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Davies JM, Teh JJ, Ewais T, Begun J. Does Improving Depression Symptoms in Young Adults With Inflammatory Bowel Disease Alter Their Microbiome? Inflamm Bowel Dis 2024:izae121. [PMID: 38839073 DOI: 10.1093/ibd/izae121] [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: 08/08/2023] [Indexed: 06/07/2024]
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBDs) are more likely to have depression and anxiety symptoms compared with healthy individuals and those with other chronic illnesses. Previous studies have shown a link between the microbiome composition and depression symptoms; however, many antidepressant medications have antibacterial activity confounding cross-sectional studies of these populations. Therefore, we aimed to determine whether we could detect longitudinal changes in the microbiome of a subset of patients who participated in a previously published mindfulness-based cognitive therapy (MBCT) study to improve depression symptoms in adolescents and young adults with IBD. METHODS Stool samples were collected at baseline and 8 weeks (n = 24 participants, 37 total samples, 13 paired samples). During this time, some participants achieved a 50% reduction in their depression symptoms either through MBCT or treatment as usual with their mental health team (responders). The microbiome composition and function of responders were compared with participants who did not improve their depression scores (nonresponders). Depression scores were determined using the depression, anxiety, and stress score (DASS-21), and metagenomic sequencing of stool samples was performed. RESULTS No difference in alpha diversity was found between responders and nonresponders. Beta diversity measures were similarly unchanged. Clinical features including fecal calprotectin, C-reactive protein, and serum IL-6 levels were unchanged. CONCLUSIONS In this small longitudinal study, we were not able to detect longitudinal changes in the microbiome associated with improvement in depression scores. Follow-up studies that are sufficiently powered to detect changes in the microbiome are required to confirm our results.
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Affiliation(s)
- Julie M Davies
- Mater Research-The University of Queensland, Woolloongabba, QLD, Australia
| | - Jing Jie Teh
- Frazer Institute, The University of Queensland, Woolloongabba QLD, Australia
| | - Tatjana Ewais
- Mater Adolescent and Young Adult Health Clinic, South Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Jakob Begun
- Mater Research-The University of Queensland, Woolloongabba, QLD, Australia
- Department of Gastroenterology, Mater Hospital Brisbane, South Brisbane, Australia
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Milo F, Imondi C, D’Amore C, Angelino G, Knafelz D, Bracci F, Dall’Oglio L, De Angelis P, Tabarini P. Short-term Psychodynamic Psychotherapy in Addition to Standard Medical Therapy Increases Clinical Remission in Adolescents and Young Adults with Inflammatory Bowel Disease: a Randomised Controlled Trial. J Crohns Colitis 2024; 18:256-263. [PMID: 37621051 PMCID: PMC10896630 DOI: 10.1093/ecco-jcc/jjad145] [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: 05/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Inflammatory bowel diseases [IBD] are chronic and pervasive conditions of the gastrointestinal tract with a rising incidence in paediatric and young adult populations. Evidence suggests that psychological disorders might be associated with relapse of disease activity. This study aims to evaluate the efficacy of short-term psychodynamic psychotherapy [STPP] in addition to standard medical therapy [SMT] in maintaining clinical remission in adolescents and young adults [AYA] with quiescent IBD, compared with SMT alone. METHODS A two-arm, single-centre, randomised, controlled trial was conducted in 60 IBD AYA in clinical remission. Patients were randomised to receive an 8-week STPP + SMT [n = 30] or SMT alone [n = 30]. The primary outcome was the steroid-free remission rate at 52 weeks after treatment. Secondary outcomes included the overall hospitalisation rate within 52 weeks after treatment, and medication adherence obtained from patient's electronic medical records. RESULTS Intention-to-treat analysis showed significant improvement in maintaining disease remission rates in the 8-week STPP + SMT group compared with the control one. The proportion of patients maintaining steroid-free remission at 52 weeks was higher in patients in STTP group [93.1%] compared with patients randomised to control group [64.3%; p = 0.01]. There were no significant differences in secondary outcomes, except for depression reduction in STPP + SMT group. CONCLUSIONS An 8-week STPP intervention in addition to SMT effectively increases the steroid-free remission rates in AYA with quiescent IBD. Results do not support effects for other secondary outcomes, except for depression reduction.
