B, Fungaro Rissatti L, Piassa Pollizi V, Sardela de Miranda F, D'Almeida V, Demarzo M. Fostering emotional self-regulation in female teachers at the public teaching network: A mindfulness-based intervention improving psychological measures and inflammatory biomarkers. Brain Behav Immun Health 2022; 21:100427. [PMID: 35243406 PMCID: PMC8881415 DOI: 10.1016/j.bbih.2022.100427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To examine the effect of a mindfulness-based program specifically designed for teachers in reducing perceived stress and improving the quality of experienced emotion in female active working teachers. A second outcome evaluated is the associated change in cellular inflammatory activity, measured by peripheral blood levels of cytokines. METHOD Eighty-eight female active teachers from public schools from São Paulo Municipality were recruited, and randomly allocated to an eight-week Mindfulness-Based Health Program for Educators (MBHP-Educa) or to Neuroscience for Education Program (Neuro-Educa: active control group). The venue of both programs were several public school facilities, where many of the teachers actually worked. Both groups received activities during eight weeks in a 2 h/week regimen, totalizing 16 h. Sixty-five participants completed the program and pre- and post-interventions measures were taken from the following scales: Interpersonal Multidimensional Reactivity Scale (IRI), Positive-and-Negative Affects Scale (PANAS), Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RISC), and a primary outcome in Ryff's Psychological Well-Being Scale (PBWS). At pre-and post-intervention, blood samples were collected for the measurement of several important inflammatory biomarkers, Tumor Necrosis Factor - α (TNF-α), Interleukin 1β (IL-1β), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10) and Interleukin 12p70 (IL-12P70) through flow cytometry assay. Intervention effects were analyzed via Generalized mixed models (GLMM). RESULTS According to the GLMM, MBHP-Educa significantly reduced the scores of perceived stress (p < 0.0001), and negative affect (p < 0.0001) compared to active control group (Neuro-Educa). Conversely, an increase was observed on Psychological Well Being Scale in dimensions of Self-acceptance (p < 0.0001), and Autonomy (p = 0.001), as well as improvements in Resilience (p < 0.0001), and Positive Affect (p < 0.0001). MBHP-Educa also promoted a reduction in the levels of IL-6 (p = 0.003), IL-8 (p = 0.036), and increase in the levels of IL-10 (p < 0.0001) and IL-12p70 (p < 0.044). TNF-α, IL-1β, and IL-10p70 showed results below theoretical limit of detection accepted for CBA kit. CONCLUSIONS Our data suggest that mindfulness-based interventions introduced as a strategy for reducing stress, promoting well-being and improve immune function can be a useful asset in promoting psychological health among teachers in Basic Education.
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Affiliation(s)
- David Wilson
- Department of Preventive Medicine, Graduate Program in Collective Health, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Daniela Rodrigues de Oliveira
- Department of Preventive Medicine, Graduate Program in Collective Health, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Pathology, Graduate Program in Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP, Brazil
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Fanny Palace-Berl
- Department of Pathology, Graduate Program in Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Laboratory of Medical Investigation (LIM-26), Department of Surgery, University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Bárbara de Mello Ponteciano
- Department of Pathology, Graduate Program in Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Luciana Fungaro Rissatti
- Department of Pathology, Graduate Program in Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Valéria Piassa Pollizi
- Department of Preventive Medicine, Graduate Program in Collective Health, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Flávia Sardela de Miranda
- Laboratory of Imunomodulation, Department of Imunology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vânia D'Almeida
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Demarzo
- Department of Preventive Medicine, Graduate Program in Collective Health, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Mente Aberta - Brazilian Center for Mindfulness and Health Promotion, Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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11
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Schlee C, Uecker C, Bauer N, Koch AK, Langhorst J. Multimodal stress reduction and lifestyle modification program for patients with ulcerative colitis: a qualitative study. BMC Complement Med Ther 2022; 22:60. [PMID: 35260152 PMCID: PMC8903167 DOI: 10.1186/s12906-021-03478-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Over 2 million people in Europe are affected by ulcerative colitis, which often severely impacts the quality of life of those concerned. Among other factors, lifestyle and psychosocial factors seem to play an important role in pathogenesis and course of the disease and can be addressed as a complement to pharmacotherapy in comprehensive lifestyle modification programs. METHODS This qualitative study as part of a mixed methods approach was carried out in the framework of a randomized controlled trial that examined the effect of a comprehensive lifestyle-modification-program (10-week-day clinic program) on quality of life in patients with ulcerative colitis. Qualitative interviews were conducted with 20 out of 47 patients of the intervention group after the program. The aim was to deepen, supplement, and expand the quantitative results of the trial, i.e. to examine individual perceptions of the intervention, including subjective changes and the extent to which elements of the program were integrated into everyday life. Qualitative content analysis techniques utilizing the software MAXQDA were used. RESULTS Patients with ulcerative colitis in our sample often experienced multiple negative effects on different levels (physical, psychological, and social) and impaired quality of life because of their disease. They reported generally positively about the program itself, and emphasized perceived positive changes regarding their psychological and physical well-being. The interviews indicated a good implementation of elements learned during the intervention in everyday life. CONCLUSIONS Through participation in a comprehensive lifestyle modification program in the structure of a day clinic complementary to pharmacotherapy, patients with ulcerative colitis can reduce psychosocial stress and physical symptoms and thereby actively improve their well-being and general quality of life. This patient-centered, holistic approach was rated as useful in countering the complex disease manifestation as well as meeting the individual needs of the patients regarding their disease. TRIAL REGISTRATION clinicaltrials.gov NCT02721823.
