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Colombel JF, Schreiber S, D'Haens G, Rizzo J, Kligys K, Griffith J, Zambrano J, Zhou Q, Zhang Y, Kalabic J, Rieder F, Dubinsky MC, Panaccione R. Risankizumab Induction Therapy Achieves Early Symptom Improvements That Are Associated With Future Clinical and Endoscopic Outcomes in Crohn's Disease: Post Hoc Analysis of the ADVANCE, MOTIVATE, and FORTIFY Phase 3 Studies. J Crohns Colitis 2024; 18:818-827. [PMID: 38069472 PMCID: PMC11147806 DOI: 10.1093/ecco-jcc/jjad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/19/2023] [Accepted: 12/04/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] symptoms are a main driver for impaired quality of life, and fast relief is important for patient care. Stool frequency [SF] and abdominal pain score [APS] are patient-reported outcomes [PROs] measuring symptom severity, which are supported as treatment targets by the STRIDE-II consensus. This post hoc analysis examined the efficacy of risankizumab [RZB], a humanised monoclonal antibody with high specificity for interleukin-23 p19, for providing early symptom relief, along with the prognostic value of early symptom relief for achieving future clinical and endoscopic endpoints. METHODS Individual and combined measures of SF and AP at Weeks 1, 2, and 3 were assessed in patients with moderate to severe CD who received 600 mg intravenous RZB or placebo [PBO] in the ADVANCE or MOTIVATE induction studies. Multivariate logistic regression was used to examine the predictiveness of early symptom improvement for clinical and endoscopic outcomes following RZB induction and maintenance. RESULTS Higher rates of SF/APS clinical remission and enhanced clinical response were observed as early as Week 1 with RZB vs PBO. A larger proportion of patients achieved clinical endpoints with RZB vs PBO, irrespective of prior bio-failure status. Early PRO improvement was associated with a greater likelihood of achieving clinical and endoscopic improvement following 12-week induction and 52-week maintenance RZB dosing. CONCLUSIONS After the first intravenous RZB induction dose, significantly greater rates of symptom improvement vs PBO were achieved. Improvements could be observed as early as Week 1 and were predictive of Weeks 12 and 52 clinical and endoscopic improvement.
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Affiliation(s)
- Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefan Schreiber
- Department of Medicine I, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Geert D'Haens
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | - Qian Zhou
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marla C Dubinsky
- Susan and Leonard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
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Zhong D, Jin K, Wang R, Chen B, Zhang J, Ren C, Chen X, Lu J, Zhou M. Microalgae-Based Hydrogel for Inflammatory Bowel Disease and Its Associated Anxiety and Depression. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2312275. [PMID: 38277492 DOI: 10.1002/adma.202312275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/19/2024] [Indexed: 01/28/2024]
Abstract
Patients diagnosed with inflammatory bowel disease (IBD) exhibit a notable prevalence of psychiatric disorders, such as anxiety and depression. Nevertheless, the etiology of psychiatric disorders associated with IBD remains uncertain, and an efficacious treatment approach has yet to be established. Herein, an oral hydrogel strategy (SP@Rh-gel) is proposed for co-delivery of Spirulina platensis and rhein to treat IBD and IBD-associated anxiety and depression by modulating the microbiota-gut-brain axis. SP@Rh-gel improves the solubility, release characteristics and intestinal retention capacity of the drug, leading to a significant improvement in the oral therapeutic efficacy. Oral administration of SP@Rh-gel can reduce intestinal inflammation and rebalance the disrupted intestinal microbial community. Furthermore, SP@Rh-gel maintains intestinal barrier integrity and reduces the release of pro-inflammatory factors and their entry into the hippocampus through the blood-brain barrier, thereby inhibiting neuroinflammation and maintaining neuroplasticity. SP@Rh-gel significantly alleviates the colitis symptoms, as well as anxiety- and depression-like behaviors, in a chronic colitis mouse model. This study demonstrates the significant involvement of the microbiota-gut-brain axis in the development of IBD with psychiatric disorders and proposes a safe, simple, and highly efficient therapeutic approach for managing IBD and comorbid psychiatric disorders.
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Affiliation(s)
- Danni Zhong
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
- Institute of Translational Medicine, Zhejiang University, Hangzhou, 310029, P. R. China
| | - Kangyu Jin
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
- Institute of Translational Medicine, Zhejiang University, Hangzhou, 310029, P. R. China
| | - Ruoxi Wang
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
- Institute of Translational Medicine, Zhejiang University, Hangzhou, 310029, P. R. China
| | - Bing Chen
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
| | - Jinghui Zhang
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, P. R. China
| | - Chaojie Ren
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, Surgery, Chemical and Biomolecular Engineering, and Biomedical Engineering, Yong Loo Lin School of Medicine and College of Design and Engineering, National University of Singapore, Singapore, 119074, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
| | - Jing Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
- Zhejiang Key Laboratory of Precision Psychiatry, Hangzhou, 310003, P. R. China
| | - Min Zhou
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China
- Institute of Translational Medicine, Zhejiang University, Hangzhou, 310029, P. R. China
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University, Haining, 314400, P. R. China
- National Key Laboratory of Biobased Transportation Fuel Technology, Zhejiang University, Hangzhou, 310027, P. R. China
- Zhejiang University-Erdos Etuoke Joint Research Center, The Second Affiliated Hospital, Zhejiang University, Hangzhou, 310029, P. R. China
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Chappell KD, Meakins D, Marsh-Joyal M, Bihari A, Goodman KJ, Le Melledo JM, Lim A, Peerani F, Kroeker KI. Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial. JMIR Form Res 2024; 8:e53550. [PMID: 38709548 PMCID: PMC11106704 DOI: 10.2196/53550] [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: 10/10/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Individuals with inflammatory bowel disease (IBD) experience cycles of aggressive physical symptoms including abdominal pain, diarrhea, and fatigue. These acute symptoms regress and return, and chronic symptoms and complications often linger. The nature of the disease can also cause individuals to experience psychological distress including symptoms of anxiety and depression; however, unlike the physical symptoms of IBD, these psychological symptoms often remain untreated. OBJECTIVE This study aims to evaluate the feasibility, acceptability, and effectiveness of virtual mindfulness-based stress reduction (v-MBSR) for adults with IBD. METHODS IBD patients with self-reported anxiety or depression were recruited from clinics in Alberta, Canada to participate in an 8-week v-MSBR intervention. Eligible patients participated in v-MBSR delivered by psychiatrists using a videoconferencing platform. Primary feasibility outcomes included trial uptake, adherence, attendance, and attrition rates. Secondary effectiveness outcomes included measures of anxiety, depression, quality of life (QoL), and mindfulness. Effectiveness data were collected at 3 time points: baseline, at intervention completion, and 6 months after completion. To further assess feasibility and acceptability, participants were invited to participate in a semistructured interview after completing v-MBSR. RESULTS A total of 16 of the 64 (25%) referred patients agreed to participate in v-MBSR with the most common reason for decline being a lack of time while 7 of the 16 (43.8%) participants completed the program and experienced encouraging effects including decreased anxiety and depression symptoms and increased health-related QoL with both improvements persisting at 6-month follow-up. Participants described improved coping strategies and disease management techniques as benefits of v-MBSR. CONCLUSIONS Patients with IBD were interested in a psychiatrist-led virtual anxiety management intervention, but results demonstrate v-MBSR may be too time intensive for some patients with IBD patients. v-MBSR was acceptable to those who completed the intervention, and improvements to anxiety, depression, and QoL were promising and sustainable. Future studies should attempt to characterize the patients with IBD who may benefit most from interventions like v-MBSR.
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Affiliation(s)
- Kaitlyn Delaney Chappell
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Diana Meakins
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Allison Bihari
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen J Goodman
- 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
| | - Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Ivy Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Bernstein CN, Dolovich C, Prichodko M, Fisk JD, Graff LA, Patten SB, Bolton J, Hitchon C, Marrie RA. Perceived Need for Mental Health Care in a Cohort of Persons With Inflammatory Bowel Disease. J Clin Gastroenterol 2024; 58:464-470. [PMID: 37725433 DOI: 10.1097/mcg.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Psychiatric comorbidity is common in inflammatory bowel disease (IBD) and can negatively affect disease outcomes. We explored the perceived need for mental health care among persons with IBD. STUDY Persons with IBD completed self-report questionnaires, including the Hospital Anxiety and Depression Scale (HADS), and reported whether they wanted help with their mood. Each was also assessed using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorders (SCIDs). We used logistic regression analyses to determine factors associated with the perceived need for mental health care. RESULTS Of 245 participants, 28% met the criteria for a past diagnosis of depression or anxiety disorder by SCID, and nearly 23% met the criteria for a current diagnosis of depression or anxiety disorder. One-third (n = 74) reported a perceived need for mental health care. Among those meeting criteria for a current SCID diagnosis of depression or anxiety, only 58% reported needing mental health care. Need for mental health care was reported by 79% of persons currently treated for either depression or 71% treated for anxiety. Persons with a perceived need for mental health care had higher mean HADS for depression and HADS for anxiety scores and also higher IBD symptom activity scores. Of those reporting no perceived need for mental health care, 13% had a current diagnosis of depression or anxiety disorder by SCID; even fewer had symptoms of depression or anxiety. CONCLUSIONS Symptoms of depression or anxiety are more important than a formal diagnosis of depression or anxiety in predicting which persons with IBD will perceive a need for mental health care.
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Affiliation(s)
- Charles N Bernstein
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | - Casandra Dolovich
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | | | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Nova Scotia Health, Dalhousie University, Halifax
| | - Lesley A Graff
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Department of Community Health Sciences
| | | | - James Bolton
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carol Hitchon
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
| | - Ruth Ann Marrie
- Department of Internal Medicine
- The University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg
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Ji Y, Li H, Dai G, Zhang X, Ju W. Systematic review and meta-analysis: Impact of depression on prognosis in inflammatory bowel disease. J Gastroenterol Hepatol 2024. [PMID: 38655853 DOI: 10.1111/jgh.16568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/19/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIM Depression is highly prevalent in patients with inflammatory bowel disease (IBD), which may affect the prognosis of IBD. This aimed to investigate the impact of depression on prognosis in IBD. METHODS A systematic literature search was performed in four databases (Medline, Embase, Web of Science, and PsycINFO) up to December 31, 2023. Studies were included if they investigated the impact of depression on prognosis in IBD. The primary outcome was flare in IBD, and secondary outcomes were hospitalization, readmission, emergency visits, surgery, and escalation of medical therapy. Relative risks (RRs) were utilized to estimate the risk in each of the above prognostic indicators. RESULTS Fourteen cohort and 10 case-control studies matched our entry criteria, comprising 630 408 patients with IBD. Twenty-two of included studies were considered to have a low risk of bias. Depression was found to significantly increase the risk of flare (RR = 1.37, 95% CI 1.16-1.63), hospitalization (RR = 1.11, 95% CI 1.00-1.23), readmission (RR = 1.32, 95% CI 1.04-1.67), emergency visits (RR = 1.33, 95% CI 1.12-1.59), surgery (1.38, 95% CI 1.08-1.76), and escalation of medical therapy (RR = 1.38, 95% CI 1.13-1.69) in IBD. Of note, patients with depression in ulcerative colitis had significant differences in readmission (RR = 1.38, 95% CI 1.19-1.60) and escalation of medical therapy (RR = 1.78, 95% CI 1.55-2.04). Additionally, the association was observed in patients with Crohn's disease in terms of flare (RR = 1.47, 95% CI 1.08-2.01) and hospitalization (RR = 1.20, 95% CI 1.03-1.40). CONCLUSIONS Current evidence suggested that depression could significantly increase the risk of poor prognosis worsening in patients with IBD. However, the association varied in IBD subtypes.