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Affiliation(s)
- Francesco Milo
- Clinical Psychology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Imondi
- Digestive Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Carmen D’Amore
- Clinical Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Angelino
- Digestive Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Daniela Knafelz
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Fiammetta Bracci
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Luigi Dall’Oglio
- Digestive Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola De Angelis
- Digestive Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola Tabarini
- Clinical Psychology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Bauer N, Löffler C, Oeznur O, Uecker C, Schlee C, Adamczyk A, Elsenbruch S, Pfuhlmann K, Reissmann R, Westendorf A, Keil T, Langhorst J. Evaluation of a Multimodal Stress Management and Comprehensive Lifestyle Modification Program on Quality of Life and Gastrointestinal Symptoms in Patients with Crohn's Disease: A Randomized Controlled Pilot Trial with 9-Month Follow-Up. Digestion 2024; 105:201-212. [PMID: 38350430 DOI: 10.1159/000536659] [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: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Stress and lifestyle factors impact the course of Crohn's disease (CD). Our primary objective was to assess whether patients with CD benefit from a mind-body-medicine stress management and lifestyle modification (MBM) program. METHODS This 9-month two-arm pilot trial was conducted in Bamberg, Germany (2020-2021). Patients (18-75 years) with mild to moderate activity of CD and stable medication were enrolled and randomly assigned to either a 10-week MBM program (intervention group, IG) or a single 90-min education session (waiting list control group, CG). Primary endpoints were quality of life (IBDQ) and disease activity (HBI). Secondary endpoints were emotional distress, core self-evaluation, and inflammatory biomarkers 3 and 9 months after baseline assessment. RESULTS We analyzed data from 37 patients (IG: n = 19, mean ± SD age 49.6 ± 13.1 years, 68% female; CG: 18, 46.8 ± 11.4, 67% female). Immediately after the intervention, 79% (IG) and 44% (CG) experienced a clinically relevant improvement (IBDQ score ≥16 points). This was similar after 9 months (63% vs. 44%). There was no difference in disease activity (3 months: p = 0.082, 95% CI -1.3 to 2.6; 9 months: p = 0.251, 95% CI -1.2 to 2.5). Secondary outcomes indicated improvements in emotional distress, core self-evaluation, erythrocyte sedimentation rate after three and in emotional distress, T-cell profiling in the blood, and fecal lactoferrin and calprotectin group after 9 months in the IG. CONCLUSION Our study suggested benefits of a multimodal stress management and lifestyle modification program for patients with CD. Larger trials are needed to determine if the program can supplement or at least partially replace pharmacological treatment approaches.
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Affiliation(s)
- Nina Bauer
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Claudia Löffler
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany,
| | - Oezlem Oeznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Christine Uecker
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Christoph Schlee
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
- Department of Sociology, University of Bamberg, Bamberg, Germany
| | - Alexandra Adamczyk
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Katrin Pfuhlmann
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Ralf Reissmann
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Astrid Westendorf
- Department of Infectionimmunology, University Hospital Essen, Essen, Germany
| | - Thomas Keil
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
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Seaton N, Hudson J, Harding S, Norton S, Mondelli V, Jones ASK, Moss-Morris R. Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?: a systematic review and meta-analysis. EBioMedicine 2024; 100:104910. [PMID: 38272759 PMCID: PMC10878994 DOI: 10.1016/j.ebiom.2023.104910] [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: 10/06/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Psychoneuroimmunological mechanisms and the gut-brain axis appear relevant to disease activity and progression in Inflammatory Bowel Disease (IBD). A recent review showed no effect of psychological therapies on self-reported disease activity in IBD. This meta-analysis aims to establish whether interventions targeting mood outcomes (e.g., depression, anxiety and stress) impact inflammation levels in IBD and possible moderators of these effects. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched five electronic databases and included randomised controlled trials where interventions targeted mood and assessed inflammatory outcomes pre- and post-intervention in adults with IBD. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMDs) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). FINDINGS 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (-0.35, 95% CI: -0.48, -0.22, p < 0.001) and medium effects on mood outcomes (-0.50, 95% CI: -0.73, -0.27, p < 0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (-0.19, 95% CI: -0.34, -0.03, p = 0.018) and C-Reactive Protein (-0.29, 95% CI: -0.47, -0.10, p = 0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD ≥0.2) on mood. INTERPRETATION Treatments which address mood outcomes have beneficial effects on generic inflammation as well as disease-specific biomarkers (faecal calprotectin and C-Reactive Protein). Psychological interventions and interventions with larger treatment effects on mood accentuated the effect on biomarkers. More research is required to understand the biological or behavioural mechanisms underlying this effect. FUNDING The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.