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Affiliation(s)
- Christoph Schlee
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Buger Str. 80, 96049, Bamberg, Germany.,Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Buger Str. 80, 96049, Bamberg, Germany.,Department of Sociology, University of Bamberg, Feldkirchenstr. 21, 96052, Bamberg, Germany
| | - Christine Uecker
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Buger Str. 80, 96049, Bamberg, Germany.,Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Buger Str. 80, 96049, Bamberg, Germany
| | - Nina Bauer
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Buger Str. 80, 96049, Bamberg, Germany.,Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Buger Str. 80, 96049, Bamberg, Germany
| | - Anna K Koch
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Buger Str. 80, 96049, Bamberg, Germany.,Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Medical Faculty, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276, Essen, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Buger Str. 80, 96049, Bamberg, Germany. .,Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Buger Str. 80, 96049, Bamberg, Germany.
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12
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Lyall K, Beswick L, Evans S, Cummins RA, Mikocka-Walus A. Mindfulness Practice Is Associated With Subjective Wellbeing Homeostasis Resilience in People With Crohn's Disease but Not Ulcerative Colitis. Front Psychiatry 2022; 13:797701. [PMID: 35295784 PMCID: PMC8918514 DOI: 10.3389/fpsyt.2022.797701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES People with Crohn's disease and ulcerative colitis (inflammatory bowel disease: IBD), commonly experience high levels of depressive symptoms and stress and low levels of subjective wellbeing (SWB). Mindfulness is increasingly considered an adjuvant IBD treatment. The relationships between depression, disease symptoms and mindfulness have not previously been considered within the theory of SWB homeostasis. This theory states that SWB is normally maintained by a homeostatic system around a setpoint range but can fail when psychological challenges dominate consciousness. This study explored the relationship among SWB and patient-reported psychological and IBD symptoms and investigated whether mindfulness practice is independently associated with SWB homeostatic resilience. DESIGN This cross-sectional study recruited participants through online IBD support groups. METHODS Participants (n = 739; 62% Crohn's disease) detailed symptoms of depression and stress, patient-reported disease symptoms, and regularity of mindfulness practice. RESULTS The sample had significantly lower SWB (hedges g = -0.98) than normative data. A logistic regression found mindfulness practice doubled the Crohn's disease participants' odds of reporting SWB within the normal homeostatic range, after controlling for psychological, physical, and demographic variables (OR 2.15, 95% CI: 1.27, 3.66). A one-point increase of patient-reported bowel symptoms reduced the participant's odds of reporting SWB in the normal homeostatic range by about a third (OR 0.66, 95% CI: 0.50, 0.85). However, the influence of mindfulness or disease symptoms on SWB was not observed for people with ulcerative colitis. CONCLUSION These findings provide initial evidence for an association between mindfulness and SWB homeostatic resilience in a clinical population.
