Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part I

The Impact of Antispasmodic Use on Abdominal Pain and Opioid Use in Inflammatory Bowel Disease: A Population-Based Study

BACKGROUND

Patients with inflammatory bowel disease (IBD) are often prescribed antispasmodics for chronic abdominal pain. Large-scale data regarding efficacy and impact on clinical outcomes are lacking.

AIM

To examine the association between antispasmodic use and outcomes of abdominal pain and opioid use before and after propensity matching key demographic and clinical characteristics.

METHODS

We used TriNetX Diamond Network, a medical and claims database. Patients were stratified by baseline abdominal pain and opioid use. Secondary outcomes were corticosteroid use, IBD-related complications and surgeries, emergency room (ER) visits, hospitalisation and mortality.

RESULTS

We included 85,859 patients (median age 50; 53.8% female) with IBD; 5661 used antispasmodics. On follow-up, those with antispasmodic use had higher rates of abdominal pain and opioid use (p < 0.001) regardless of baseline abdominal pain or opioid use. After matching, 5629 patients remained per group. Patients who used antispasmodics had higher rates of abdominal pain at 1 month, regardless of baseline abdominal pain. Opioid-naïve patients who used antispasmodics had higher rates of opioid use at follow-up (1.1% vs. 0.2%; p < 0.001). The likelihood of corticosteroid use, clinic visits, ER visits and hospitalisation were higher in those with antispasmodic use. No differences in IBD-related complications, surgery or mortality were observed.

CONCLUSIONS

Antispasmodic use in patients with IBD was associated with increased abdominal pain and opioid use in opioid-naïve patients. Antispasmodic use was associated with increased likelihood of corticosteroid use, clinic and ER visits and hospitalisation.

Long-term efficacy and safety of upadacitinib in patients with moderately to severely active ulcerative colitis: an interim analysis of the phase 3 U-ACTIVATE long-term extension study

BACKGROUND

The U-ACTIVATE long-term extension study aims to evaluate the long-term efficacy and safety of upadacitinib in patients with moderately to severely active ulcerative colitis. Here, we report interim results after 3 years of total treatment.

METHODS

U-ACTIVATE is an ongoing, 288-week, phase 3, long-term extension study done at 307 centres across 43 countries (active sites on Dec 31, 2021, are presented as part of this interim analysis) and began on Jan 31, 2017. In brief, patients aged 16-75 years with a confirmed diagnosis of moderately to severely active ulcerative colitis for 90 days or more, an adapted Mayo score of 5-9, and an endoscopic subscore of 2 or 3 were eligible for the upadacitinib induction studies; patients who had a clinical response in the induction studies were eligible to enter the U-ACHIEVE maintenance study. Individuals who completed the U-ACHIEVE maintenance study were subsequently eligible for inclusion in the efficacy population of this long-term extension study. Patients in clinical remission per adapted Mayo score at week 52 of the maintenance study could continue their double-masked treatment upon entering the long-term extension study. Patients not in clinical remission originally randomly assigned to upadacitinib 15 mg were eligible to escalate to upadacitinib 30 mg, those originally randomly assigned to upadacitinib 30 mg continued on upadacitinib 30 mg, and those originally assigned to placebo were eligible to escalate to upadacitinib 15 mg in a masked way. We present data from weeks 48 and 96 of the long-term extension period. Key efficacy outcomes were clinical remission (per adapted Mayo score), endoscopic remission, maintenance of clinical remission, and maintenance of endoscopic remission, and are presented for those patients who had a clinical response after 8 weeks of upadacitinib 45 mg induction, completed 52 weeks of maintenance (U-ACHIEVE maintenance), and subsequently entered the long-term extension. Safety outcomes were treatment-emergent adverse events and adverse events of special interest, which were prespecified and were recorded in two populations: one comprising patients who received at least one dose of study drug in the long-term extension study and the other comprising all patients in the maintenance or long-term extension studies. Our primary approach for efficacy analysis was as-observed (ie, all observed data were used without imputation for missing data until patients switched to a different dose during the long-term extension study). This study is registered with ClinicalTrials.gov (NCT03006068).