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Affiliation(s)
- Yuejin Ji
- Department of Clinical Pharmacology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongxiao Li
- College of Acupuncture Moxibustion and Tuina, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guoliang Dai
- Department of Clinical Pharmacology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xu Zhang
- School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenzheng Ju
- Department of Clinical Pharmacology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Wang J, Wang Y, Zhu Y, Cui C, Feng T, Huang Q, Liu S, Wu Q. Peripheral inflammation triggering central anxiety through the hippocampal glutamate metabolized receptor 1. CNS Neurosci Ther 2024; 30:e14723. [PMID: 38676295 PMCID: PMC11053250 DOI: 10.1111/cns.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/01/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
AIMS This study aimed to investigate the relationship between ulcerative colitis (UC) and anxiety and explore its central mechanisms using colitis mice. METHODS Anxiety-like behavior was assessed in mice induced by 3% dextran sodium sulfate (DSS) using the elevated plus maze and open-field test. The spatial transcriptome of the hippocampus was analyzed to assess the distribution of excitatory and inhibitory synapses, and Toll-like receptor 4 (TLR4) inhibitor TAK-242 (10 mg/kg) and AAV virus interference were used to examine the role of peripheral inflammation and central molecules such as Glutamate Receptor Metabotropic 1 (GRM1) in mediating anxiety behavior in colitis mice. RESULTS DSS-induced colitis increased anxiety-like behaviors, which was reduced by TAK-242. Spatial transcriptome analysis of the hippocampus showed an excitatory-inhibitory imbalance mediated by glutamatergic synapses, and GRM1 in hippocampus was identified as a critical mediator of anxiety behavior in colitis mice via differential gene screening and AAV virus interference. CONCLUSION Our work suggests that the hippocampus plays an important role in brain anxiety caused by peripheral inflammation, and over-excitation of hippocampal glutamate synapses by GRM1 activation induces anxiety-like behavior in colitis mice. These findings provide new insights into the central mechanisms underlying anxiety in UC and may contribute to the development of novel therapeutic strategies for UC-associated anxiety.
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Affiliation(s)
- Jun‐Meng Wang
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Yue‐Mei Wang
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Yuan‐Bing Zhu
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Chan Cui
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Tong Feng
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Qin Huang
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Shu‐Qing Liu
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
| | - Qiao‐Feng Wu
- Acupuncture and Moxibustion SchoolChengdu University of Traditional Chinese MedicineChengduChina
- Institute of Acupuncture and Homeostasis RegulationChengdu University of Traditional Chinese MedicineChengduChina
- Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of EducationChengduChina
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Zhang J, Liu C, An P, Chen M, Wei Y, Li J, Zeng S, Xiang D, Cai Y, Li J, Chen B, Cui L, Qian J, Liu Z, Jiang C, Shi J, Wu K, Dong W. Psychological symptoms and quality of life in patients with inflammatory bowel disease in China: A multicenter study. United European Gastroenterol J 2024; 12:374-389. [PMID: 38315582 PMCID: PMC11017770 DOI: 10.1002/ueg2.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024] Open
Abstract
AIMS To investigate the current situation of mental psychology and quality of life (QoL) in patients with inflammatory bowel disease (IBD) in China, and analyze the influencing factors. METHODS A unified questionnaire was developed to collect clinical data on IBD patients from 42 hospitals in 22 provinces from September 2021 to May 2022. Multivariate Logistic regression analysis was conducted, and independent influencing factors were screened out to construct nomogram. The consistency index (C-index), receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, accuracy, and clinical utility of the nomogram model. RESULTS A total of 2478 IBD patients were surveyed, including 1371 patients with ulcerative colitis (UC) and 1107 patients with Crohn's disease (CD). Among them, 25.5%, 29.7%, 60.2%, and 37.7% of IBD patients had anxiety, depression, sleep disturbance and poor QoL, respectively. The proportion of anxiety, depression, and poor QoL in UC patients was significantly higher than that in CD patients (all p < 0.05), but there was no difference in sleep disturbance between them (p = 0.737). Female, higher disease activity and the first visit were independent risk factors for anxiety, depression and sleep disturbance in IBD patients (all p < 0.05). The first visit, higher disease activity, abdominal pain and diarrhea symptoms, anxiety, depression and sleep disturbance were independent risk factors for the poor QoL of patients (all p < 0.05). The AUC value of the nomogram prediction model for predicting poor QoL was 0.773 (95% CI: 0.754-0.792). The calibration diagram of the model showed that the calibration curve fit well with the ideal curve, and DCA showed that the nomogram model could bring clinical benefits. CONCLUSION IBD patients have higher anxiety, depression, and sleep disturbance, which affect their QoL. The nomogram prediction model we constructed has high accuracy and performance when predicting QoL.
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Affiliation(s)
- Jixiang Zhang
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Chuan Liu
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Ping An
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Min Chen
- Department of GastroenterologyXijing HospitalAir Force Medical UniversityXi'anChina
| | - Yuping Wei
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Jinting Li
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Suqi Zeng
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Dan Xiang
- Center for Mental HealthRenmin Hospital of Wuhan UniversityWuhanChina
| | - Yanhui Cai
- Department of PsychiatryXijing HospitalAir Force Medical UniversityXi'anChina
| | - Jun Li
- Department of GastroenterologyPeking University Third HospitalBeijingChina
| | - Baili Chen
- Department of GastroenterologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Liqian Cui
- Department of Clinical PsychologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jiaming Qian
- Department of GastroenterologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhongchun Liu
- Center for Mental HealthRenmin Hospital of Wuhan UniversityWuhanChina
| | - Changqing Jiang
- Department of Clinical PsychologyBeijing Anding HospitalCapital Medical UniversityBeijingChina
| | - Jie Shi
- Department of Medical PsychologyChinese People's Liberation Army Rocket Army Characteristic Medical CenterBeijingChina
| | - Kaichun Wu
- Department of GastroenterologyXijing HospitalAir Force Medical UniversityXi'anChina
| | - Weiguo Dong
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
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Schleef J, Castellanos-Alvarenga LM, Olivera MP, Ortiz MS. Disentangling between-person and within-person associations of physical symptoms of depression with self-perceived health and life satisfaction: A longitudinal study in Chilean adults. J Health Psychol 2024:13591053241229533. [PMID: 38433616 DOI: 10.1177/13591053241229533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Depression is a major health problem in Chile. Evidence suggests that physical symptoms of depression (PSD) negatively impact self-perceived health and life satisfaction. The aim of this study was to determine the between-person and within-person associations of PSD with self-perceived health and life satisfaction in Chilean adults. The sample consisted of 1424 participants (64.54% female; Mage = 46.77, SD = 14.88) with data in five waves of the Social Longitudinal Study of Chile. Variables were measured through self-report questionnaires. Hypotheses were tested using multilevel analysis. At the within-person level, physical slowing, fatigue, and sleep problems were associated with poorer self-perceived health and lower life satisfaction. At the between-person level, physical slowing and fatigue were associated with poorer perceived health and lower life satisfaction. PSD are associated with self-perceived health and life satisfaction in Chilean adults longitudinally. The study highlights the importance of monitoring PSD changes in Chilean adults.
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Affiliation(s)
- Jorge Schleef
- Departamento de Psicología, Universidad de La Frontera, Chile
| | | | - Mauro P Olivera
- Departamento de Psicología, Universidad de La Frontera, Chile
| | - Manuel S Ortiz
- Departamento de Psicología, Universidad de La Frontera, Chile
- Laboratorio de Estrés y Salud, Chile
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Singh A, Bhardwaj A, Tripathi A, Ranjan MK, Singh D, Sachdeva A, Marwah M, Sadana KS, Bansal N, Mahajan R, Kaur K, Midha V, Sood A. Burden of Anxiety, Depression and Perceived Stress in Patients with Inflammatory Bowel Disease: A Cohort Study from North India. Dig Dis Sci 2024; 69:775-790. [PMID: 38282185 DOI: 10.1007/s10620-023-08242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patients with Inflammatory bowel disease (IBD) are susceptible to psychiatric co-morbidities. We aimed to ascertain the burden of anxiety, depression, and perceived stress in patients with IBD from north India. METHODS Consenting adult patients with an established diagnosis of IBD were enrolled. The enrolled patients filled the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS) questionnaires. The patient and disease characteristics were analyzed to determine the correlations and predictors of psychiatric comorbidities. RESULTS A total of 318 patients (255 UC, 63 CD; mean age 40.13 ± 12.06 years, 168 [52.8%] males; mean partial Mayo score 2.10 ± 2.35; and mean HBI 2.77 ± 2.13) were enrolled. The prevalence of anxiety, depression and moderate to high perceived stress was 14%, 12%, and 41%, respectively. Females had higher mean perceived stress, anxiety and depression scores compared to males. The partial Mayo score (PMS) correlated poorly with anxiety (ρ = 0.083, p = 0.187), depression (ρ = 0.123, p = 0.49) and perceived stress (ρ = 0.169; p = 0.007). The Harvey Bradshaw index (HBI) correlated fairly with anxiety (ρ = 0.336, p = 0.007) and poorly with depression (ρ = 0.287, p = 0.022) and perceived stress (ρ = 0.20; p = 0.117). Younger age (OR 0.93, 95% CI 0.90-0.97; p = 0.001) and hand-grip strength (OR 4.63, 95% CI 1.88-11.42; p = 0.001) predicted anxiety in patients with UC while rural area of residence (OR 4.75, 95% CI 1.03-21.98; p = 0.046) and HBI (OR 1.60, 95% CI 1.12-2.29; p = 0.009) were significant predictors of anxiety in patients with CD. CONCLUSION Psychiatric comorbidities are common in patients with IBD, with higher prevalence in females. Young adults with UC and sarcopenia; and individuals with active CD living in rural areas are at an increased risk of anxiety.
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Affiliation(s)
- Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India
| | - Arshia Bhardwaj
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India
| | - Ashish Tripathi
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Dharmatma Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India
| | - Ashi Sachdeva
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Mahima Marwah
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kriti Sood Sadana
- Department of Pediatrics, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Namita Bansal
- Research and Development Centre, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, 141001, India.
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10
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Delprete C, Rimondini Giorgini R, Lucarini E, Bastiaanssen T, Scicchitano D, Interino N, Formaggio F, Uhlig F, Ghelardini C, Hyland N, Cryan J, Liguori R, Candela M, Fiori J, Turroni S, Di Cesare Mannelli L, Caprini M. Disruption of the microbiota-gut-brain axis is a defining characteristic of the α-Gal A (-/0) mouse model of Fabry disease. Gut Microbes 2023; 15:2256045. [PMID: 37712629 PMCID: PMC10506438 DOI: 10.1080/19490976.2023.2256045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
Fabry disease (FD) is an X-linked metabolic disease caused by a deficiency in α-galactosidase A (α-Gal A) activity. This causes accumulation of glycosphingolipids, especially globotriaosylceramide (Gb3), in different cells and organs. Neuropathic pain and gastrointestinal (GI) symptoms, such as abdominal pain, nausea, diarrhea, constipation, and early satiety, are the most frequent symptoms reported by FD patients and severely affect their quality of life. It is generally accepted that Gb3 and lyso-Gb3 are involved in the symptoms; nevertheless, the origin of these symptoms is complex and multifactorial, and the exact mechanisms of pathogenesis are still poorly understood. Here, we used a murine model of FD, the male α-Gal A (-/0) mouse, to characterize functionality, behavior, and microbiota in an attempt to elucidate the microbiota-gut-brain axis at three different ages. We provided evidence of a diarrhea-like phenotype and visceral hypersensitivity in our FD model together with reduced locomotor activity and anxiety-like behavior. We also showed for the first time that symptomology was associated with early compositional and functional dysbiosis of the gut microbiota, paralleled by alterations in fecal short-chain fatty acid levels, which partly persisted with advancing age. Interestingly, most of the dysbiotic features suggested a disruption of gut homeostasis, possibly contributing to accelerated intestinal transit, visceral hypersensitivity, and impaired communication along the gut-brain axis.