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Affiliation(s)
- Kimina Lyall
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Lauren Beswick
- Barwon Health, Department of Gastroenterology, Geelong, VIC, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Robert A Cummins
- School of Psychology, Deakin University, Melbourne, VIC, Australia
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13
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Large-scale genomic study reveals robust activation of the immune system following advanced Inner Engineering meditation retreat. Proc Natl Acad Sci U S A 2021; 118:2110455118. [PMID: 34907015 DOI: 10.1073/pnas.2110455118] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
The positive impact of meditation on human well-being is well documented, yet its molecular mechanisms are incompletely understood. We applied a comprehensive systems biology approach starting with whole-blood gene expression profiling combined with multilevel bioinformatic analyses to characterize the coexpression, transcriptional, and protein-protein interaction networks to identify a meditation-specific core network after an advanced 8-d Inner Engineering retreat program. We found the response to oxidative stress, detoxification, and cell cycle regulation pathways were down-regulated after meditation. Strikingly, 220 genes directly associated with immune response, including 68 genes related to interferon signaling, were up-regulated, with no significant expression changes in the inflammatory genes. This robust meditation-specific immune response network is significantly dysregulated in multiple sclerosis and severe COVID-19 patients. The work provides a foundation for understanding the effect of meditation and suggests that meditation as a behavioral intervention can voluntarily and nonpharmacologically improve the immune response for treating various conditions associated with excessive or persistent inflammation with a dampened immune system profile.
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14
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Volodina M, Smetanin N, Lebedev M, Ossadtchi A. Cortical and autonomic responses during staged Taoist meditation: Two distinct meditation strategies. PLoS One 2021; 16:e0260626. [PMID: 34855823 PMCID: PMC8638869 DOI: 10.1371/journal.pone.0260626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Meditation is a consciousness state associated with specific physiological and neural correlates. Numerous investigations of these correlates reported controversial results which prevented a consistent depiction of the underlying neurophysiological processes. Here we investigated the dynamics of multiple neurophysiological indicators during a staged meditation session. We measured the physiological changes at rest and during the guided Taoist meditation in experienced meditators and naive subjects. We recorded EEG, respiration, galvanic skin response, and photoplethysmography. All subjects followed the same instructions split into 16 stages. In the experienced meditators group we identified two subgroups with different physiological markers dynamics. One subgroup showed several signs of general relaxation evident from the changes in heart rate variability, respiratory rate, and EEG rhythmic activity. The other subgroup exhibited mind concentration patterns primarily noticeable in the EEG recordings while no autonomic responses occurred. The duration and type of previous meditation experience or any baseline indicators we measured did not explain the segregation of the meditators into these two groups. These results suggest that two distinct meditation strategies could be used by experienced meditators, which partly explains the inconsistent results reported in the earlier studies evaluating meditation effects. Our findings are also relevant to the development of the high-end biofeedback systems.
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Affiliation(s)
- Maria Volodina
- Center for Bioelectric Interfaces, HSE University, Moscow, Russia
| | - Nikolai Smetanin
- Center for Bioelectric Interfaces, HSE University, Moscow, Russia
| | - Mikhail Lebedev
- Center for Bioelectric Interfaces, HSE University, Moscow, Russia
| | - Alexei Ossadtchi
- Center for Bioelectric Interfaces, HSE University, Moscow, Russia
- Artificial intelligence Research Institute, Moscow, Russia
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15
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Trindade IA, Sirois FM. The prospective effects of self-compassion on depressive symptoms, anxiety, and stress: A study in inflammatory bowel disease. J Psychosom Res 2021; 146:110429. [PMID: 33810862 DOI: 10.1016/j.jpsychores.2021.110429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To date, research with people with inflammatory bowel disease (IBD) has only examined how self-compassion is linked with stress, and have exclusively used cross-sectional designs. This study aims to examine the associations of self-compassion with depressive symptoms, anxiety, and stress in people with IBD over time. METHODS Participants were 155 adults with IBD who completed the SCS and the DASS-21 at two different times, spaced 9 months apart. The study design is longitudinal: three separate hierarchical regression models were conducted to examine whether self-compassion at baseline predicted depressive symptoms, anxiety, and stress measured at follow-up, while controlling for the effects of baseline IBD symptomatology and the respective outcome. RESULTS Participants who had IBD for a longer period of time presented higher levels of self-compassion. Self-compassion at baseline predicted lower follow-up levels of depressive symptoms (β = -0.17, p = 0.015), anxiety (β = -0.15, p = 0.032), and stress (β = -0.26, p = 0.001), even in the presence of baseline levels of IBD symptomatology and the outcome. Isolation (as opposed to common humanity) was the most relevant self-compassion component for explaining higher depression levels, while the mindfulness component was important for explaining lower anxiety and stress. CONCLUSIONS This study is the first to demonstrate the prospective effects of self-compassion on mental health indicators in IBD. Given these findings, and previous evidence on the high comorbidity of depression and anxiety and frequent self-report of illness shame and self-criticism in this population, compassion-based interventions may be particularly beneficial for improving well-being in people with IBD.