FINDINGS

414 patients from the phase 3 upadacitinib U-ACHIEVE maintenance study were eligible to enter this long-term extension study for assessment of efficacy endpoints following treatment with upadacitinib. Of these individuals, 369 patients (231 [63%] male individuals and 138 [37%] female individuals) were treated with upadacitinib in the long-term extension study: 142 patients with upadacitinib 15 mg and 227 with upadacitinib 30 mg. In the as-observed population, 84 (71%) of 118 patients receiving upadacitinib 15 mg were in clinical remission at week 48, as were 130 (67%) of 193 receiving upadacitinib 30 mg; by week 96, 69 (76%) of 91 patients receiving upadacitinib 15 mg and 104 (74%) of 141 of those receiving upadacitinib 30 mg were in clinical remission. Most patients who entered the long-term extension in clinical remission maintained it in the as-observed analysis (week 48 upadacitinib 15 mg 62 [81%] of 77 and upadacitinib 30 mg 90 [81%] of 111; week 96 upadacitinib 15 mg 50 [78%] of 64 and upadacitinib 30 mg 69 [84%] of 82). In the as-observed population, 60 (49%) of 123 patients receiving upadacitinib 15 mg and 93 (46%) of 202 receiving upadacitinib 30 mg were in endoscopic remission at week 48; by week 96, 45 (47%) of 95 patients receiving upadacitinib 15 mg and 69 (45%) of 153 receiving upadacitinib 30 mg were in endoscopic remission. Most patients who entered the long-term extension in endoscopic remission maintained it in the as-observed analysis (week 48 upadacitinib 15 mg 28 [70%] of 40 and upadacitinib 30 mg 51 [76%] of 67; week 96 upadacitinib 15 mg 20 [65%] of 31 and upadacitinib 30 mg 37 [73%] of 51). In the long-term extension-only safety analysis, we assessed data from 467 patients, representing 1027·9 patient-years of continuous long-term extension exposure on a consistent upadacitinib dose. Treatment-emergent adverse events were recorded at 238·5 events per 100 patient-years for upadacitinib 15 mg and 233·4 events per 100 patient-years for upadacitinib 30 mg. Event rates of serious treatment-emergent adverse events were 11·7 events per 100 patient-years for upadacitinib 15 mg and 12·4 events per 100 patient-years for upadacitinib 30 mg. The most common adverse events of special interest were hepatic disorder, lymphopenia, creatine phosphokinase elevation, serious infection, neutropenia, and herpes zoster. Three treatment-emergent adverse events leading to death were reported in the long-term extension-only safety population.

INTERPRETATION

This interim analysis supports the positive long-term risk-benefit profile for upadacitinib 15 mg and 30 mg among patients with moderately to severely active ulcerative colitis.

FUNDING

AbbVie.

The impact of anxiety and depression on quality of life in a cohort of inflammatory bowel disease patients from Northeastern of Brazil

OBJECTIVE

This study aims to assess whether the association between chronic pathologies and depressive and/or anxious disorders is high, resulting in a reduction in the patient's quality of life.

PATIENTS AND METHODS

This is a prospective cross-sectional study with a descriptive and analytical design. Sociodemographic data and lifestyle habits were collected. Subsequently, the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Hospital Anxiety and Depression Scale (HADS) were applied.

RESULTS

A total of 141 patients participated in the study, with a mean age of 45.78 (SD 16.01) years, of which 60.3% were female (n=85) and 39.7% were male (n=56). 58.9% had ulcerative colitis (UC) (n=83), and 41.1% had Crohn's disease (CD) (n=58). 16.5% of patients had a previous diagnosis of generalized anxiety disorder (GAD) and/or major depression (MD) (n=23). Regarding IBDQ scores, participants with anxiety had significantly lower mean scores in all IBDQ items (p<0.001), while the depression diagnosis obtained significantly lower mean values for systemic (p=0.015), emotional (p=0.001), and intestinal symptoms (p=0.005).

CONCLUSION

The results indicate that anxiety and depression negatively impact the quality of life of patients with IBD independently of the disease activity.

Probiotics: a promising future in the treatment of ulcerative colitis?

Ulcerative colitis is an idiopathic and chronic inflammatory bowel disease, characterized by inflammation of the mucosa of the colon and rectum. Clinical manifestations commonly include abdominal pain, diarrhea (with or without hematochezia), and weight loss. The pathogenesis of ulcerative colitis is multifactorial, involving a combination of genetic predispositions and lifestyle factors. High consumption of processed food, sedentary habits, alcohol intake, and stress are among the lifestyle factors implicated in disease onset and progression. Current treatment strategies focus on managing symptoms and inducing remission, however, the chronic nature of the disease, along with the adverse effects of conventional therapies, often compromises patient's quality of life. Therefore, exploring alternative therapies that can prolong remission and reduce symptom burden is important. Experimental evidence suggests that probiotics may extend remission duration in ulcerative colitis. Moreover, probiotics exhibit efficacy in amelioration clinical symptoms by reducing inflammation markers, preserving, and restoring intestinal epithelial. This review explores the advantages of the administration of probiotics in the treatment of ulcerative colitis, elucidating their mechanism of action.