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Affiliation(s)
- Natasha Seaton
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK.
| | - Joanna Hudson
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Sophie Harding
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Sam Norton
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Valeria Mondelli
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Annie S K Jones
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
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Riggott C, Mikocka-Walus A, Gracie DJ, Ford AC. Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:919-931. [PMID: 37543040 DOI: 10.1016/s2468-1253(23)00186-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND There is increasing evidence for an influence of the gut-brain axis on the natural history of inflammatory bowel disease (IBD). Psychological therapies could, therefore, have beneficial effects in individuals with IBD, but data are conflicting. We aimed to update our previous systematic review and meta-analysis to assess whether the inclusion of more randomised controlled trials (RCTs) showed any beneficial effects and whether these effects varied by treatment modality. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Embase Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from Jan 1, 2016, to April 30, 2023, for RCTs published in any language recruiting individuals aged 16 years or older with IBD that compared psychological therapy with a control intervention or treatment as usual. We pooled dichotomous data to obtain relative risks (RR) with 95% CIs of inducing remission in people with active disease or of relapse in people with quiescent disease at final follow-up. We pooled continuous data to estimate standardised mean differences (SMD) with 95% CIs in disease activity indices, anxiety scores, depression scores, stress scores, and quality-of-life scores at completion of therapy and at final follow-up. We pooled all data using a random-effects model. Trials were analysed separately according to whether they recruited people with clinically active IBD or predominantly individuals whose disease was quiescent. We conducted subgroup analyses by mode of therapy and according to whether trials recruited selected groups of people with IBD. We used the Cochrane risk of bias tool to assess bias at the study level and assessed funnel plots using the Egger test. We assessed heterogeneity using the I2 statistic. FINDINGS The updated literature search identified a total of 469 new records, 11 of which met eligibility criteria. 14 studies were included from our previous meta-analysis published in 2017. In total, 25 RCTs were eligible for this meta-analysis, all of which were at high risk of bias. Only four RCTs recruited patients with active IBD; there were insufficient data for meta-analysis of remission, disease activity indices, depression scores, and stress scores. In patients with active IBD, psychological therapy had no benefit compared with control for anxiety scores at completion of therapy (two RCTs; 79 people; SMD -1·04, 95% CI -2·46 to 0·39), but did have significant benefit for quality-of-life scores at completion of therapy (four RCTs; 309 people; 0·68, 0·09 to 1·26), although heterogeneity between studies was high (I2=82%). In individuals with quiescent IBD, RR of relapse of disease activity was not reduced with psychological therapy (ten RCTs; 861 people; RR 0·83, 95% CI 0·62 to 1·12), with moderate heterogeneity (I2=60%), and the funnel plot suggested evidence of publication bias or other small study effects (Egger test p=0·046). For people with quiescent IBD at completion of therapy, there was no difference in disease activity indices between psychological therapy and control (13 RCTs; 1015 people; SMD -0·01, 95% CI -0·13 to 0·12; I2=0%). Anxiety scores (13 RCTs; 1088 people; -0·23, -0·36 to -0·09; 18%), depression scores (15 RCTs; 1189 people; -0·26, -0·38 to -0·15; 2%), and stress scores (11 RCTs; 813 people; -0·22, -0·42 to -0·03; 47%) were significantly lower, and quality-of-life scores (16 RCTs; 1080 people; 0·31, 0·16 to 0·46; 30%) were significantly higher, with psychological therapy versus control at treatment completion. Statistically significant benefits persisted up to final follow-up for depression scores (12 RCTs; 856 people; -0·16, -0·30 to -0·03; 0%). Effects were strongest in RCTs of third-wave therapies and in RCTs that recruited people with impaired psychological health, fatigue, or reduced quality of life at baseline. INTERPRETATION Psychological therapies have beneficial, short-term effects on anxiety, depression, stress, and quality-of-life scores, but not on disease activity. Further RCTs in selected groups are needed to establish the place for such therapies in IBD care. FUNDING None.
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Affiliation(s)
- Christy Riggott
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research, St James's University Hospital, Leeds, UK
| | | | - David J Gracie
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research, St James's University Hospital, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research, St James's University Hospital, Leeds, UK.
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