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Affiliation(s)
- Inês A Trindade
- CINEICC (Center for Research in Neuropsychology and Cognitive Behavioral Intervention), Faculty of Psychology and Education Sciences, University of Coimbra, Portugal.
| | - Fuschia M Sirois
- Department of Psychology, The University of Sheffield, United Kingdom
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16
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Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study. CHILDREN-BASEL 2021; 8:children8050368. [PMID: 34063034 PMCID: PMC8147916 DOI: 10.3390/children8050368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
The aim of this pilot study was to assess: (1) the feasibility and acceptability of a Mindfulness-Based Virtual Reality (MBVR) intervention among children and young adults with Inflammatory Bowel Disease (IBD), and (2) the preliminary efficacy of MBVR on key psychological (anxiety) and physical (pain) outcomes. Participants were 62 children to young adults with IBD (M = 15.6 years; 69.4% Crohn's disease; 58% male) recruited from an outpatient pediatric IBD clinic. Participants completed a baseline assessment, underwent the 6-min MBVR intervention, completed a post-intervention assessment and study satisfaction survey, and provided qualitative feedback. Results suggest strong feasibility and acceptability. Participants reported high levels of satisfaction with MBVR including high levels of enjoyment (M = 4.38; range 1-5) and relaxation (M = 4.35; range 1-5). Qualitative data revealed several key themes including participants interest in using MBVR in IBD medical settings (e.g., hospitalizations, IBD procedures, IBD treatments), as well as in their daily lives to support stress and symptom management. Preliminary analyses demonstrated improvements in anxiety (t = 4.79, p = 0.001) and pain (t = 3.72, p < 0.001) following MBVR. These findings provide initial support for the feasibility and acceptability of MBVR among children and young adults with IBD. Results also suggest MBVR may improve key IBD outcomes (e.g., anxiety, pain) and highlight the importance of conducting a randomized controlled trial and more rigorous research to determine intervention efficacy.
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17
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Leyro TM, Versella MV, Yang MJ, Brinkman HR, Hoyt DL, Lehrer P. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clin Psychol Rev 2021; 84:101980. [PMID: 33540222 PMCID: PMC8302658 DOI: 10.1016/j.cpr.2021.101980] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Respiratory abnormalities are a hallmark of anxiety symptomatology and may serve as clinically useful modifiers for alleviating anxiety symptoms. However, gold-standard anxiety treatments (e.g., cognitive-behavioral interventions) often do not directly address respiratory components despite their theoretical utility and clinical accessibility. This review examined the clinical effectiveness of respiratory interventions, interventions that directly target respiration abnormalities and processes, in treating trait anxiety symptoms. METHODS The final analysis included 40 randomized controlled trials including at least one measure of trait anxiety, a respiratory-focused intervention group, and a non-respiratory control-group (active or inactive treatment). Overall effects of respiratory focused interventions were examined, as well as the effect of hypothesized moderators. RESULTS Respiratory component interventions yielded significantly greater improvements (moderate to large effect) in anxiety symptoms than controls, with the stronger effects observed in comparison to inactive, rather than active, control conditions. Significant heterogeneity in findings suggests that variability in intervention design, population, and control comparison may obfuscate interpretation of findings. CONCLUSIONS Evidence supports the clinical utility of respiratory interventions as either an independent anxiety treatment, or as an adjunct to other interventions. Clinical and research implications of findings along with recommendations for ongoing investigations in this domain are discussed.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, United States.
| | - Mark V Versella
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, United States; Department of Health Outcomes and Behavior, Moffitt Cancer Center, United States
| | - Hannah R Brinkman
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Danielle L Hoyt
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Paul Lehrer
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, United States
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18
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Pernet CR, Belov N, Delorme A, Zammit A. Mindfulness related changes in grey matter: a systematic review and meta-analysis. Brain Imaging Behav 2021; 15:2720-2730. [PMID: 33624219 PMCID: PMC8500886 DOI: 10.1007/s11682-021-00453-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 12/01/2022]
Abstract
Knowing target regions undergoing strfuncti changes caused by behavioural interventions is paramount in evaluating the effectiveness of such practices. Here, using a systematic review approach, we identified 25 peer-reviewed magnetic resonance imaging (MRI) studies demonstrating grey matter changes related to mindfulness meditation. An activation likelihood estimation (ALE) analysis (n = 16) revealed the right anterior ventral insula as the only significant region with consistent effect across studies, whilst an additional functional connectivity analysis indicates that both left and right insulae, and the anterior cingulate gyrus with adjacent paracingulate gyri should also be considered in future studies. Statistical meta-analyses suggest medium to strong effect sizes from Cohen’s d ~ 0.8 in the right insula to ~ 1 using maxima across the whole brain. The systematic review revealed design issues with selection, information, attrition and confirmation biases, in addition to weak statistical power. In conclusion, our analyses show that mindfulness meditation practice does induce grey matter changes but also that improvements in methodology are needed to establish mindfulness as a therapeutic intervention.