Engineered Probiotics Enable Targeted Gut Delivery of Dual Gasotransmitters for Inflammatory Bowel Disease Therapy

Inflammatory bowel disease (IBD) remains an incurable condition, often accompanied by high rates of anxiety and depression, further diminishing the quality of life of patients. Endogenous gasotransmitters, such as carbon monoxide (CO) and hydrogen sulfide (H₂S), exhibit potent anti-inflammatory and immunomodulatory effects. However, their therapeutic application is limited by challenges in targeted delivery to affected tissues. Here, we propose a novel strategy for targeted gut delivery of CO/H2S through engineering Escherichia coli Nissle 1917 (EcN) with CO/H2S-releasing copolymer (POSR) loading. This engineered probiotic (POSR@EcN) enhances EcN colonization in the intestine and enables controlled, localized release of CO/H2S at inflamed sites. The release of CO/H2S modulates inflammation, restores intestinal barrier integrity, and reshapes gut microbiota by promoting beneficial bacteria and increasing short-chain fatty acids production, effectively alleviating IBD symptoms. Notably, targeted CO/H2S delivery also elevates neuroprotective metabolites like indoleacetic acid and γ-aminobutyric acid, reducing neuroinflammation via the gut-brain axis and mitigating anxiety- and depression-like behaviors in IBD mice. This approach highlights the potential of EcN as a probiotic carrier for the targeted delivery of gasotransmitters, offering a promising strategy for IBD treatment.

Patient-reported real-world experience of risankizumab on-body device (OBD) for the treatment of Crohn's disease in the UK (COMMODUS)

OBJECTIVE

To evaluate real-world patient-reported experience with subcutaneous (SC) risankizumab administered by on-body device (OBD) in patients with Crohn's disease (CD).

METHODS

Uncontrolled observational cross-sectional study in five UK units between October 2023 and May 2024. Patients who had received maintenance risankizumab via SC injection of four pre-filled syringes (PFS) self-administered in hospital were switched to OBD self-injection. Self-Injection Assessment Questionnaires (SIAQ) were completed pre- and post-first OBD use. The primary end-point was "Overall, how satisfied are you with your current way of taking your medication (self-injection)?" from post-injection SIAQ. Baseline patient data were collected retrospectively from medical records.

RESULTS

The study recruited 50 patients with moderate-to-severe CD, 48 completed the study. Most (81%) were satisfied/very satisfied with self-injection using OBD vs only 54% with PFS. Satisfaction with the OBD was highest with home use (90% vs 65%). Confidence was high with the OBD; numerically higher rates of patients were confident in giving themselves an injection in the right way (83% vs 64%), in a clean and sterile way (90% vs 74%) and safely (85% vs 72%) post-OBD than before using OBD. Self-injection using the OBD was reported as easy by 92% and convenient by 83% of participants. Most participants reported that they would continue to use the OBD (82%) and be confident to self-inject at home (81%). The OBD was well tolerated.

CONCLUSION

The OBD provides a safe, easy to use and convenient way to self-administer risankizumab at home using one injection with improved satisfaction and confidence vs self-administration of four PFS in hospital.

Current and forecasted 10-year prevalence and incidence of inflammatory bowel disease in Hong Kong, Japan, and the United States

BACKGROUND

The rising incidence of inflammatory bowel disease (IBD) globally has increased disease burden and economic impact. Gaps remain in understanding the IBD burden between Asian and Western populations.

AIM

To estimate the current and following 10-year prevalence and incidence of IBD in Hong Kong, Japan, and the United States.

METHODS

Patients diagnosed with IBD were identified from a territory-wide electronic medical records database in Hong Kong (2003-2022, including all ages) and two large employment-based healthcare claims databases in Japan and the United States (2010-2022, including < 65 age). We used Autoregressive Integrated Moving Average models to predict prevalence and incidence from 2023 to 2032, stratified by disease subtype [ulcerative colitis (UC); Crohn’s disease (CD)], sex, and age, with 95% prediction intervals (PIs). The forecasted annual average percentage change (AAPC) with 95% confidence intervals was calculated.