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Affiliation(s)
- C. Delprete
- Laboratory of Human and General Physiology, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - R. Rimondini Giorgini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - E. Lucarini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, Pharmacology and ToxicoKGMI_A_2256045logy Section, University of Florence, Florence, Italy
| | - T.F.S. Bastiaanssen
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - D. Scicchitano
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - N. Interino
- Complex Operational Unit Clinica Neurologica, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - F. Formaggio
- Laboratory of Human and General Physiology, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - F. Uhlig
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Physiology, University College Cork, Cork, Ireland
| | - C. Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, Pharmacology and ToxicoKGMI_A_2256045logy Section, University of Florence, Florence, Italy
| | - N.P. Hyland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Physiology, University College Cork, Cork, Ireland
| | - J.F. Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - R. Liguori
- Complex Operational Unit Clinica Neurologica, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, ltaly
| | - M. Candela
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - J. Fiori
- Complex Operational Unit Clinica Neurologica, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Chemistry “G. Ciamician”, University of Bologna, Bologna, Italy
| | - S. Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - L. Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, Neurofarba, Pharmacology and ToxicoKGMI_A_2256045logy Section, University of Florence, Florence, Italy
| | - M. Caprini
- Laboratory of Human and General Physiology, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
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11
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Wang J, Liu G, Xu K, Ai K, Huang W, Zhang J. The role of neurotransmitters in mediating the relationship between brain alterations and depressive symptoms in patients with inflammatory bowel disease. Hum Brain Mapp 2023; 44:5357-5371. [PMID: 37530546 PMCID: PMC10543356 DOI: 10.1002/hbm.26439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
A growing body of evidence from neuroimaging studies suggests that inflammatory bowel disease (IBD) is associated with functional and structural alterations in the central nervous system and that it has a potential link to emotional symptoms, such as anxiety and depression. However, the neurochemical underpinnings of depression symptoms in IBD remain unclear. We hypothesized that changes in cortical gamma-aminobutyric acid (GABA+) and glutamine (Glx) concentrations are related to cortical thickness and resting-state functional connectivity in IBD as compared to healthy controls. To test this, we measured whole-brain cortical thickness and functional connectivity within the medial prefrontal cortex (mPFC), as well as the concentrations of neurotransmitters in the same brain region. We used the edited magnetic resonance spectroscopy (MRS) with the MEGA-PRESS sequence at a 3 T scanner to quantitate the neurotransmitter levels in the mPFC. Subjects with IBD (N = 37) and healthy control subjects (N = 32) were enrolled in the study. Compared with healthy controls, there were significantly decreased GABA+ and Glx concentrations in the mPFC of patients with IBD. The cortical thickness of patients with IBD was thin in two clusters that included the right medial orbitofrontal cortex and the right posterior cingulate cortex. A seed-based functional connectivity analysis indicated that there was higher connectivity of the mPFC with the left precuneus cortex (PC) and the posterior cingulate cortex, and conversely, lower connectivity in the left frontal pole was observed. The functional connectivity between the mPFC and the left PC was negatively correlated with the IBD questionnaire score (r = -0.388, p = 0.018). GABA+ concentrations had a negative correlation with the Hamilton Depression Scale (HAMD) score (r = -0.497, p = 0.002). Glx concentration was negatively correlated with the HAMD score (r = -0.496, p = 0.002) and positively correlated with the Short-Form McGill Pain Questionnaire score (r = 0.330, p = 0.046, uncorrected). There was a significant positive correlation between the ratio of Glx to GABA+ and the HAMD score (r = 0.428, p = 0.008). Mediation analysis revealed that GABA+ significantly mediated the main effect of the relationship between the structural and functional alterations and the severity of depression in patients with IBD. Our study provides initial evidence of neurochemistry that can be used to identify potential mechanisms underlying the modulatory effects of GABA+ on the development of depression in patients with IBD.
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Affiliation(s)
- Jun Wang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Guangyao Liu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Kun Xu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Kai Ai
- Deparment of Clinical and Technical Support, Philips HealthcareXi'anChina
| | - Wenjing Huang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Jing Zhang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
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12
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Milo F, Angelino G, Romeo EF, De Angelis P, Tabarini P. Depression symptoms increase the risk for initiation or switching to biologic therapy in pediatric inflammatory bowel disease patients in remission. BMC Gastroenterol 2023; 23:355. [PMID: 37833631 PMCID: PMC10571381 DOI: 10.1186/s12876-023-02993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/11/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIMS Anxiety and depression symptoms are common in IBD population, both adult and pediatric patients. Increased psychological distress might contribute to initiation and switching to biologic therapy in adult patients with IBD or other chronic inflammatory diseases. Aim of the present study are to evaluate anxiety and depression symptoms in IBD pediatric patients with disease remission and investigate their role in initiation or switching to biologic therapy. METHODS We performed a retrospective analysis on IBD pediatric patients, assessing for anxiety (GAD-7) and depression (PHQ-9) symptoms. Demographic and disease characteristics were obtained from medical records. RESULTS Eighty-six patients [31 (36%) females - mean age = 15.6 (SD = 2.8) years] were included. Patients scored above cut-off (> 10) on PHQ-9 and GAD-7 were 17 (19.7%) and 18 (20.9%), respectively. No differences were found between UC and CD patients. Baseline clinically relevant depression symptoms were significantly associated with the odds of initiating or switching to biologic therapy within 2 years [OR = 4.5 (1.4-14.3)], even after confounders adjustment [4.2 (1.2-14.9)]. Relationship was not significant with anxiety symptoms. CONCLUSION Anxiety and depression symptoms is relatively common in pediatric IBD population, even with disease remission. Pediatric IBD patients with high depression symptoms are at increased risk of initiating or switching to biologic therapy. Mental health screening programs should be incorporated in routine clinical practice, especially for depression, regardless of disease activity and disease type. Early diagnosis and proper intervention for mental illness should be part of routine IBD management.
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Affiliation(s)
- F Milo
- Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - G Angelino
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - E F Romeo
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P De Angelis
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P Tabarini
- Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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13
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Wang C, Sheng Y, Yu L, Tian F, Xue Y, Zhai Q. Effects of cognitive behavioral therapy on mental health and quality of life in inflammatory bowel disease patients: A meta-analysis of randomized controlled trials. Behav Brain Res 2023; 454:114653. [PMID: 37657513 DOI: 10.1016/j.bbr.2023.114653] [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] [Received: 02/16/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
We aim to assess the roles of cognitive behavioral therapy (CBT) in improving quality of life (QoL) and mental health in inflammatory bowel disease (IBD) patients. In this study, PubMed, Web of Science, PsycINfO, and the Cochrane Library databases were used for locating proper randomized controlled trials (RCTs) (to October 2022). IBD Questionnaire (IBDQ), Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and Hospital Anxiety and Depression Scale-Depression Scale (HADS-D) were selected for analysis. Finally, nine eligible RCTs were included in this study. The analysis of these RCTs showed that CBT significantly increased IBDQ scores (standardized mean difference (SMD): 0.26, 95% confidence interval (CI): [0.05, 0.47], p = 0.02), decreased HADS-A (SMD: -0.25, 95% CI: [-0.45, -0.05], p = 0.01), HADS-D (SMD: -0.17, 95% CI: [-0.31, -0.02], p = 0.02) scores. The result of subgroup analysis, based on treatment duration, showed that long-term CBT (≥ 12 weeks; SMD: 0.23, 95% CI: [0.05, 0.41]; p = 0.01; I2 = 28%) increased IBDQ scores. Thus, CBT is helpful for alleviating anxiety, depression and enhancing QoL in IBD patients.
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Affiliation(s)
- Chen Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, PR China; College of Food Science, Southwest University, Chongqing 400715, PR China
| | - Yingyue Sheng
- Department of Gastroenterology, Affiliated hospital of Jiangnan University, Wuxi, Jiangsu, PR China
| | - Leilei Yu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, PR China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, PR China
| | - Fengwei Tian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, PR China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, PR China
| | - Yuzheng Xue
- Department of Gastroenterology, Affiliated hospital of Jiangnan University, Wuxi, Jiangsu, PR China.
| | - Qixiao Zhai
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, PR China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, PR China.
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14
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Matsumoto T, Imai K, Goda Y, Fujimitsu Y, Kajioka T, Kihara H, Funaki Y, Imaki S, Ueno M. Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn's Disease, Ulcerative Colitis, Patients Survey. CROHN'S & COLITIS 360 2023; 5:otad069. [PMID: 38028953 PMCID: PMC10676197 DOI: 10.1093/crocol/otad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background/Aims The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey. Methods Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences. Results Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred. Conclusions Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Keita Imai
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Goda
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Fujimitsu
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | | | - Hideaki Kihara
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuji Funaki
- Department of Integrated Marketing, EA Pharma Co., Ltd., Tokyo, Japan
| | - Shigeru Imaki
- Department of Corporate Communication, EA Pharma Co., Ltd., Tokyo, Japan
| | - Masato Ueno
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
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15
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Graff LA, Geist R, Kuenzig ME, Benchimol EI, Kaplan GG, Windsor JW, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Peña-Sánchez JN, Targownik LE, Jannati N, Jones May T, Akhtar Sheekha T, Davis T, Weinstein J, Dahlwi G, Im JHB, Amankwah Osei J, Rohatinsky N, Ghandeharian S, Goddard Q, Gorospe J, Gertsman S, Louis M, Wagner R, Brass C, Sanderson R, Bernstein CN. The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:S64-S75. [PMID: 37674499 PMCID: PMC10478810 DOI: 10.1093/jcag/gwad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.
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Affiliation(s)
- Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tyrel Jones May
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tasbeen Akhtar Sheekha
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ghaida Dahlwi
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shira Gertsman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Richelle Wagner
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Lee K, Kumazoe M, Marugame Y, Fujimura Y, Tachibana H. Dextran sulfate sodium-induced mild chronic colitis induced cognitive impairment accompanied by inhibition of neuronal maturation in adolescent mice. Biochem Biophys Res Commun 2023; 669:46-53. [PMID: 37262952 DOI: 10.1016/j.bbrc.2023.05.112] [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] [Received: 05/17/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Epidemiological studies indicated that inflammatory bowel disease (IBD), with Crohn's disease and ulcerative colitis as its two main types, is associated with dementia. However, little is known about how adolescents with IBD will affect their cognitive ability as adults. The hippocampus, which is crucial for memory and adult neurogenesis, is closely associated with modulation of cognitive processes. Using a low kDa dextran sulfate sodium (DSS, 5 kDa)-induced chronic colitis (mild chronic colitis) mice model in adolescent mice, we investigated the effects of mild chronic colitis on cognitive functions and hippocampal neurogenesis from adolescent mice to adult mice. METHODS We induced DSS-induced mild chronic colitis in C57BL/6J male mice by multiple-cycle administration of 1%-2% DSS in autoclaved drinking water. Mice were subjected to novel-object recognition and Y-maze tests. Neurogenesis markers and neuroinflammation-related proteins in the hippocampus of mice were measured. Tight junction proteins in the colon of mice were measured. RESULTS Mild chronic colitis induced cognitive impairment and decreased adult neurogenesis. Notably, we found a positive correlation with the protein levels between tight junction protein, ZO-1, in the colon and mature neuron marker, NeuN, in the hippocampus. Moreover, mild chronic colitis leads to hippocampal neuroinflammation in adolescent mice. CONCLUSION Our findings provide new evidence of the association between IBD and dementia risk.
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Affiliation(s)
- Kwanwoo Lee
- Division of Applied Biological Chemistry, Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Fukuoka, 819-0395, Japan
| | - Motofumi Kumazoe
- Division of Applied Biological Chemistry, Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Fukuoka, 819-0395, Japan
| | - Yuki Marugame
- Division of Applied Biological Chemistry, Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Fukuoka, 819-0395, Japan
| | - Yoshinori Fujimura
- Division of Applied Biological Chemistry, Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Fukuoka, 819-0395, Japan
| | - Hirofumi Tachibana
- Division of Applied Biological Chemistry, Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Fukuoka, 819-0395, Japan.
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17
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Zhou S, Yu J. Crohn's disease and breast cancer: a literature review of the mechanisms and treatment. Intern Emerg Med 2023; 18:1303-1316. [PMID: 37138170 PMCID: PMC10412481 DOI: 10.1007/s11739-023-03281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
This is a literature review describes Crohn's disease (CD) concomitant with breast cancer and summarizes possible common pathogenic mechanisms shared by the two diseases involving the IL-17 and NF-κB signaling pathways. Inflammatory cytokines including TNF-α and Th17 cells in CD patients can induce activation of the ERK1/2, NF-κB and Bcl-2 pathways. Hub genes are involved in the generation of cancer stem cells (CSCs) and are related to inflammatory mediators, including CXCL8, IL1-β and PTGS2, which promote inflammation and breast cancer growth, metastasis, and development. CD activity is highly associated with altered intestinal microbiota processes, including secretion of complex glucose polysaccharides by Ruminococcus gnavus colonies; furthermore, γ-proteobacteria and Clostridium are associated with CD recurrence and active CD, while Ruminococcaceae, Faecococcus and Vibrio desulfuris are associated with CD remission. Intestinal microbiota disorder promotes breast cancer occurrence and development. Bacteroides fragilis can produce toxins that induce breast epithelial hyperplasia and breast cancer growth and metastasis. Gut microbiota regulation can also improve chemotherapy and immunotherapy efficacy in breast cancer treatment. Intestinal inflammation can affects the brain through the brain-gut axis, which activates the hypothalamic‒pituitary‒adrenal (HPA) axis to induce anxiety and depression in patients; these effects can inhibit the antitumor immune responses of the immune system and promote breast cancer occurrence in patients with CD. There are few studies on the treatment of patients with CD concomitant with breast cancer, but published studies show three main strategies: new biological agents combined with breast cancer treatment methods, intestinal fecal bacteria transplantation, and dietary treatment.