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Affiliation(s)
- Cyril R Pernet
- Centre for Clinical Brain Sciences, Edinburgh Imaging, The University of Edinburgh, Edinburgh, UK.
| | - Nikolai Belov
- Department of Psychology, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Arnaud Delorme
- CerCo, CNRS, Paul Sabatier University, Toulouse, France.,SCCN, INC, University of California San Diego, La Jolla, CA, USA
| | - Alison Zammit
- Centre for Clinical Brain Sciences, Edinburgh Imaging, The University of Edinburgh, Edinburgh, UK
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Abstract
Inflammatory bowel disease (IBD) is associated with significant psychological comorbidities, with associated impacts on patient quality of life, disease course, and health care costs. The present article reviews the latest evidence on the etiology of psychological comorbidities in IBD, with a focus on shared inflammatory pathways. The current state of practice in managing and understanding psychological comorbidities from the perspective of both gastroenterology practice and psychological treatment is reviewed, with a focus on evidence-based treatments shown to be effective in managing depression, anxiety, stress, and improving IBD-related health outcomes.
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20
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Dave U, Dave A, Taylor-Robinson SD. Mindfulness in Gastroenterology Training and Practice: A Personal Perspective. Clin Exp Gastroenterol 2020; 13:497-502. [PMID: 33177857 PMCID: PMC7650088 DOI: 10.2147/ceg.s278590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background Work-related stress is becoming an increasingly recognised occupational hazard that can have detrimental effects on the health of both patient and doctor. The practice of gastroenterology not only includes the demands of clinics and in-patient work faced by other medical specialities but also the additional burden of complex, and often high-risk, endoscopic interventions. Mindfulness, a secular form of meditation, can relieve stress, even if only practiced for a few minutes a day. Methods and Results We present a personal perspective of the burnout experienced in stressful gastroenterology careers and the personal use of mindfulness in the daily routine to provide a source of calm when surrounded by many different pressures. We review some of the literature exploring the role of mindfulness in clinical practice with an emphasis on gastroenterology. While the practice of mindfulness is not designed to obviate immediacy and quick decisions in a rapidly changing clinical environment, it has been held widely useful to mitigate the stress involved in making those decisions. Conclusion Practicing mindfulness, meditation and mindful living offers many advantages to gastroenterologists’ wellbeing as well improved patient care. We advocate its teaching to both gastroenterology trainees and consultants who are not familiar with the technique.
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Affiliation(s)
- Umakant Dave
- Department of Gastroenterology, Morriston Hospital, Swansea, Wales SA6 6NL, UK
| | - Anjali Dave
- Department of Psychology, Birmingham University, Birmingham B15 2TT, UK
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21
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Langhorst J, Schöls M, Cinar Z, Eilert R, Kofink K, Paul A, Zempel C, Elsenbruch S, Lauche R, Ahmed M, Haller D, Cramer H, Dobos G, Koch AK. Comprehensive Lifestyle-Modification in Patients with Ulcerative Colitis-A Randomized Controlled Trial. J Clin Med 2020; 9:E3087. [PMID: 32987894 PMCID: PMC7599849 DOI: 10.3390/jcm9103087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
Patients with ulcerative colitis suffer from impaired health-related quality of life (HrQoL). Comprehensive lifestyle-modification might increase HrQoL and decrease disease activity. Ninety-seven patients in clinical remission with impaired HrQoL were randomly assigned to a 10 week comprehensive lifestyle-modification program (LSM; n = 47; 50.28 ± 11.90 years) or control (n = 50; 45.54 ± 12.49 years) that received a single workshop of intense training in naturopathic self-help strategies. Primary outcome was HrQoL (Inflammatory Bowel Disease Questionnaire; IBDQ) at week 12. Secondary outcomes included IBDQ subscales; generic HrQoL; disease activity and microbiome. Both groups showed improvement in HrQoL from baseline to post-treatment at week 12. The IBDQ sum score showed no significant group difference (p = 0.251). If patients attended more than 50% of the training sessions, a significant group effect (p = 0.034) was evident in favor of LSM. In addition, the SF-36 mental component summary (p = 0.002) was significantly different between the groups in favor of LSM. Disease activity microbiome and adverse events did not differ. Both a single workshop and a 10-week comprehensive lifestyle-modification program can improve HrQoL in patients with ulcerative colitis in remission with no apparent effects on clinical disease activity. A treatment difference was observed when examining a subsample of patients who attended ≥ 50% of sessions.