RESULTS

The age-standardized prevalence of IBD for 2032 is forecasted at 105.88 per 100000 in Hong Kong (95%PI: 83.01-128.75, AAPC: 5.85%), 645.79 in Japan (95%PI: 562.51-741.39, AAPC: 5.78%), and 629.85 in the United States (95%PI: 569.09-690.63, AAPC: 2.85%). Prevalence is estimated to rise most significantly among those under 18 in Japan and the United States. Over the next decade, the incidence of IBD is estimated to increase annually by 3.3% in Hong Kong with forecasted increases across all age groups (although the AAPC for each group is not statistically significant); by 2.88% in Japan with a significant rise in those under 18 and stability in 18-65; and remaining stable in the United States. By 2032, the prevalence of CD is estimated to surpass UC in Hong Kong and the United States, whereas UC will continue to be more prevalent in Japan. A higher prevalence and incidence of IBD is forecast for males in Hong Kong and Japan, whereas rates will be similar for both males and females in the United States.

CONCLUSION

The prevalence of IBD is forecasted to increase in Hong Kong, Japan, and the United States, while estimates of incidence vary. The forecasts show distinct patterns across disease subtype, sex, and age groups. Health systems will need to plan for the predicted increasing prevalence among different demographics.

Therapeutic Potential and Translational Challenges for Bacterial Extracellular Vesicles in Inflammatory Bowel Disease

Despite the availability of numerous new immune-directed therapeutics, the major constituents of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-continue to afflict millions worldwide, resulting in significant morbidity and long-term health risks. IBD results from a triad of immune, environmental (eg, gut microbiome), and genetic (including epigenetic) mechanisms, and therefore has been subject to a wide variety of therapeutic strategies. Among these, the administration of probiotics, particularly Gram-positive lactic acid bacteria (LAB), targeting both immune and environmental factors, has shown promising potential for efficacy in selected populations in early clinical trials. However, knowledge gaps and inconsistent efficacy currently prevent recommendations for the use of probiotics in larger IBD patient populations. The inconsistent efficacy of probiotics is likely due to variable cell viability and potency after administration, further exacerbated by IBD patient heterogeneity. Thus, an alternative to live probiotics for IBD has emerged in the form of bacterial extracellular vesicles (BEVs)-cell-secreted nanovesicles containing abundant bioactive cargo that, like live probiotics, can regulate immune and environmental factors but with fewer viability limitations and safety concerns. In this review, we summarize the work done to date establishing the potential of BEVs to provide the therapeutic benefits in IBD and discuss the hurdles BEVs must overcome to achieve clinical translation. We also consider future directions for BEV therapeutics, especially treatment potential for necrotizing enterocolitis (NEC), which shares similarities in pathophysiology with IBD.

Six-Year Observation Data Reveal Reduction in Concomitant Steroid Overuse for Inflammatory Bowel Disease in Germany

BACKGROUND

Maintenance and/or prolonged treatment with oral corticosteroid (OCS) in inflammatory bowel disease (IBD) is not recommended, yet remains common. This study assessed concomitant OCS use and overuse in IBD patients in Germany from 2017 to 2022.

METHODS

We retrospectively analyzed German claims data (2017-2022). Patients over 18 years of age with continuous insurance and at least s2 quarterly diagnoses of Crohn's disease (CD) or ulcerative colitis (UC) within 2 years were included. To increase the diagnostic certainty and clinical relevance, only patients with IBD who were currently receiving any form of IBD therapy were included in the analysis. OCS overuse was defined as receiving ≥2 OCS prescriptions within 1 year alongside other IBD medications.

RESULTS

The study identified 9407 patients with confirmed CD and 11 772 patients with confirmed UC who were treated with IBD medications excluding OCS monotherapy within the observation period. Among those, 42.8% of CD patients and 39.0% of UC patients were treated with concomitant OCS (CD vs. UC, P < .0001), while 31.3% of CD patients and 29.4% of UC patients exhibited concomitant OCS overuse (CD vs. UC, P < .01). Concomitant OCS use and overuse were more common among younger age groups (P < .01). OCS use and OCS overuse decreased significantly (P < .0001) from 2017 to 2022.

CONCLUSIONS

This study provides real-world insights into the patterns of OCS use and overuse in IBD patients. The continued reliance on OCS is highlighted, particularly in CD patients and younger age groups. Notably, steroid overuse has decreased significantly over the last 6 years.

Practical Application of Evidence-Based Dietary Therapy in Inflammatory Bowel Disease: The DELECTABLE Program

BACKGROUND/OBJECTIVES

Exclusive Enteral Nutrition (EEN) and the Crohn's Disease Exclusion Diet (CDED) have been shown to induce remission in Crohn's disease. Low-sulphur, plant-based diets are being explored for ulcerative colitis, and wholefood, low-additive approaches are emerging as significant. Although Inflammatory Bowel Disease (IBD) patients modify their diet, evidence for tolerability and benefit outside clinical trials is limited. The DELECTABLE program aimed to assess satisfaction, adherence, and efficacy of dietary therapies as part of IBD care.