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Affiliation(s)
- Sisi Zhou
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Jing Yu
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
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18
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Duan S, Yang Y, Cao Y, Chen P, Liang C, Zhang Y. Symptoms of anxiety and depression associated with steroid efficacy and clinical outcomes in patients with inflammatory bowel disease. Front Psychiatry 2023; 14:1029467. [PMID: 37547213 PMCID: PMC10400767 DOI: 10.3389/fpsyt.2023.1029467] [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] [Received: 08/27/2022] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Background Anxiety and depression symptoms are very common in patients with inflammatory bowel disease (IBD). We aimed to explore the impact of anxiety and depression on the efficacy of medications, as well as IBD-related poor outcomes. Method This was a prospective longitudinal observational study. Hospital Anxiety and Depression Scale was used to assess anxiety and depression symptoms. Logistic regression analyses were used to assess the association between anxiety/depression and the response to different medications. Kaplan-Meier survival analysis and Cox regression model were applied to analyze the relationship between anxiety/depression and IBD-related poor outcomes, which were defined as urgent IBD-related hospitalization, IBD-related surgery, or death. Results A total of 325 IBD patients were enrolled, 118 of whom were treated with corticosteroids, 88 with azathioprine/6-mercaptopurine (AZA/6-MP), and 147 with anti-TNF agents. Anxiety/depression symptoms were found to be significantly related to steroid resistance, but independent of AZA/6-MP and anti-TNF agents nonresponse. There was a significant association between anxiety/depression symptoms and IBD-related poor outcomes. Coexisting with anxiety/depression symptoms was an independent influencing factor of steroid resistance and IBD-related poor outcomes. Conclusion IBD patients with anxiety/depression symptoms were at a higher risk of developing steroid resistance and IBD-related poor outcomes. Future studies are needed to explore whether interventions for anxiety and depression will improve their response to medications and change their prognosis.
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Kim JS, Chen MH, Wang HE, Lu CL, Wang YP, Zhang B. Inflammatory Bowel Disease and Neurodegenerative Diseases. Gut Liver 2023; 17:495-504. [PMID: 36843420 PMCID: PMC10352055 DOI: 10.5009/gnl220523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 02/28/2023] Open
Abstract
A growing body of evidence has demonstrated an intricate association between inflammatory bowel disease (IBD) and neurodegenerative conditions, expanding beyond previous foci of comorbidities between IBD and mood disorders. These new discoveries stem from an improved understanding of the gut-microbiome-brain axis: specifically, the ability of the intestinal microbiota to modulate inflammation and regulate neuromodulatory compounds. Clinical retrospective studies incorporating large sample sizes and population-based cohorts have demonstrated and confirmed the relevance of IBD and chronic neurodegeneration in clinical medicine. In this review, we expound upon the current knowledge on the gut-microbiome-brain axis, highlighting several plausible mechanisms linking IBD with neurodegeneration. We also summarize the known associations between IBD with Parkinson disease, Alzheimer disease, vascular dementia and ischemic stroke, and multiple sclerosis in a clinical context. Finally, we discuss the implications of an improved understanding of the gut-microbiome-brain axis in preventing, diagnosing, and managing neurodegeneration among IBD and non-IBD patients.
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Affiliation(s)
- Jin Sun Kim
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hohui E. Wang
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Ching-Liang Lu
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Po Wang
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhang
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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20
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Gravina AG, Pellegrino R, Palladino G, Coppola A, Brandimarte G, Tuccillo C, Ciardiello F, Romano M, Federico A. Hericium erinaceus, in combination with natural flavonoid/alkaloid and B 3/B 8 vitamins, can improve inflammatory burden in Inflammatory bowel diseases tissue: an ex vivo study. Front Immunol 2023; 14:1215329. [PMID: 37465689 PMCID: PMC10350490 DOI: 10.3389/fimmu.2023.1215329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
Hericium erinaceus, berberine, and quercetin are effective in experimental colitis. It is unknown whether they can ameliorate inflammatory bowel diseases in humans. This ex vivo study aimed to evaluate the anti-inflammatory potential of a nutraceutical compound of HBQ-Complex® (H. erinaceus, berberine, and quercetin), biotin, and niacin in inflammatory bowel disease patients. Tissue specimens were obtained either from Normal-Appearing Mucosa (NAM) or from Inflamed Mucosa (IM) in 20 patients with inflammatory bowel disease. mRNA and protein expression of COX-2, IL-10, and TNF-α were determined in NAM and IM biopsy samples (T0). IM samples were then incubated in HBQ-Complex® (with the addition of niacin and biotin), and COX-2, IL-10, and TNF-α tissue levels were evaluated at 120 minutes (T1) and 180 minutes (T2). Incubation with this compound resulted in a progressive decrease in gene and protein COX-2 and TNF-α expression at T1/T2 in the IM. IL-10 showed an opposite trend, with a progressive increase of mRNA and protein expression over the same time window. HBQ-Complex® (with the addition of niacin and biotin) decreased the expression of proinflammatory cytokines at the mRNA and protein levels in IBD tissue. On the contrary, mRNA and protein expression of the anti-inflammatory cytokine IL-10 showed a progressive increase.
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Affiliation(s)
- Antonietta Gerarda Gravina
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Pellegrino
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanna Palladino
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annachiara Coppola
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Concetta Tuccillo
- Medical Oncology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fortunato Ciardiello
- Medical Oncology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Romano
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessandro Federico
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Iordache MM, Belu AM, Vlad SE, Aivaz KA, Dumitru A, Tocia C, Dumitru E. Calprotectin, Biomarker of Depression in Patients with Inflammatory Bowel Disease? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1240. [PMID: 37512053 PMCID: PMC10383955 DOI: 10.3390/medicina59071240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Calprotectin is a marker for intestinal inflammation. Recent research suggests a link between inflammation and depression. This study assessed the association between the levels of calprotectin in patients from South-Eastern Europe and the severity of depression, anxiety, and quality of life. Materials and Methods: This cross-sectional study included 30 confirmed patients with Crohn's disease (CD) and ulcerative colitis (UC) who were assessed using clinical interviews for determining the severities of mental disorders (i.e., depression severity-PHQ-9, anxiety-GAD-7) and the quality of life (EQ-5D). Stool samples were collected from all participants for measuring their levels of calprotectin. Results: The level of calprotectin is correlated with PHQ-9 (ρ = 0.416, p = 0.022) and EQ-5D (ρ = -0.304, p = 0.033) but not with GAD 7 (ρ = 0.059, p = 0.379). Calprotectin levels in patients with mild, moderate, and moderately severe depression were significantly higher than in patients with minimal depression (198 µg/g vs. 66,9 µg/g, p = 0.04). Calprotectin level was corelated with the following depressive symptoms: autolytic ideation (ρ = 0.557, p = 0.001), fatigue (ρ = 0.514, p = 0.002), slow movement (ρ = 0.490, p = 0.003), and sleep disorders (ρ = 0.403, p = 0.014). Calprotectin was an independent predictor of depression with an odds ratio of 1.01 (95%: 1.002-1.03, p < 0.01). An ROC analysis showed that a level of calprotectin of 131 µg/g or higher has a sensitivity of 82%, a specificity of 61%, and an accuracy of 70% for predicting depression. In this study, no significant correlations were found between calprotectin level and anxiety. Conclusions: Calprotectin levels are associated with the severity of depression, and checking for a calprotectin level of 131 µg/g or higher may be a potential accessible screening test for depression in patients with inflammatory bowel disease.
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Affiliation(s)
- Miorita Melina Iordache
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- Prof. Alexandru Obregia Psychiatry Hospital, 10 Berceni Str., 041914 Bucharest, Romania
| | - Anca Mihaela Belu
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Sabina E Vlad
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, "Ovidius" University of Constanta, 900591 Constanta, Romania
| | - Kamer Ainur Aivaz
- Faculty of Economics, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Andrei Dumitru
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Cristina Tocia
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, "Ovidius" University of Constanta, 900591 Constanta, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 050045 Bucharest, Romania
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Fracas E, Costantino A, Vecchi M, Buoli M. Depressive and Anxiety Disorders in Patients with Inflammatory Bowel Diseases: Are There Any Gender Differences? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6255. [PMID: 37444101 PMCID: PMC10340762 DOI: 10.3390/ijerph20136255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/11/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
Gender differences were identified in the frequency and clinical presentations of inflammatory bowel disease (IBD) and depressive and anxiety disorders, which are more common in IBD patients than in the general population. The present manuscript provides a critical overview of gender differences in the frequency and clinical course of mood and anxiety disorders in IBD patients, with the aim of helping clinicians provide individualized management for patients. All of the included studies found that IBD patients reported a higher frequency of depressive and anxiety disorders than the general population. These findings should encourage healthcare providers to employ validated tools to monitor the mental health of their IBD patients, such as the Patient Health Questionnaire (PHQ-9). In addition, most studies confirm that women with IBD are more likely than men to develop affective disorders and show that up to 65% of women with IBD have depressive and anxiety disorders. Women with IBD require close mental health monitoring and ultimately a multidisciplinary approach involving mental health professionals. Drug treatment in women should be individualized and medications that may affect mental health (e.g., corticosteroids) should be thoroughly reconsidered. Further data are needed to ensure individualized treatment for IBD patients in a framework of precision medicine.
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Affiliation(s)
- Elia Fracas
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (E.F.); (A.C.); (M.V.)
| | - Andrea Costantino
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (E.F.); (A.C.); (M.V.)
- Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (E.F.); (A.C.); (M.V.)
- Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (E.F.); (A.C.); (M.V.)
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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23
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Yu R, Liu C, Zhang J, Li J, Tian S, Ding F, Liu Z, Wang T, Liu Z, Jiang C, Shi J, Wu K, Dong W. Correlation Analysis Between Disease Activity and Anxiety, Depression, Sleep Disturbance, and Quality of Life in Patients with Inflammatory Bowel Disease. Nat Sci Sleep 2023; 15:407-421. [PMID: 37261369 PMCID: PMC10228587 DOI: 10.2147/nss.s407388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Objective To explore the correlation between disease activity and anxiety, depression, sleep quality, and quality of life in patients with inflammatory bowel disease (IBD). Methods The disease activity of IBD patients was evaluated by 66 gastroenterologists from 42 hospitals in 22 provinces in China from September 2021 to May 2022. Anxiety, depression, sleep quality and quality of life of IBD patients were investigated and statistically analyzed by different scales, including Generalized Anxiety Disorder 7-item Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and Inflammatory Bowel Disease Quality-of-Life Questionnaire (IBD-Q). Results A total of 2478 IBD patients were included, of which 1532 (61.8%) were in active stage and 946 (38.2%) were in remission. The proportions of active IBD with anxiety, depression, sleep disturbance, and poor quality of life were 29.5%, 29.7%, 71.1%, and 50.1%, respectively, while the proportions of remission IBD with anxiety, depression, sleep disturbance, and poor quality of life were 19.1%, 24.4%, 69.3%, and 17.4%, respectively. IBD patients who also had anxiety, depression, sleep disturbances and poor quality of life had 80 cases (8.46%) in remission and 114 cases (7.44%) in active stage, with 54 cases (9.18%) in mild activity, 51 cases (6.95%) in moderate activity and 9 cases (4.49%) in severe activity. IBD patients with different disease activity levels differed in GAD-7 scores, PHQ-9 scores, PSQI scores, and IBD-Q scores (all P<0.001). In IBD patients, anxiety, depression, and sleep disturbance, which interact with each other, can further aggravate their disease activity (all P<0.001). Conclusion Anxiety, depression, sleep disturbances, and quality of life are strongly correlated with disease activity in IBD patients, and IBD patients with psychological disturbances are most often in the active stage and have a poor quality of life.