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Affiliation(s)
- Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Germany, Chair for Integrative Medicine, University of Duisburg-Essen, Buger Straße 80, 96049 Bamberg, Germany
- Integrative Gastroenterology, University of Duisburg-Essen, Evang. Kliniken-Essen-Mitte, Am Deimelsberg 34 a, 45276 Essen, Germany; (M.S.); (Z.C.); (R.E.); (K.K.)
| | - Margarita Schöls
- Integrative Gastroenterology, University of Duisburg-Essen, Evang. Kliniken-Essen-Mitte, Am Deimelsberg 34 a, 45276 Essen, Germany; (M.S.); (Z.C.); (R.E.); (K.K.)
| | - Zehra Cinar
- Integrative Gastroenterology, University of Duisburg-Essen, Evang. Kliniken-Essen-Mitte, Am Deimelsberg 34 a, 45276 Essen, Germany; (M.S.); (Z.C.); (R.E.); (K.K.)
| | - Ronja Eilert
- Integrative Gastroenterology, University of Duisburg-Essen, Evang. Kliniken-Essen-Mitte, Am Deimelsberg 34 a, 45276 Essen, Germany; (M.S.); (Z.C.); (R.E.); (K.K.)
| | - Kerstin Kofink
- Integrative Gastroenterology, University of Duisburg-Essen, Evang. Kliniken-Essen-Mitte, Am Deimelsberg 34 a, 45276 Essen, Germany; (M.S.); (Z.C.); (R.E.); (K.K.)
| | - Anna Paul
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany; (A.P.); (C.Z.); (H.C.); (G.D.); (A.K.K.)
| | - Christina Zempel
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany; (A.P.); (C.Z.); (H.C.); (G.D.); (A.K.K.)
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Universitätsstraße 150, 44801 Bochum, Germany;
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, Lismore Campus, Military Rd, Lismore, NSW 2480, Australia;
| | - Mohamed Ahmed
- Technical University of Munich, Chair of Nutrition and Immunology, Gregor-Mendel-Str. 2, 85354 Freising-Weihenstephan, Germany; (M.A.); (D.H.)
| | - Dirk Haller
- Technical University of Munich, Chair of Nutrition and Immunology, Gregor-Mendel-Str. 2, 85354 Freising-Weihenstephan, Germany; (M.A.); (D.H.)
- ZIEL-Institute for Food and Health, Technical University of Munich, 85354 Freising, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany; (A.P.); (C.Z.); (H.C.); (G.D.); (A.K.K.)
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany; (A.P.); (C.Z.); (H.C.); (G.D.); (A.K.K.)
| | - Anna K. Koch
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany; (A.P.); (C.Z.); (H.C.); (G.D.); (A.K.K.)
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Konturek PC, Konturek K, Zopf Y. [Stress and inflammatory bowel disease]. MMW Fortschr Med 2020; 162:3-6. [PMID: 32661894 DOI: 10.1007/s15006-020-0657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
Different mechanisms have a negative impact on the course of inflammatory bowel disease. Important mechanisms include amongst others an increased release of pro-inflammatory cytokines, intestinal dysbiosis, increased permeability of the intestinal barrier, increased release of corticotropin-releasing factor (CRF) in the brain, activation of mast cells in the intestinal mucosa and inadequate central pain processing with the consequences of anxiety and depression. All of these factors can increase the inflammatory response in the intestine and lead to acute flare-ups. For this reason, appropriate stress management is extremely important for the success of therapy.