METHODS

In this dietitian-led, open-label, prospective study, patients with Crohn's disease were offered the CDED or a whole-food, additive-free diet (WFD), and patients with ulcerative colitis were offered a low-sulphur, plant-based diet (UCD) or WFD. Primary outcomes were 12-week diet satisfaction (modified DSAT-28) and diet adherence, including food additive intake. Secondary outcomes were quality of life (QoL) (IBDQ-9), disease activity (CDAI for Crohn's disease, partial Mayo score for ulcerative colitis), and biochemical markers (CRP, faecal calprotectin). Analyses were conducted within, rather than between, diet arms due to the non-random nature of the study. Diet adherence and disease activity change across time points (baseline, week 6, week 12) were assessed using repeated measures ANOVA or Friedman's test, with pairwise paired t-test or Wilcoxon Signed-Rank test. Diet satisfaction and quality of life changes across time (baseline/week 1, week 12) were assessed using a paired t-test or Wilcoxon Signed-Rank test.

RESULTS

Of 165 referrals, 76 patients enrolled, with 64 completing the 12-week program (CDED: n = 15, WFD: n = 42, UCD: n = 7). Diet satisfaction was initially high and remained stable over time on CDED (p = 0.212) and improved on WFD (p = 0.03). Patient- and dietitian-rated adherence was high at baseline and did not significantly decrease on any diet arm (p > 0.349). Food additive intake decreased on WFD (p = 0.009). QoL improved on CDED and WFD (p < 0.001). CRP, calprotectin, and CDAI were reduced on CDED (p < 0.045), and CDAI and partial Mayo were reduced on WFD (p < 0.027).

CONCLUSIONS

Well-balanced therapeutic diets are feasible and well-accepted by patients with IBD, with a promising impact on disease activity.

Is Health Status in Patients With Chronic Disorders of the Gastrointestinal System Disease-Specific? Results From an Integral Approach

BACKGROUND

In patients with chronic disorders of the gastrointestinal (GI) system, integral health is disturbed in all dimensions: physical, mental, quality of life, participation, meaningfulness, and daily functioning. In this group, three large subgroups are distinguished: Inflammatory Bowel Diseases (IBD), Hepato-Pancreatico-Biliary diseases (HPB), and NeuroGastroenterology and Motility (NGM) disorders. Our aim was to compare integral health status between these three subgroups. For the NGM group, we focused on patients with documented motility disorders, not on patients with functional GI-disorders. We hypothesized that the NGM group will have lower scores for integral health status compared to the IBD and HPB groups.

METHODS

A prospective, observational, questionnaire study was performed in patients with chronic GI-system disorders (IBD, HPB, and NGM) attending the Maastricht University Medical Center outpatient department. Validated questionnaires and patient file data were used to quantify six health dimensions.

KEY RESULTS

Data from 416 patients were collected. In all domains, apart from meaningfulness, the NGM group (n = 93) had significantly (0.001 ≤ p ≤ 0.033) lower scores compared to the IBD (n = 174) and HPB (n = 149) groups. From the NGM group, 66% were malnourished, had symptoms of depression (36%) and anxiety (19%), and work participation was lowest (32%). Correlations between intra- and interdimensional parameters were moderate to strong apart from meaningfulness.

CONCLUSIONS & INFERENCES

Compared to patients with chronic IBD and HPB disorders, patients with NGM disorders have significantly lower scores in five of six dimensions of health: physical and mental well-being, quality of life, daily functioning, and participation.

Developing IBD counsellors in low- and middle-income countries: bridging gaps in patient care

The global burden of inflammatory bowel disease (IBD) is progressively increasing, with a particularly sharp rise in newly industrialized and resource-limited settings. These regions face unique and pressing challenges in IBD care, including a shortage of trained specialists, delayed or missed diagnoses, financial and geographic barriers to access, and the persistent stigma surrounding the disease. Furthermore, cultural dynamics; especially the prominent role of family in healthcare decisions; profoundly influence patient engagement, treatment adherence, and overall outcomes. However, current healthcare models and global guidelines are largely shaped by Western systems that prioritize individual patient autonomy and may not fully align with the sociocultural realities of resource-limited settings. This viewpoint aims to highlight the need for culturally contextualized, scalable solutions to improve IBD care. Specifically, we propose the development and integration of IBD counsellors as a novel and pragmatic approach to bridge existing gaps in care. These counsellors, trained in the nuances of IBD and sensitive to local sociocultural norms, can serve as critical intermediaries; facilitating communication among patients, families, and providers; supporting adherence and follow-up; and offering tailored psychosocial and dietary guidance. By presenting this model, we seek to stimulate discourse around innovative, culturally adaptive strategies and advocate for policy-level recognition and investment to promote health equity in IBD care globally.