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Affiliation(s)
- Rong Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Chuan Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Jixiang Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Jiao Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Shan Tian
- Department of Infectious Diseases, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People’s Republic of China
| | - Fugui Ding
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Zhengru Liu
- Department of Gastroenterology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, People’s Republic of China
| | - Ting Wang
- Department of Gastroenterology, First Affiliated Hospital of Hainan Medical College, Haikou, 570102, People’s Republic of China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Changqing Jiang
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, People’s Republic of China
| | - Jie Shi
- Department of Medical Psychology, Chinese People’s Liberation Army Rocket Army Characteristic Medical Center, Beijing, 100088, People’s Republic of China
| | - Kaichun Wu
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Weiguo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
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24
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Bisgaard TH, Allin KH, Elmahdi R, Jess T. The bidirectional risk of inflammatory bowel disease and anxiety or depression: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 83:109-116. [PMID: 37172544 DOI: 10.1016/j.genhosppsych.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) is associated with anxiety and depression, but the magnitude and directionality of risk remains uncertain. This study quantifies the risk of anxiety or depression following a diagnosis of IBD, and the risk of IBD in individuals with anxiety or depression, using population representative data. METHOD We performed a systematic literature search using MEDLINE and Embase and included unselected cohort studies reporting risk of anxiety or depression in patients with IBD or risk of IBD in patients with anxiety or depression. We undertook Random Effect Model meta-analysis to calculate pooled Hazard Ratios (HR) for the risk of anxiety and depression in IBD and subgroup meta-analysis to calculate risk by IBD subtype and in pediatric-onset IBD. RESULTS Nine studies were included; seven of which examined incidence of anxiety or depression among a total of >150,000 IBD patients. Meta-analysis showed an increased risk of both anxiety (HR: 1.48, 95% CI: 1.29-1.70) and depression (HR: 1.55, 95% CI: 1.35-1.78) following IBD diagnosis. Two studies investigating >400,000 individuals with depression showed a 2-fold increased risk of IBD. CONCLUSIONS The bidirectional association between IBD and anxiety and depression is clinically relevant and could indicate shared or mutually dependent disease mechanisms.
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Affiliation(s)
- Tania H Bisgaard
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
| | - Kristine H Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Rahma Elmahdi
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Lung and Infectious Disease Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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25
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Horrigan JM, Louis E, Spinelli A, Travis S, Moum B, Salwen-Deremer J, Halfvarson J, Panaccione R, Dubinsky MC, Munkholm P, Siegel CA. The Real-World Global Use of Patient-Reported Outcomes for the Care of Patients With Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2023; 5:otad006. [PMID: 36937140 PMCID: PMC10022710 DOI: 10.1093/crocol/otad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Indexed: 02/24/2023] Open
Abstract
Background Many patient-reported outcomes (PROs) have been developed for inflammatory bowel disease (IBD) without recommendations for clinical use. PROs differ from physician-reported disease activity indices; they assess patients' perceptions of their symptoms, functional status, mental health, and quality of life, among other areas. We sought to investigate the current global use and barriers to using PROs in clinical practice for IBD. Methods A cross-sectional survey was performed. An electronic questionnaire was sent to an international group of providers who care for patients with IBD. Results There were 194 respondents, including adult/pediatric gastroenterologists, advanced practice providers, and colorectal surgeons from 5 continents. The majority (80%) use PROs in clinical practice, 65% frequently found value in routine use, and 50% frequently found PROs influenced management. Thirty-one different PROs for IBD were reportedly used. Barriers included not being familiar with PROs, not knowing how to incorporate PRO results into clinical practice, lack of electronic medical record integration, and time constraints. Most (91%) agreed it would be beneficial to have an accepted set of consistently used PROs. The majority (60%) thought that there should be some cultural differences in PROs used globally but that PROs for IBD should be consistent around the world. Conclusions PROs are used frequently in clinical practice with wide variation in which are used and how they influence management. Education about PROs and how to use and interpret an accepted set of PROs would decrease barriers for use and allow for global harmonization.
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Affiliation(s)
- Jamie M Horrigan
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Edouard Louis
- Department of Gastroenterology, CHU Liège University Hospital, Liège, Belgium
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simon Travis
- Kennedy Institute of Rheumatology, Translational Gastroenterology Unit, and Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bjorn Moum
- Department of Gastroenterology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jessica Salwen-Deremer
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Department of Psychiatry, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marla C Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Corey A Siegel
- Address correspondence to: Corey A. Siegel, Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA ()
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Patel R, Marrie RA, Bernstein CN, Bolton JM, Graff LA, Marriott JJ, Figley CR, Kornelsen J, Mazerolle EL, Uddin MN, Fisk JD. Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease. Sci Rep 2023; 13:4317. [PMID: 36922532 PMCID: PMC10017678 DOI: 10.1038/s41598-023-31160-3] [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: 10/05/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal fluency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modified Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn's disease; mean (SD) age was 53.36 (13.95) years, and a high proportion were females (n = 58). As the risk score (FRS) increased, participants demonstrated lower performance in information processing speed (β = - 0.12; 95% CI - 0.24, - 0.006) and verbal learning (β = - 0.14; 95% CI - 0.28, - 0.01) at the 50th percentile. After adjusting for IBD type and disease activity, higher FRS remained associated with lower information processing speed (β = - 0.14; 95% CI - 0.27, - 0.065). Vascular comorbidity is associated with lower cognitive functioning in persons with IBD, particularly in the area of information processing speed. These findings suggest that prevention, identification, and treatment of vascular comorbidity in IBD may play a critical role for improving functional outcomes in IBD.
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Affiliation(s)
- Ronak Patel
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, PZ350-771 Bannatyne Ave., Winnipeg, MB, R3E 3N4, Canada.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley A Graff
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, PZ350-771 Bannatyne Ave., Winnipeg, MB, R3E 3N4, Canada
| | - James J Marriott
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R Figley
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Erin L Mazerolle
- Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Md Nasir Uddin
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
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Ma S, Wang W, Gong Q, Xiang D, Yao L, Xu S, Xie X, Wang H, Wang G, Yang J, Liu Z. Inflammatory bowel disease and the long-term risk of depression: A prospective cohort study of the UK biobank. Gen Hosp Psychiatry 2023; 82:26-32. [PMID: 36924701 DOI: 10.1016/j.genhosppsych.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Depression is more common in patients with chronic inflammatory diseases, but whether inflammatory bowel disease (IBD), a chronic, relapsing immune-mediated disease, is associated with a higher risk of depression remains uncertain. METHOD We studied 497,134 participants in the UK Biobank, including 3561 IBD patients. Multivariate Cox proportional risk models were constructed to investigate the risk associated with IBD and depression adjusting for potential confounding factors including sociodemographic, lifestyle, and family history variables. RESULTS The average age of participants was 56.54 ± 8.09 years; 54.3% were female and 90.4% were white. Over a mean follow-up period of 13.3 years, the cumulative incidence of depression was 8.2% (95% CI: 7.3%-9.1%) in IBD patients compared with 4.9% (95% CI: 4.9%-5.0%) in individuals without IBD. Compared with non-IBD participants, the adjusted hazard ratio (HR) for depression among IBD patients was 1.56 (95% CI: 1.39-1.76), with an adjusted HR of 1.54 (95% CI: 1.25-1.90) in Crohn's disease and 1.52 (95% CI: 1.30-1.78) in ulcerative colitis, respectively. CONCLUSION IBD patients had a significantly higher risk of depression than non-IBD participants after adjusting for multiple confounding factors. We recommend screening for depression in middle-aged adults with IBD and no established history of depression.
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Affiliation(s)
- Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuxian Xu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinhui Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Yang
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China.
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Li M, Tao Y, Sun Y, Wu J, Zhang F, Wen Y, Gong M, Yan J, Liang H, Bai X, Niu J, Miao Y. Constructing a prediction model of inflammatory bowel disease recurrence based on factors affecting the quality of life. Front Med (Lausanne) 2023; 10:1041505. [PMID: 36968835 PMCID: PMC10034041 DOI: 10.3389/fmed.2023.1041505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
AimThis study aimed to determine the factors affecting the quality of life of patients with inflammatory bowel disease (IBD) and to construct a disease recurrence prediction model based on these influencing factors.MethodsA prospective, single-center study in China was conducted between October 2020 and March 2021. The quality of life of patients was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ). Multiple stepwise regression analysis was used to analyze the factors influencing the quality of life of patients with IBD. The chi-square test and the point-biserial correlation analysis were performed to identify factors associated with clinical recurrence. A binary logistic regression model was constructed to predict the recurrence. The receiver operating characteristic curve was used to evaluate the prediction model. Patients with IBD from April 2021 to June 2021 were randomly included for model verification to evaluate the disease recurrence prediction model.ResultsThe average IBDQ score of patients with IBD was 172.2 ± 35.0 (decreased by 23.2%). The scores of all dimensions of the IBDQ were decreased, especially emotional function and systemic symptoms. Disease activity, age, extraintestinal manifestations (EIMs), and annual household income were important factors influencing the IBDQ scores of patients with ulcerative colitis, and these accounted for ~57.0% of the factors affecting the quality of life. Disease activity, EIMs, and occupational stress were important factors influencing the IBDQ scores of patients with Crohn's disease, and they accounted for approximately 75.1% of the factors affecting the quality of life. Annual household income, occupational stress, and IBDQ scores were independent risk factors for recurrence. The area under the curve of the recurrence prediction model was 81.1%. The sensitivity and specificity were 81.7 and 71.7%, respectively. The Youden index of the model was 0.534. The established recurrence prediction model has good discriminant validity in the validation cohort.ConclusionThe quality of life of patients with IBD was generally poor. The use of factors affecting the quality of life to predict disease recurrence has high predictive value and can support the management of IBD by selecting patients at a higher risk for relapse.
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Affiliation(s)
- Maojuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Yan Tao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Yang Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Jing Wu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Fengrui Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Yunling Wen
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Min Gong
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Jingxian Yan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Hao Liang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Xinyu Bai
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
| | - Junkun Niu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
- Junkun Niu
| | - Yinglei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, Yunnan, China
- *Correspondence: Yinglei Miao
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The microbiota-gut-brain axis in pathogenesis of depression: A narrative review. Physiol Behav 2023; 260:114056. [PMID: 36528127 DOI: 10.1016/j.physbeh.2022.114056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/22/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
The microbiota-gut-brain axis is a bidirectional regulatory pathway between the brain and the gastrointestinal tract, which plays an important role in maintain homeostasis. Gut microbiota could influence the behavior, cognition, stress response and others via the axis. Depression is a complex psychiatric disease, giving rise to heavy social health and economic burden. In recent years, studies have shown that the gut microbiota are closely linked to the pathophysiological processes of depression. In this article, the interaction and its underlying mechanisms between depression and gut microbiota were summarized.
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Liu C, Zhang J, Chen M, An P, Xiang J, Yu R, Zeng S, Wei S, Deng B, Liu Z, Jiang C, Shi J, Wu K, Dong W. Gender Differences in Psychological Symptoms and Quality of Life in Patients with Inflammatory Bowel Disease in China: A Multicenter Study. J Clin Med 2023; 12:jcm12051791. [PMID: 36902578 PMCID: PMC10002859 DOI: 10.3390/jcm12051791] [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: 01/22/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To explore the gender differences in the psychological symptoms, sleep quality, and quality of life of patients with inflammatory bowel disease (IBD). METHODS A unified questionnaire was developed to collect clinical data on the psychology and quality of life of IBD patients from 42 hospitals in 22 provinces in China from September 2021 to May 2022. The general clinical characteristics, psychological symptoms, sleep quality, and quality of life of IBD patients of different genders were analyzed via a descriptive statistical analysis. A multivariate logistic regression analysis was conducted, and independent influencing factors were screened to construct a nomogram to predict the quality of life. The consistency index (C-index), receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), and calibration curve were used to evaluate the discrimination and accuracy of the nomogram model. Decision curve analysis (DCA) was used to evaluate the clinical utility. RESULTS A total of 2478 IBD patients (1371 patients with ulcerative colitis (UC) and 1107 patients with Crohn's disease (CD)) were investigated, including 1547 males (62.4%) and 931 females (37.6%). The proportion of anxiety in females was significantly higher than in males (IBD: 30.5% vs. 22.4%, p < 0.001; UC: 32.4% vs. 25.1%, p = 0.003; CD: 26.8% vs. 19.9%, p = 0.013), and there were differences in the severity of anxiety between the genders (IBD: p < 0.001; UC: p < 0.001; CD: p = 0.050). The proportion of depression in females was higher than in males (IBD: 33.1% vs. 27.7%, p = 0.005; UC: 34.4% vs. 28.9%, p = 0.031; CD: 30.6% vs. 26.6%, p = 0.184), and there were differences in the severity of depression between the genders (IBD: p = 0.004; UC: p = 0.022; CD: p = 0.312). The proportion suffering from sleep disturbances among females was slightly higher than among males (IBD: 63.2% vs. 58.4%, p = 0.018; UC: 63.4% vs. 58.1%, p = 0.047; CD: 62.7% vs. 58.6%, p = 0.210), and the proportion of females with a poor quality of life was higher than that of males (IBD: 41.8% vs. 35.2%, p = 0.001; UC: 45.1% vs. 39.8%, p = 0.049; CD: 35.4% vs. 30.8%, p = 0.141). The AUC values of the female and male nomogram prediction models for predicting poor quality of life were 0.770 (95% CI: 0.7391-0.7998) and 0.771 (95% CI: 0.7466-0.7952), respectively. The calibration diagrams of the two models showed that the calibration curves fitted well with the ideal curve, and the DCA that showed nomogram models could bring clinical benefits. CONCLUSIONS There were significant gender differences in the psychological symptoms, sleep quality, and quality of life of IBD patients, suggesting that females need more psychological support. In addition, a nomogram model with high accuracy and performance was constructed to predict the quality of life of IBD patients of different genders, which is helpful for the timely clinical formulation of personalized intervention plans that can improve the prognosis of patients and save medical costs.