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Affiliation(s)
- Peter Christopher Konturek
- Thüringen-Klinik Saalfeld, Akademisches Lehrkrankenhaus der Universitätsklinik Jena, Deutschland. .,Klinik für Innere Medizin II Thüringen-Kliniken "Georgius Agricola", Rainweg 68, D-07318, Saalfeld/Saale, Deutschland.
| | | | - Yurdagül Zopf
- Klinik für Innere Medizin I, FAU Erlangen-Nürnberg, Deutschland
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Sinagra E, Utzeri E, Morreale GC, Fabbri C, Pace F, Anderloni A. Microbiota-gut-brain axis and its affect inflammatory bowel disease: Pathophysiological concepts and insights for clinicians. World J Clin Cases 2020; 8:1013-1025. [PMID: 32258072 PMCID: PMC7103973 DOI: 10.12998/wjcc.v8.i6.1013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/14/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023] Open
Abstract
Despite the bi-directional interaction between gut microbiota and the brain not being fully understood, there is increasing evidence arising from animal and human studies that show how this intricate relationship may facilitate inflammatory bowel disease (IBD) pathogenesis, with consequent important implications on the possibility to improve the clinical outcomes of the diseases themselves, by acting on the different components of this system, mainly by modifying the microbiota. With the emergence of precision medicine, strategies in which patients with IBD might be categorized other than for standard gut symptom complexes could offer the opportunity to tailor therapies to individual patients. The aim of this narrative review is to elaborate on the concept of the gut-brain-microbiota axis and its clinical significance regarding IBD on the basis of recent scientific literature, and finally to focus on pharmacological therapies that could allow us to favorably modify the function of this complex system.
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Affiliation(s)
- Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, Cefalù 90015, Italy
- Euro-Mediterranean Institute of Science and Technology, Palermo 90100, Italy
| | - Erika Utzeri
- Nuova Casa di Cura di Decimomannu, Cagliari 09100, Italy
| | | | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, Azienda USL Romagna, Forlì 47121, Italy
| | - Fabio Pace
- Unit of Gastroenterology, Bolognini Hospital, Bergamo 24100, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano 20089, Italy
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24
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Managing Pain and Psychosocial Care in IBD: a Primer for the Practicing Gastroenterologist. Curr Gastroenterol Rep 2020; 22:20. [PMID: 32185521 DOI: 10.1007/s11894-020-0757-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the relationship between trauma and pain in inflammatory bowel disease (IBD), and offers effective treatment strategies. RECENT FINDINGS Recent evidence points to bidirectional pathways between psychiatric disorders and IBD. The impact of trauma and development of post-traumatic stress symptoms on IBD disease course is beginning to be appreciated including its relationship with pain. First-line treatments for both psychiatric and chronic pain disorders include behavioral interventions such as cognitive behavioral therapy, hypnosis, and mindfulness, and there is emerging evidence studying Acceptance and Commitment Therapy and telehealth interventions. Pharmacological treatments using neuromodulators can also be beneficial. An integrated care team, such as a subspecialty medical home model, can provide the best patient experience and address comprehensive care needs efficiently and effectively. Psychosocial factors impact IBD course and necessitate effective management. Despite the significant limitations of research, particularly lack of clinical trials examining behavioral and pharmacotherapy interventions in IBD, effective treatments exist and are best utilized in an integrated care setting.
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25
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26
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Ahmed Z, Sarvepalli S, Garber A, Regueiro M, Rizk MK. Value-Based Health Care in Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:958-968. [PMID: 30418558 DOI: 10.1093/ibd/izy340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disease associated with significant resource utilization and health care burden. It is emerging as a global disease affecting an increasing proportion of the population. Along with evolving epidemiological trends, the paradigm of managing IBD has also changed. With a burgeoning repertoire of therapeutic options, improved use of health informatics, and emphasis on health care value, the treatment paradigm for IBD has experienced seismic shifts. In this review, we focused on value-based health care (VBHC)-a health care model that emphasizes monitoring outcomes to emphasize patient-centered, cost-effective IBD patient care. Several quality initiatives have been developed worldwide, and successful models of care were created for proper implementation of these initiatives. Although there are significant challenges to scale these models to a national level, it is still possible to successfully implement VBHC models within health systems to improve the quality of care provided to patients with IBD.