JAK Inhibitors: A Double-Edged Sword in Immune-Mediated Diseases Management

JAK inhibitors are pivotal in treating immune-mediated inflammatory diseases (IMIDs) like rheumatoid arthritis (RA) and inflammatory bowel disease. However, emerging safety concerns warrant careful evaluation. A recent analysis of the FDA Adverse Event Reporting System (FAERS) revealed that RA patients using JAK inhibitors face nearly double the risk of gastrointestinal perforations (GIPs) compared to those on biologics, particularly with concurrent steroid or NSAID use. Additionally, the FDA's ORAL Surveillance study linked tofacitinib with higher rates of cancer and cardiovascular events, prompting regulatory restrictions. These findings highlight the importance of balancing JAK inhibitors' therapeutic benefits with potential risks, emphasizing the need for patient-centred risk assessment and vigilant monitoring to optimize outcomes.

Family Factors and the Psychological Well-Being of Children and Adolescents with Inflammatory Bowel Disease-An Exploratory Study

Background/Objectives: The aim of our study was to examine the influence of family structure and the number of siblings on psychological problems and illness-related emotions in children and adolescents with inflammatory bowel disease (IBD) and the relationship between emotional coping in children and parents. Methods: CEDNA is a nationwide German online and paper-based questionnaire administered between October 2021 and April 2022. Adolescents with IBD, aged 12 to 17 years, and parents of children aged 0 to 17 years with diagnosed IBD, were included. SAS was used for descriptive statistics and logistic regression analysis was performed using R Studio (PBC; 2023.06.0 + 421). Results: 1158 participants (450 adolescents and 708 parents) were included in the study. A two-parent household could not be associated with mental illness as a comorbidity in pediatric IBD patients (p = 0.06) but was shown to decrease the risk of sadness (p < 0.001), helplessness (p < 0.01), feeling left alone and lonely (p < 0.05). A single-parent household increased the risk of sadness (p = 0.001), helplessness (p = 0.002), and loneliness (p = 0.006). Having one to two siblings was associated with a lower risk of mental health problems (p = 0.03) and reduced anxiety (p = 0.005). An association was also found between parents and children's emotional coping skills. Conclusions: Further research on family structure and siblings in pediatric IBD is needed, given the potential impact on children's psychological well-being.

Psychological interventions for treatment of inflammatory bowel disease

BACKGROUND

Persons with inflammatory bowel disease (IBD) have an increased risk of suffering from psychological problems. The association is assumed to be bi-directional. Psychological treatment is expected to improve quality of life (QoL), psychological issues and, possibly, disease activity. Many trials have tested various psychotherapy approaches, often in combination with educational modules or relaxation techniques, with inconsistent results.

OBJECTIVES

To assess the effects of psychological interventions on quality of life, emotional state and disease activity in persons of any age with IBD.

SEARCH METHODS

We searched Web of Science Core Collection, KCI-Korean Journal Database, Russian Science Citation Index, MEDLINE, Psyndex, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, and LILACS from inception to May 2023. We also searched trial registries and major gastroenterological and selected other IBD-related conferences from 2019 until 2023.

SELECTION CRITERIA

Randomized controlled trials of psychological interventions in children or adults with IBD compared to no therapy, sham (i.e. simulated intervention), or other active treatment, with a minimum follow-up time of two months, were eligible for inclusion, irrespective of publication status and language of publication. Interventions included psychotherapy and other non-pharmacological interventions addressing cognitive or emotional processing, patient education, or relaxation techniques to improve individual health status.

DATA COLLECTION AND ANALYSIS

Two raters independently extracted data and assessed the study quality using the Risk of Bias 2 Tool. Pooled standardized mean differences (SMD) for continuous outcomes and relative risks (RR) for event data were calculated with 95% confidence intervals (CI), based on separate random-effects models by age group, type of therapy and type of control. An SMD of 0.2 was considered a minimally relevant difference. SMD ≥ 0.4 was considered a moderate effect. Group analyses were planned to examine differential effects by type of IBD, disease activity, psychological comorbidity, therapy subtype, and treatment intensity. Statistical heterogeneity was determined by calculating the I2 statistic. Publication bias was assessed by presenting a funnel plot and calculating the Eggers Test. GRADE Profiling was used to describe the certainty of the evidence for relevant results.