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Affiliation(s)
- Chuan Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jixiang Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Min Chen
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Ping An
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jiankang Xiang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Rong Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Suqi Zeng
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Shuchun Wei
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Beiying Deng
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Changqing Jiang
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Jie Shi
- Department of Medical Psychology, Chinese People’s Liberation Army Rocket Army Characteristic Medical Center, Beijing 100088, China
| | - Kaichun Wu
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
- Correspondence: (K.W.); (W.D.)
| | - Weiguo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Correspondence: (K.W.); (W.D.)
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Fons A, Kalisvaart K, Maljaars J. Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence. J Clin Med 2023; 12:jcm12020533. [PMID: 36675461 PMCID: PMC9860672 DOI: 10.3390/jcm12020533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty assessment methods, the prevalence of frailty, risk factors for frailty and the prognostic value of frailty in IBD. A scoping literature search was performed using the PubMed database. Frailty prevalence varied from 6% to 53.9%, depending on the population and frailty assessment method. Frailty was associated with a range of adverse outcomes, including an increased risk for all-cause hospitalization and readmission, mortality in non-surgical setting, IBD-related hospitalization and readmission. Therefore, frailty assessment should become integrated as part of routine clinical care for older patients with IBD.
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Affiliation(s)
- Anne Fons
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
- Correspondence: ; Tel.: +31-71-526-3507
| | - Kees Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
| | - Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Li Q, Meng F, Ma X, Sun Z, Dai J, Liu J, Li D, Cong P, Xu R, Zhao D, Wang W, Wang D, Liu C, Wang F, Li C, Lian H. The colonic interleukin-19 aggravates the dextran sodium sulfate/stress-induced comorbidities due to colitis and anxiety. Front Immunol 2023; 14:1153344. [PMID: 36936941 PMCID: PMC10018752 DOI: 10.3389/fimmu.2023.1153344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Comorbidities due to inflammatory bowel disease (IBD) and anxiety are commonly acknowledged; however, their underlying basis is unclear. In the current study, we first conducted a clinical retrospective analysis to identify the enhancive incidence rate of IBD before or after the epidemic of Corona Virus Disease 2019 (COVID-19), with higher Generalized Anxiety Disorder-7 (GAD-7), as well as poorer Gastrointestinal Quality of Life Index (GIQLI). Then, the dextran sodium sulfate (DSS) and chronic unpredictable stress (CUS)-induced IBD and anxiety comorbid models were established with the correlational relations between symptoms of IBD and anxiety-related behaviors. We found dysfunctional up-regulation of a new inflammatory factor interleukin (IL)-19 in the colon of DSS/CUS treated mice. Overexpression of IL-19 in colon induced anxious phenotypes, and accelerated the anxious condition and symptoms of colitis in the DSS/CUS model by promoting the expression of inducible nitric oxide synthase (iNOS), IL-1β, and IL-6 pro-inflammatory factors, and activating signal transducer and activator of transcription 3 (STAT3) signaling pathway in the colon. Furthermore, overexpression of IL-19 in the colon also reduced the expression levels of brain-derived neurotrophic factor (BDNF), extracellular signal-regulated kinase (ERK), and cAMP-response element binding protein (CREB) signaling pathways activity in the hippocampus. These results suggest that IL-19 was a pivotal player in DSS/CUS-induced comorbidities of colitis and anxiety with different signaling pathways for the colon and hippocampus, which provides a candidate gene to explore the pathophysiology of comorbidities due to colitis and anxiety.
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Affiliation(s)
- Qiongyu Li
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Fantao Meng
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Xiangxian Ma
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
- Department of Psychology, Binzhou Medical University Hospital, Binzhou, China
| | - Zhe Sun
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Juanjuan Dai
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
| | - Jing Liu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Dan Li
- College of Nursing, Binzhou Medical University, Binzhou, China
| | - Peijia Cong
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Ruixue Xu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Di Zhao
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Wentao Wang
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Dan Wang
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Cuilan Liu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Faxiang Wang
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- *Correspondence: Chen Li, ; Haifeng Lian, ; Faxiang Wang,
| | - Chen Li
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
- *Correspondence: Chen Li, ; Haifeng Lian, ; Faxiang Wang,
| | - Haifeng Lian
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
- Medical Research Center, Binzhou Medical University Hospital, Binzhou, China
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
- *Correspondence: Chen Li, ; Haifeng Lian, ; Faxiang Wang,
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The Interplay of Biopsychosocial Factors and Quality of Life in Inflammatory Bowel Diseases: A Network Analysis. J Clin Gastroenterol 2023; 57:57-65. [PMID: 34608023 DOI: 10.1097/mcg.0000000000001625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/06/2021] [Indexed: 12/14/2022]
Abstract
GOAL The aim of this study was to investigate the network of biopsychosocial factors and quality of life (QoL) in persons with inflammatory bowel diseases (IBDs) and explore the influence of psychological factors on the course of the disease. BACKGROUND QoL of persons with IBD depends on disease activity but also on numerous interacting psychosocial factors. The influence of psychosocial factors on the disease course in controversially discussed. MATERIALS AND METHODS In 2 independent IBD samples (sample 1: n=209, anonymous internet survey; sample 2: n=84, outpatients with active disease), we measured QoL, anxiety, depression, illness identity, self-esteem, loneliness, childhood trauma, and visceral sensitivity with questionnaires. In addition, fatigue, hemoglobin levels, and response to therapy were assessed in sample 2. We estimated multiple regularized partial correlation networks and conducted accuracy and stability tests of the networks. RESULTS In both samples, QoL had the strongest relationships with visceral sensitivity and the illness identity engulfment. Depression was the most central factor in the networks. Baseline depression scores, visceral sensitivity, and engulfment were associated with response to therapy in sample 2. CONCLUSIONS This first network study to assess the interplay between biopsychosocial factors and QoL in IBD reveals a comparable network structure in 2 samples. Results partly replicate findings from previous studies with regard to the importance of depression and yield information on the central role of the newly introduced concepts of illness identity and visceral sensitivity. Preliminary findings point to an influence of these parameters on the disease course, which indicates their role as a possible target in individualized therapy.
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Patel P, Ali H, Manickam S, Pamarthy R, Fatakhova K, Rajapakse R. Substance abuse and inpatient outcomes in inflammatory bowel disease hospitalizations in the United States: a propensity matched analysis. Ann Gastroenterol 2023; 36:32-38. [PMID: 36593809 PMCID: PMC9756027 DOI: 10.20524/aog.2022.0767] [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: 09/17/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic intestinal inflammation resulting in a genetically susceptible population. The present study aimed to look at the effect of substance abuse on IBD hospitalizations in the United States. Methods We identified primary IBD hospitalizations with substance abuse using the National Inpatient Sample database (2016-2019). A matched comparison cohort of IBD hospitalizations without substance abuse was identified by 1:N propensity score matching using the nearest-neighbor method, based on demographics, hospital-level factors, and comorbidities. Results We matched 4437 IBD hospitalizations with a diagnosis of substance abuse to 4528 hospitalizations without abuse. The median age was higher in the substance abuse group than no abuse (44 vs. 38 years, P<0.001). There was a higher prevalence of discharge to care facilities (2.9% vs. 2.2%) and against medical advice (4.9% vs. 1.8%) in the substance abuse group compared to the no abuse (P<0.001). The median length of hospital stays (LOS) (P=0.74) and hospitalization charge did not differ significantly (P=0.57). There was no significant difference in 30-day inpatient mortality among cohorts (adjusted hazard ratio 0.74, 95% confidence interval 0.32-1.81; P=0.54). There was a higher prevalence of psychoses (2.5% vs. 1.3%) and depression (18.8% vs. 15.7%) in IBD hospitalizations with substance abuse compared to those without abuse (P<0.001). Conclusions This study reports no difference in median LOS, hospitalization charge, or mortality risk in IBD hospitalizations based on substance abuse. There is a higher prevalence of psychoses and depression in IBD patients, requiring screening for substance abuse to improve overall outcomes.
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Affiliation(s)
- Pratik Patel
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, New York (Pratik Patel, Karina Fatakhova, Ramona Rajapakse)
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina (Hassam Ali, Swethaa Manickam, Rahul Pamarthy)
| | - Swethaa Manickam
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina (Hassam Ali, Swethaa Manickam, Rahul Pamarthy)
| | - Rahul Pamarthy
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina (Hassam Ali, Swethaa Manickam, Rahul Pamarthy)
| | - Karina Fatakhova
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, New York (Pratik Patel, Karina Fatakhova, Ramona Rajapakse)
| | - Ramona Rajapakse
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, New York (Pratik Patel, Karina Fatakhova, Ramona Rajapakse)
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35
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Liu C, Zhu S, Zhang J, Ren K, Li K, Yu J. Inflammatory bowel diseases, interleukin-6 and interleukin-6 receptor subunit alpha in causal association with cerebral cortical structure: a Mendelian randomization analysis. Front Immunol 2023; 14:1154746. [PMID: 37153572 PMCID: PMC10157470 DOI: 10.3389/fimmu.2023.1154746] [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: 01/31/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Background Neurological involvement and psychiatric manifestations have been documented in clinical cases of inflammatory bowel disease (IBD); however, the presence of a causal relationship remains elusive. The objective of this study is to investigate the modifications occurring in the cerebral cortex as a result of IBD. Methods A compendium of data extracted from a genome-wide association study (GWAS) involving a maximum of 133,380 European subjects. A series of Mendelian random analyses were applied to exclude heterogeneity and pleiotropy, ensuring the stability of the results. Results Neither IBDs nor inflammatory cytokines (IL-6/IL-6Rα) were found to have a significant causality with surface area (SA) and thickness (TH) at the global level. At the regional functional brain level, Crohn's disease (CD) significantly decreased the TH of pars orbitalis (β=-0.003mm, Se=0.001mm, pivw =4.85×10-4). IL-6 was observed to reduce the SA of middle temporal (β=-28.575mm2, Se=6.482mm2, pivw=1.04×10-5) and increase the TH of fusiform (β=0.008mm, Se=0.002mm, pivw=8.86×10-5) and pars opercularis (β=0.009mm, Se=0.002mm, pivw=2.34×10-4). Furthermore, a causal relationship between IL-6Rα and an increase in the SA of superior frontal (β=21.132mm2, Se=5.806mm2, pivw=2.73×10-4) and the TH of supramarginal (β=0.003mm, Se=0.0002mm, pivw=7.86×10-37). All results passed sensitivity analysis and no heterogeneity and pleiotropy were detected. Conclusion The correlation between IBD and changes in cerebral cortical structures implies the existence of a gut-brain axis at the organismal level. It is recommended that clinical patients with IBD prioritize long-term management of inflammation, as changes at the organismal level can lead to functional pathologies. Magnetic resonance imaging (MRI) may be considered as an additional screening option for IBD.