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Affiliation(s)
- Zunirah Ahmed
- Department of Internal Medicine, University of Alabama, Montgomery, Alabama
| | | | - Ari Garber
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Miguel Regueiro
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Maged K Rizk
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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27
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Kruger AJ, Hinton A, Afzali A. Index Severity Score and Early Readmission Predicts Increased Mortality in Ulcerative Colitis Patients. Inflamm Bowel Dis 2019; 25:894-901. [PMID: 30247551 DOI: 10.1093/ibd/izy297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Readmissions are common after hospitalization related to ulcerative colitis (UC). A risk score to stratify the severity of UC hospitalizations and risk of colectomy has been previously reported. Our aim was to predict hospital-related outcomes after hospitalizations for UC utilizing this severity score. METHODS We utilized the Nationwide Readmissions Database (2010-2014) for hospitalized patients with UC and differentiated patients by index severity (low, intermediate, high). Baseline characteristics, surgical rates, readmissions, mortality, and hospital outcomes were collected. The primary outcomes of interest included readmission and mortality rates. RESULTS There were 133,819 patients admitted with UC with 22,762 (17%) readmitted within 30 days. Those readmitted within 30 days had a 4.5% calendar year mortality rate, compared with 0.45% in those not readmitted within 30 days (P < 0.001). Index surgery rates (19.2% vs 12.3%), length of stay (6.9 vs 5.4 days), and hospital costs ($13,530 vs $10,366; P < 0.001 for all) were higher in those readmitted within 30 days. Patients with high-severity presentations had higher surgical rates (31.6%), higher 30-day and calendar year readmission rates (24.3% and 46.0%, respectively), increased index and calendar year mortality (2.5% and 2.0%, respectively), longer length of stay (15.1 days), and increased costs ($31,136) compared with those with low severity (P < 0.001 for all). Calendar-year survival rates in those with intermediate and high scores were significantly lower than in those with low scores. CONCLUSIONS An index severity score of intermediate or high and early readmissions are predictors of calendar year mortality. Future efforts should emphasize more focused care in high-risk patients, as this may reduce readmissions and improve outcomes.
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Affiliation(s)
- Andrew J Kruger
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Anita Afzali
- Inflammatory Bowel Disease Center at The Ohio State University Wexner Medical Center, Columbus, Ohio.,Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Affiliation(s)
- Joshua Korzenik
- Brigham and Women's Hospital Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts.
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Fernández A, Simian D, Quera R, Flores L, Ibáñez P, Lubascher J, Figueroa C, Kronberg U, Pizarro G, Fluxá D. Complementary and alternative medicine in patients with inflammatory bowel disease: A survey performed in a tertiary center in Chile. Complement Ther Med 2018; 40:77-82. [PMID: 30219473 DOI: 10.1016/j.ctim.2018.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the type and prevalence of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease (IBD) who are treated at our center. DESIGN Observational, cross-sectional questionnaire-based study that included patients from the IBD program of our center. SETTING Tertiary clinical center in Santiago, Chile. MAIN OUTCOME MEASURES Types of CAM being used by patients with IBD. RESULTS A total of 200 patients were included, 68% ulcerative colitis, 29% Crohn's disease, and 3% non-classifiable IBD. Overall, 25% of the patients reported current use of CAM, 30% reported using in it the past, and 45% indicated that they had never used it before. The use of CAM was recommended in 20% of the patients by other healthcare professionals and in 10% of the patients by the gastroenterologist. Forty-nine percent of the patients informed the gastroenterologist that they were using CAM. Overall, 86% of the patients did not modify the conventional medical treatment (CMT). None of the patients who were using curcumin, homeopathic medicine, acupuncture or biomagnetism modified the CMT. CONCLUSIONS The type of CAM being used plays an important role when the patient makes the decision to inform the gastroenterologist. Other healthcare professionals play an important role in providing the advice to start CAM. Gastroenterologists must be aware of the high prevalence of CAM use in IBD patients, actively ask about CAM use and guide the patients who want to use CAM in a responsible and safe manner.
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Affiliation(s)
- Antonia Fernández
- Inflammatory Bowel Disease Research Fellow, Clínica Las Condes, Santiago, Chile
| | - Daniela Simian
- Academic Research Unit, Clínica Las Condes, Santiago, Chile
| | - Rodrigo Quera
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile.
| | - Lilian Flores
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Patricio Ibáñez
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Jaime Lubascher
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Carolina Figueroa
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Udo Kronberg
- Colorectal Unit, Surgery Department, Inflammatory Bowel Disease program, Clínica Las Condes, Santiago, Chile
| | - Gonzalo Pizarro
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Daniela Fluxá
- Inflammatory Bowel Disease Research Fellow, Clínica Las Condes, Santiago, Chile
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