MAIN RESULTS

Sixty-eight studies were eligible. Of these, 48 had results reported in sufficient detail for inclusion in the meta-analyses (6111 adults, 294 children and adolescents). Two trials were excluded from the meta-analysis following sensitivity analysis and tests for asymmetry because of implausible results. Most studies used multimodular approaches. The risk of bias was moderate for most outcomes, and high for some. The most common problems in individual trials were the inability to blind participants and investigators and outcome measures susceptible to measurement bias. The main issues leading to downgrading of the certainty of the evidence were heterogeneity of results, low precision and high or moderate risk of bias in the included trials. Publication bias could not be shown for any of the inspected analyses. In adults, psychotherapy was slightly more effective than care-as-usual (CAU) in improving short-term QoL (SMD 0.23, 95% CI 0.12 to 0.34; I2 = 13%; 20 trials, 1572 participants; moderate-certainty), depression (SMD -0.27, 95% CI -0.39 to -0.16; I2 = 0%; 16 trials, 1232 participants; moderate-certainty), and anxiety (SMD -0.29, 95% CI -0.40 to -0.17; I2 = 1%; 15 studies, 1135 participants; moderate-certainty). The results for disease activity were not pooled due to high heterogeneity (I2 = 72%). Interventions which used patient education may also have small positive short-term effects on QoL (SMD 0.19, 95% CI 0.06 to 0.32; I2 = 11%; 12 trials, 1058 participants; moderate-certainty), depression (SMD -0.22, 95% CI -0.37 to -0.07; I2 = 11%; 7 studies, 765 participants; moderate-certainty) and anxiety (SMD -0.16, 95% CI -0.32 to 0.00; I2 = 10%; 6 studies, 668 participants; moderate-certainty). We did not find an effect of education on disease activity (SMD -0.09, 95% CI -0.28 to 0.10; I2 = 38%; 7 studies, 755 participants; low-certainty). Pooled results on the effects of relaxation techniques showed small effects on QoL (SMD 0.25, 95% CI 0.08 to 0.41; I2 = 30%; 12 studies, 916 participants; moderate-certainty), depression (SMD -0.18, 95% CI -0.35 to -0.02; I2 = 0%; 7 studies, 576 participants; moderate-certainty), and anxiety (SMD -0.26, 95% CI -0.43 to -0.09; I2 = 13%; 8 studies, 627 participants; moderate-certainty). Results for disease activity were not pooled due to high heterogeneity (I2 = 72%). In children and adolescents, multimodular psychotherapy increased quality of life (SMD 0.54, 95% CI 0.06 to 1.02; I2 = 19%; 3 studies, 91 participants; moderate-certainty). The results for anxiety were inconclusive (SMD -0.09; 95% CI 0.-64 to 0.46; 2 trials, 51 patients, very low-certainty). Pooled effects were not calculated for depressive symptoms. Disease activity was not assessed in any of the trials compared to CAU. In education, based on one study, there might be a positive effect of the intervention on quality of life (MD 7.1, 95% CI 2.18 to 12.02; 40 patients; low-certainty evidence) but possibly not on depression (MD -6, 95% CI -12.01 to 0.01; 41 patients; very low-certainty). Anxiety and disease activity were not assessed for this comparison. Regarding the effects of relaxation techniques on children and adolescents, all results were inconclusive (very low-certainty).

AUTHORS' CONCLUSIONS

Psychological interventions in adults are likely to improve the quality of life, depression and anxiety slightly. Psychotherapy is probably also effective for improving the quality of life in children and adolescents. The evidence suggests that psychological interventions may have little to no effect on disease activity. The interpretation of these results presents a challenge due to the clinical heterogeneity of the included trials, particularly concerning the type and various components of the common multimodular interventions. This complexity underscores the need for further research and exploration in this area.

Flourishing in life in patients with Inflammatory Bowel Disease: The role of illness identity and health-related quality of life

Amidst chronic challenges in Inflammatory Bowel Disease (IBD), including physical symptoms, emotional stress, and social constraints, this study aimed to elucidate how patients' perceptions of their illness and its integration into their self-concept are related to their ability to flourish in life. We hypothesized that having a positive and integrative illness identity and social identification will predict higher flourishing, mediated by enhanced health-related quality of life (HRQoL). In an online survey with 244 German-speaking IBD adults (Mage = 36.62, 85% women), we found that lower engulfment (where the disease dominates one's identity) predicted higher levels of flourishing, mediated by higher HRQoL. Enrichment, reflecting personal growth from illness, directly predicted higher flourishing, while stronger social identification predicted higher subjective well-being, but not flourishing. The results highlight the potential of fostering positive illness identities and social connections to enhance flourishing in individuals with IBD or similar chronic conditions.