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Affiliation(s)
- Chunlong Liu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People’s Hospital, Anhui Medical University, Fuyang, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Jian Zhang
- Department of Neurosurgery, The Seventh Clinical College of China Medical University, Fushun, China
| | - Kuiwu Ren
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People’s Hospital, Anhui Medical University, Fuyang, China
| | - Kangkang Li
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People’s Hospital, Bengbu Medical College, Fuyang, China
| | - Jiangtao Yu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People’s Hospital, Anhui Medical University, Fuyang, China
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People’s Hospital, Bengbu Medical College, Fuyang, China
- *Correspondence: Jiangtao Yu,
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Arp L, Jansson S, Wewer V, Burisch J. Psychiatric Disorders in Adult and Paediatric Patients With Inflammatory Bowel Diseases - A Systematic Review and Meta-Analysis. J Crohns Colitis 2022; 16:1933-1945. [PMID: 35775920 DOI: 10.1093/ecco-jcc/jjac095] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammatory bowel diseases [IBD], which are associated with a high disease burden, are also reported to be accompanied by a high prevalence of psychiatric disorders. However, the literature on IBD and psychiatric disorders has not been reviewed. METHODS This systematic review followed the PRISMA guidelines, and its protocol was registered at PROSPERO [ID: CRD42020214359]. PubMed, Embase and PsycINFO were consulted for the literature search. Studies reporting on diagnosed psychiatric disorders in IBD were included. Pooled prevalence rates were calculated using random effects meta-analyses. Study quality was assessed using the Newcastle-Ottawa Scale [NOS]. RESULTS Sixty-nine studies were identified with an average cohort size of 60 114 patients. Pooled prevalence rates were: mood disorders, 10% (95% confidence interval [CI] = 7%; 15%); anxiety disorders, 12% [95% CI = 8%; 18%]; substance misuse, 3% [95% CI = 1%; 7%]; psychotic disorders, 2% [95% CI = 1%; 4%]; behavioural disorders, 1% [95% CI = 0%; 3%]; personality disorders, 3% [95% CI = 1%; 10%]; developmental disorders, 1% [95% CI = 0%; 3%]; and behavioural and emotional disorders with onset usually during childhood, 1% [95% CI = 1%; 3%]. All analyses had high statistical heterogeneity [I2 > 99%]. Seven studies reported an increased risk of suicide in IBD patients compared to controls. CONCLUSION The prevalence of psychiatric comorbidities was high [11-82%] in patients with IBD and was higher than in the background population. Addressing mental health problems in patients with IBD can improve their adherence to treatment and the somatic disease course and, consequently, reduce morbidity and mortality.
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Affiliation(s)
- Laura Arp
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Sabine Jansson
- Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,The Paediatric Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Vibeke Wewer
- Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,The Paediatric Department, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescent and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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37
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Martinez-De la Torre A, Perez-Cruz F, Weiler S, Burden AM. Comorbidity clusters associated with newly treated type 2 diabetes mellitus: a Bayesian nonparametric analysis. Sci Rep 2022; 12:20653. [PMID: 36450743 PMCID: PMC9712684 DOI: 10.1038/s41598-022-24217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with the development of chronic comorbidities, which can lead to high drug utilization and adverse events. We aimed to identify common comorbidity clusters and explore the progression over time in newly treated T2DM patients. The IQVIA Medical Research Data incorporating data from THIN, a Cegedim database of anonymized electronic health records, was used to identify all patients with a first-ever prescription for a non-insulin antidiabetic drug (NIAD) between January 2006 and December 2019. We selected 58 chronic comorbidities of interest and used Bayesian nonparametric models to identify disease clusters and model their progression over time. Among the 175,383 eligible T2DM patients, we identified the 20 most frequent comorbidity clusters, which were comprised of 14 latent features (LFs). Each LF was associated with a primary disease (e.g., 98% of patients in cluster 2, characterized by LF2, had congestive heart failure [CHF]). The presence of certain LFs increased the probability of having another LF active. For example, LF2 (CHF) frequently appeared with LFs related to chronic kidney disease (CKD). Over time, the clusters associated with cardiovascular diseases, such as CHF, progressed rapidly. Moreover, the onset of certain diseases led to further complications. Our models identified established T2DM complications and previously unknown connections, thus, highlighting the potential for Bayesian nonparametric models to characterize complex comorbidity patterns.
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Affiliation(s)
- Adrian Martinez-De la Torre
- grid.5801.c0000 0001 2156 2780Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
| | - Fernando Perez-Cruz
- grid.5801.c0000 0001 2156 2780Swiss Data Science Center, ETH Zurich and EPFL, Zurich, Switzerland ,grid.5801.c0000 0001 2156 2780Institute of Machine Learning, Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Stefan Weiler
- grid.5801.c0000 0001 2156 2780Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
| | - Andrea M. Burden
- grid.5801.c0000 0001 2156 2780Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
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Acute gut inflammation reduces neural activity and spine maturity in hippocampus but not basolateral amygdala. Sci Rep 2022; 12:20169. [PMID: 36418891 PMCID: PMC9684565 DOI: 10.1038/s41598-022-24245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Gastrointestinal tract (gut) inflammation increases stress and threat-coping behaviors, which are associated with altered activity in fear-related neural circuits, such as the basolateral amygdala and hippocampus. It remains to be determined whether inflammation from the gut affects neural activity by altering dendritic spines. We hypothesized that acute inflammation alters dendritic spines in a brain region-specific manner. Here we show that acute gut inflammation (colitis) evoked by dextran sodium sulfate (DSS) did not affect the overall spine density in the CA1 region of hippocampus, but increased the relative proportion of immature spines to mature spines on basal dendrites of pyramidal neurons. In contrast, in animals with colitis, no changes in spine density or composition on dendrites of pyramidal cells was observed in the basolateral amygdala. Rather, we observed decreased spine density on dendrites of stellate neurons, but not the relative proportions of mature vs immature spines. We used cFos expression evoked by the forced swim task as a measure of neural activity during stress and found no effect of DSS on the density of cFos immunoreactive neurons in basolateral amygdala. In contrast, fewer CA1 neurons expressed cFos in mice with colitis, relative to controls. Furthermore, CA1 cFos expression negatively correlated with active stress-coping in the swim task and was negatively correlated with gut inflammation. These data reveal that the effects of acute gut inflammation on synaptic remodeling depend on brain region, neuronal phenotype, and dendrite location. In the hippocampus, a shift to immature spines and hypoactivity are more strongly related to colitis-evoked behavioral changes than is remodeling in basolateral amygdala.
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Tan C, Yan Q, Ma Y, Fang J, Yang Y. Recognizing the role of the vagus nerve in depression from microbiota-gut brain axis. Front Neurol 2022; 13:1015175. [PMID: 36438957 PMCID: PMC9685564 DOI: 10.3389/fneur.2022.1015175] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 08/08/2023] Open
Abstract
Depression is a worldwide disease causing severe disability, morbidity, and mortality. Despite abundant studies, the precise mechanisms underlying the pathophysiology of depression remain elusive. Recently, cumulate research suggests that a disturbance of microbiota-gut-brain axis may play a vital role in the etiology of depression while correcting this disturbance could alleviate depression symptoms. The vagus nerve, linking brain and gut through its afferent and efferent branches, is a critical route in the bidirectional communication of this axis. Directly or indirectly, the vagus afferent fibers can sense and relay gut microbiota signals to the brain and induce brain disorders including depression. Also, brain changes in response to stress may result in gut hyperpermeability and inflammation mediating by the vagal efferents, which may be detrimental to depression. Notably, vagus nerve stimulation owns an anti-inflammatory effect and was proved for depression treatment. Nevertheless, depression was accompanied by a low vagal tone, which may derive from response to stress and contribute to pathogenesis of depression. In this review, we aim to explore the role of the vagus nerve in depression from the perspective of the microbiota-gut-brain axis, highlighting the relationship among the vagal tone, the gut hyperpermeability, inflammation, and depression.
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Affiliation(s)
- Chaoren Tan
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science, Beijing, China
| | - Qiqi Yan
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Science, Beijing, China
| | - Yue Ma
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongsheng Yang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science, Beijing, China
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40
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Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol 2022; 19:717-726. [PMID: 35732730 DOI: 10.1038/s41575-022-00634-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, relapsing immune-mediated disease with a varying and sometimes severe disease course. IBD is often diagnosed in early adulthood and can lead to a substantial decline in quality of life. It has been suggested that patients with IBD are at increased risk of depression and anxiety, but it is still unclear to what extent these diseases co-occur and in what sequence they arise. This Review summarizes the literature on the degree of co-occurrence of IBD with depression and anxiety and the temporal relationship between these diseases. We also discuss the effect of psychological stress on the onset and course of IBD. In addition, we outline the possible mechanisms underlying the co-occurrence of IBD and depression and anxiety, which include changes in brain signalling and morphology, increases in peripheral and intracerebral pro-inflammatory cytokines, impairment of the nitric oxide pathway, changes in vagal nerve signalling, gut dysbiosis and genetics. Finally, we examine the possible effects of treatment of depression and anxiety on the risk and course of IBD, the influence of psychological interventions on IBD, and the effects of IBD treatment on psychiatric comorbidity.
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Affiliation(s)
- Tania H Bisgaard
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Kristine H Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.,Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark. .,Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
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41
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Hernández Camba A, Ramos L, Madrid Álvarez MB, Pérez-Méndez L, Nos P, Hernández V, Guerra I, Jiménez N, Lorente R, Sierra-Ausín M, Ginard D, Varela Trastoy P, Arranz L, Cabello Tapia MJ, Zabana Y, Barreiro-de Acosta M. Psychosocial impact of the COVID-19 pandemic on patients with inflammatory bowel disease in Spain. A post lockdown reflection. GASTROENTEROLOGÍA Y HEPATOLOGÍA (ENGLISH EDITION) 2022. [PMCID: PMC9670731 DOI: 10.1016/j.gastre.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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42
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Ma Y, Liu T, Li X, Kong A, Xiao R, Xie R, Gao J, Wang Z, Cai Y, Zou J, Yang L, Wang L, Zhao J, Xu H, Margaret W, Xu X, Gustafsson JA, Fan X. Estrogen receptor β deficiency impairs gut microbiota: a possible mechanism of IBD-induced anxiety-like behavior. MICROBIOME 2022; 10:160. [PMID: 36175956 PMCID: PMC9520828 DOI: 10.1186/s40168-022-01356-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although the lack of estrogen receptor β (ERβ) is a risk factor for the development of inflammatory bowel disease (IBD) and psychiatric disorders, the underlying cellular and molecular mechanisms are not fully understood. Herein, we revealed the role of gut microbiota in the development of IBD and related anxiety-like behavior in ERβ-deficient mice. RESULTS In response to dextran sodium sulfate (DSS) insult, the ERβ knockout mice displayed significant shift in α and β diversity in the fecal microbiota composition and demonstrated worsening of colitis and anxiety-like behaviors. In addition, DSS-induced colitis also induced hypothalamic-pituitary-adrenal (HPA) axis hyperactivity in ERβ-deficient mice, which was associated with colitis and anxiety-like behaviors. In addition, RNA sequencing data suggested that ErbB4 might be the target of ERβ that is involved in regulating the HPA axis hyperactivity caused by DSS insult. Gut microbiota remodeling by co-housing showed that both the colitis and anxiety-like behaviors were aggravated in co-housed wild-type mice compared to single-housed wild-type mice. These findings suggest that gut microbiota play a critical role in mediating colitis disease activity and anxiety-like behaviors via aberrant neural processing within the gut-brain axis. CONCLUSIONS ERβ has the potential to inhibit colitis development and anxiety-like behaviors via remodeling of the gut microbiota, which suggests that ERβ is a promising therapeutic target for the treatment of IBD and related anxiety-like behaviors. Video Abstract.
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Affiliation(s)
- Yuanyuan Ma
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Tianyao Liu
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Xin Li
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Anqi Kong
- Institute of Neuroscience, Soochow University, Suzhou, China
| | - Rui Xiao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Ruxin Xie
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Junwei Gao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Zhongke Wang
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Yun Cai
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Jiao Zou
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Ling Yang
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Lian Wang
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Jinghui Zhao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Haiwei Xu
- Southwest Eye Hospital, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Warner Margaret
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Xingshun Xu
- Institute of Neuroscience, Soochow University, Suzhou, China.
| | - Jan-Ake Gustafsson
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
- Center for Nuclear Receptors and Cell Signaling, University of Houston, Houston, USA.
| | - Xiaotang Fan
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University, Chongqing, China.
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Mikocka-Walus A, Skvarc D, de Acosta MB, Evertsz FB, Bernstein CN, Burisch J, Ferreira N, Gearry RB, Graff LA, Jedel S, Mokrowiecka A, Stengel A, Trindade IA, van Tilburg MAL, Knowles SR. Exploring the Relationship Between Self-Isolation and Distress Among People with Gastrointestinal Disorders During the COVID-19 Pandemic. J Clin Psychol Med Settings 2022; 29:654-665. [PMID: 34494184 PMCID: PMC8423336 DOI: 10.1007/s10880-021-09818-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to explore the association between perceived isolation and symptoms of distress in people with GI disorders at the time of the pandemic; and to examine factors which moderate this relationship. This online cross-sectional survey was advertised in May-September 2020 via patient organisations and associated social media. Overall, 831 people (82% female, mean age 49 years) from 27 countries participated. A significant relationship between social isolation and psychological distress was noted (r = .525, p < .001). GI symptoms moderated the association between isolation and distress (B = .047, t = 2.47, p = .015). Interventions targeting these factors may help to reduce distress in people with GI disorders at the time of major stressors such as the COVID-19 pandemic.
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Affiliation(s)
| | - David Skvarc
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Manuel Barreiro de Acosta
- Department of Gastroenterology, IBD Unit, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Floor Bennebroek Evertsz
- Department of Medical Psychology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Johan Burisch
- Medical Division, Hvidovre Hospital, University of Copenhagen, GastrounitHvidovre, Denmark
| | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Richard B Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Lesley A Graff
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sharon Jedel
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Anna Mokrowiecka
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
| | - Inês A Trindade
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Miranda A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA
- Division of Gastroenterology, University of North Carolina, Chapel Hill, NC, USA
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Simon R Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Fairbrass KM, Lovatt J, Barberio B, Yuan Y, Gracie DJ, Ford AC. Bidirectional brain-gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis. Gut 2022; 71:1773-1780. [PMID: 34725197 DOI: 10.1136/gutjnl-2021-325985] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The role of the brain-gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues. DESIGN We searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline. RESULTS We included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively). CONCLUSION Bidirectional effects of the brain-gut axis are present in IBD and may influence both the natural history of the disease and psychological health.
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Affiliation(s)
- Keeley M Fairbrass
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Jessica Lovatt
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
| | - Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David J Gracie
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK .,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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45
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Umar N, King D, Chandan JS, Bhala N, Nirantharakumar K, Adderley N, Zemedikun DT, Harvey P, Trudgill N. The association between inflammatory bowel disease and mental ill health: a retrospective cohort study using data from UK primary care. Aliment Pharmacol Ther 2022; 56:814-822. [PMID: 35770611 DOI: 10.1111/apt.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/18/2022] [Accepted: 06/14/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with active inflammatory bowel disease (IBD) and mental illnesses experience worse IBD outcomes. AIM To describe the incidence of mental illnesses, including deliberate self-harm, in IBD patients. METHODS A population-based retrospective cohort study using IQVIA medical research data of a primary care database covering the whole UK, between January 1995 and January 2021. IBD patients of all ages were matched 4:1 by demographics and primary care practice to unexposed controls. Following exclusion of patients with mental ill health at study entry, adjusted hazard ratios (HR) of developing depression, anxiety, deliberate self-harm, severe mental illness and insomnia were calculated using a Cox proportional hazards model. RESULTS We included 48,799 incident IBD patients: 28,352 with ulcerative colitis and 20,447 with Crohn's disease. Incidence rate ratios of mental illness were higher in IBD patients than controls (all p < 0.001): deliberate self-harm 1.31 (95% CI 1.16-1.47), anxiety 1.17 (1.11-1.24), depression 1.36 (1.31-1.42) and insomnia 1.62 (1.54-1.69). Patients with Crohn's disease were more likely to develop deliberate self-harm HR 1.51 (95% CI 1.28-1.78), anxiety 1.38 (1.16-1.65), depression 1.36 (1.26-1.47) and insomnia 1.74 (1.62-1.86). Patients with IBD are at increased risk of deliberate self-harm (HR 1.20 [1.07-1.35]). The incidence rate ratios of mental illnesses were particularly high during the first year following IBD diagnosis: anxiety 1.28 (1.13-1.46), depression 1.62 (1.48-1.77) and insomnia 1.99 (1.78-2.21). CONCLUSION Deliberate self-harm, depression, anxiety and insomnia were more frequent among patients with IBD. IBD is independently associated with an increased risk of deliberate self-harm.
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Affiliation(s)
- Nosheen Umar
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Dominic King
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nicola Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nigel Trudgill
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
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46
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Cross RK, Keefer L. Chicken or Egg, Mental Health Disorders in Inflammatory Bowel Disease: Does It Matter? Gastroenterology 2022; 163:37-39. [PMID: 35500616 DOI: 10.1053/j.gastro.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Raymond K Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Laurie Keefer
- Department of Medicine and Psychiatry, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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47
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Fairbrass KM, Gracie DJ, Ford AC. Relative Contribution of Disease Activity and Psychological Health to Prognosis of Inflammatory Bowel Disease During 6.5 Years of Longitudinal Follow-Up. Gastroenterology 2022; 163:190-203.e5. [PMID: 35339461 DOI: 10.1053/j.gastro.2022.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Symptoms of common mental disorders, such as anxiety or depression, are common in inflammatory bowel disease (IBD) and may affect prognosis. However, unlike clinical or biochemical markers of disease activity, psychological health is not a recommended therapeutic target. We assessed relative contribution of poor psychological health and clinical or biochemical activity to prognosis. METHODS Demographic features, IBD subtype, treatments, and anxiety and depression scores were recorded at baseline for 760 adults, with clinical activity determined using validated scoring systems. Fecal calprotectin was analyzed in 379 (49.9%) patients (≥250 μg/g used to define biochemical activity). Glucocorticosteroid prescription or flare, escalation, hospitalization, intestinal resection, or death were assessed during 6.5 years of follow-up. Occurrence was compared using multivariate Cox regression across 4 patient groups according to presence of disease remission or activity, with or without symptoms of a common mental disorder, at baseline. RESULTS In total, 718 (94.5%) participants provided data. Compared with clinical remission without symptoms of a common mental disorder at baseline, need for glucocorticosteroid prescription or flare (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.58-3.54), escalation (HR, 1.65; 95% CI, 1.14--2.40), and death (HR, 4.99; 95% CI, 1.80-13.88) were significantly higher in those with clinical activity and symptoms of a common mental disorder. Rates in those with clinical remission and symptoms of a common mental disorder at baseline or those with clinical activity without symptoms of a common mental disorder were not significantly higher. Similarly, with biochemical activity and symptoms of a common mental disorder, rates of glucocorticosteroid prescription or flare (HR, 2.48; 95% CI, 1.38-4.46), escalation (HR, 2.97; 95% CI, 1.74-5.06), hospitalization (HR, 3.10; 95% CI, 1.43-6.68), and death (HR, 6.26; 95% CI, 2.23-17.56) were significantly higher. CONCLUSIONS Psychological factors are important determinants of poor prognostic outcomes in IBD and should be considered as a therapeutic target.
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Affiliation(s)
- Keeley M Fairbrass
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
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48
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Abu Sneineh A, Haj Ali S, Al-Masri A, Diab A, Aldweik F, Darweesh M, Qaisi M, Alshakhatreh O, Tamimi T, Rayyan Y, Banimustafa R, Sablaban I. Prevalence of anxiety and depressive symptoms in ulcerative colitis patients in Jordan and its relationship to patient-reported disease activity. Sci Rep 2022; 12:7682. [PMID: 35538204 PMCID: PMC9091221 DOI: 10.1038/s41598-022-11911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/03/2022] [Indexed: 11/18/2022] Open
Abstract
Inflammatory bowel disease is associated with higher rates of anxiety and depression compared to the general population. We aimed to determine the prevalence of anxiety and depressive symptoms among patients with ulcerative colitis and correlation to disease activity. In this cross-sectional study, we collected data from 70 consecutive ulcerative colitis patients over one year at our inflammatory bowel disease outpatient clinic through an interview and a questionnaire containing patient demographics and disease characteristics. Anxiety and depressive symptoms were characterized using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9, respectively, with ulcerative colitis disease severity assessed by the Partial Mayo scoring system. The majority of our patients were females (68.6%) and the mean age was 39.3 years. Rates of anxiety and depressive symptoms among ulcerative colitis patients were 65.7% and 58.6%, respectively. Depressive symptoms were significantly associated with patient-reported disease activity (r = 0.361; p = 0.010). Significant percentages of ulcerative colitis patients were appreciated to have anxiety and depressive symptoms, and there was a correlation between patient-reported disease activity and depressive symptoms. At this high rate of prevalence, it is justified to screen patients for the presence of psychiatric comorbidities.
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Affiliation(s)
- Awni Abu Sneineh
- Department of Gastroenterology, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Sara Haj Ali
- Department of Internal Medicine, Faculty of Medicine, Al-Balqa Applied University, Salt, 19117, Jordan.
| | - Ahmad Al-Masri
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Amr Diab
- Department of Gastroenterology, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Farah Aldweik
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Mohammad Darweesh
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Mohammad Qaisi
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Osama Alshakhatreh
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Tarek Tamimi
- Department of Gastroenterology, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Yaser Rayyan
- Department of Gastroenterology, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Radwan Banimustafa
- Department of Psychiatry, Faculty of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Ibrahim Sablaban
- Department of Psychiatry, Henry Ford Hospital, Detroit, MI, 48202, USA
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49
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Fairbrass KM, Selinger CP, Gracie DJ, Ford AC. Prevalence and impact of Rome IV versus Rome III irritable bowel syndrome in patients with inflammatory bowel disease. Neurogastroenterol Motil 2022; 34:e14256. [PMID: 34472157 DOI: 10.1111/nmo.14256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS)-type symptoms are common in inflammatory bowel disease (IBD), but few studies have examined the prevalence and impact of IBS-type symptoms in IBD according to Rome IV criteria. METHODS We collected demographic, symptom (Rome III, Rome IV, and clinical disease activity indices), psychological (anxiety, depression, and somatization), and quality of life data from 973 IBD patients. Medical records were reviewed to document disease type, extent/location, behavior, medical therapy, and antidepressant or opioid use. We compared characteristics of individuals with no IBS-type symptoms, Rome III IBS-type symptoms, and Rome IV IBS-type symptoms. KEY RESULTS In total, 302 (31.0%) patients met the Rome III criteria for IBS, and 172 (17.7%) met Rome IV criteria. Those with IBS-type symptoms were younger, more likely to be female, and had higher rates of antidepressant (p = 0.006) or opioid use (p = 0.001). Rome IV IBS-type symptoms were associated with symptoms of mood disorders, flare of disease activity, and lower quality of life scores (p < 0.001 for all analyses). Compared with Rome III criteria, those with Rome IV IBS-type symptoms had significantly higher rates of anxiety (p < 0.001), depression (p = 0.002), and somatization (p < 0.001), lower quality of life scores (p < 0.001) and were more likely to have CD (p = 0.011), with ileal distribution (p = 0.006). CONCLUSIONS AND INFERENCES Rome IV IBS-type symptoms are associated with increased psychological co-morbidity, lower quality of life scores, and higher rates of antidepressant or opioid use. This is a cohort potentially at risk of adverse clinical outcomes and should be a focus for future research.
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Affiliation(s)
- Keeley M Fairbrass
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research, St. James's, University of Leeds, Leeds, UK
| | | | - David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research, St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research, St. James's, University of Leeds, Leeds, UK
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50
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Su S, Marrie RA, Bernstein CN. Factors Associated With Social Participation in Persons Living With Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2022; 5:59-67. [PMID: 35368323 PMCID: PMC8972209 DOI: 10.1093/jcag/gwab022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) imposes a significant burden on health-related quality of life, particularly in social domains. We sought to investigate the factors that limit social participation in patients with IBD. Methods We assessed a cohort of 239 Manitobans with IBD. We collected sociodemographic information, medical comorbidities, disease phenotype, symptom activity and psychiatric comorbidity (using the Structured Clinical Interview for DSM-IV). Participants completed the eight-item Ability to Participate in Social Roles and Activities (APSRA) questionnaire, which assesses participation restriction, including problems experienced in social interaction, employment, transportation, community, social and civic life. Results Poorer social participation scores were associated with earning less than $50,000 CAD income annually (P < 0.001), actively smoking (P = 0.006), higher symptom scores (P < 0.001 for CD, P = 0.004 for UC), and having an increasing number of chronic medical conditions (R = −0.30). History of depression (P < 0.001) and anxiety (P = 0.001) and having active depression (P < 0.001) and anxiety (P = 0.001) all predicted poor social participation scores. IBD phenotype or disease duration was not predictive. Based on multivariable linear regression analysis, significant predictors of variability in social participation were medical comorbidity, psychiatric comorbidity, psychiatric symptoms and IBD-related symptoms. Conclusions The factors that predict social participation by IBD patients include income, smoking, medical comorbidities, IBD symptom burden, and psychiatric comorbidities. Multivariable linear regression suggests that the most relevant factors are medical comorbidity, psychiatric comorbidity, psychiatric symptoms and IBD symptoms.
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Affiliation(s)
- Samuel Su
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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