Trends and Factors Related to Quality of Life in Patients with Inflammatory Bowel Disease

Background/Aims

Inflammatory bowel disease (IBD) affects health-related quality of life (HRQoL). The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) score is strongly correlated with HRQoL in IBD patients. This study aimed to assess the factors influencing HRQoL in IBD patients.

Methods

In this prospective study, all patients with ulcerative colitis (UC) and Crohn's disease (CD) completed the SIBDQ at enrollment; some patients also completed a second SIBDQ at follow-up. Multiple linear regression analysis was used to determine associations between SIBDQ scores and clinical factors.

Results

A total of 1,020 patients participated (UC, 67%; CD, 33%). The median SIBDQ score was 52 (interquartile range, 44 to 59). In UC patients, the stool frequency (β=-2.333, p<0.001), Physician Global Assessment score (β=-3.950, p<0.001), fecal calprotectin level (β=-4.014, p<0.001), and corticosteroid use (β=-4.809, p=0.006) were negatively correlated with the SIBDQ score. In CD patients, the number of diarrhea episodes per day (β=-1.467, p=0.024) and Crohn's Disease Activity Index score (β=-0.045, p<0.001) were negatively correlated with the SIBDQ score. A total of 202 patients completed the second SIBDQ within a mean of 3.4 years. The distributions of SIBDQ score changes were as follows: decrease >10%, 28%; -10%10%, 43%. In both the initial SIBDQ and follow-up SIBDQ, scores for items pertaining to systemic symptoms (tension and fatigue) were relatively low.

Conclusions

Bowel movement-related problems significantly affect the HRQoL of both UC and CD patients. IBD patients scored lower on SIBDQ items related to general well-being. After 3 years of follow-up at the IBD clinic, 43% of patients showed a significant improvement in HRQoL.

Lived Experiences of Patients With Inflammatory Bowel Disease in Italy: A Phenomenological Investigation

Inflammatory bowel disease is a type of chronic gastrointestinal inflammatory disease. The chronic nature of the disease, the severity of its symptoms, and its unpredictability make it comparable to cancers regarding both its influence on quality of life and the direct and indirect health costs. The impact of inflammatory bowel disease on daily life is well documented; however, despite the notable increase in the incidence of inflammatory bowel disease in recent years, the international literature still does not adequately take into account the perspective of patients and how they experience the disease in their daily lives. With Cohen's phenomenology method, we investigate the lived experience of people suffering from inflammatory bowel disease. Our sample included 21 participants with an average age of 47 years. Three main themes and related subthemes emerged: A "deep life change" with the subtheme of "self-isolation," being "invisibly sick," and "receiving the diagnosis" with the subtheme of "trust in health professionals." Understanding the lived experiences of people living with inflammatory bowel disease will aid in the development of educational programs and effective interventions.

Health-related quality of life at diagnosis and follow-up in Faroese and Danish patients with inflammatory bowel disease - a Faroese IBD cohort study

BACKGROUND AND AIMS

Patients with inflammatory bowel disease (IBD) have lower health-related quality of life (HRQoL) than the general population. The highest incidence and prevalence rates of IBD in the world are found in the Faroe Islands, however, the HRQoL of Faroese patients is unknown. This study aimed to determine their HRQoL at diagnosis and two years of follow-up in comparison with Danish patients.

METHODS

All patients (15 years or older) were invited to answer the Short Form 12 questionnaire (SF-12) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) at diagnosis and follow-up. Faroese patients were included from 2010 to 2022, and Danish patients in 2010.

RESULTS

160 Faroese patients and 160 Danish patients completed questionnaires twice. For Faroese patients with IBD, the physical and mental component summary scores (SF-12) significantly improved from 46.6 and 44.0 to 49.4 and 47.7, respectively. Total SIBDQ scores also improved from 46.6 to 53.9. However, Faroese patients had significantly lower scores at diagnosis of social functioning, mental health, and mental component summary (SF-12) as well as lower emotional scores (SIBDQ) compared with Danish patients.

CONCLUSIONS

Faroese patients with IBD improved their HRQoL from diagnosis to follow-up, although greater improvements were observed for Danish patients. Increased awareness of the HRQoL of this patient group is warranted as Faroese patients had lower mental and emotional scores than Danish patients at diagnosis.

Understanding diagnostic delays and health outcomes for inflammatory bowel disease: a mixed-methods study of patients' perspectives

PURPOSE

Inflammatory bowel disease (IBD) is a chronic condition affecting the digestive system with symptoms that are often episodic, unpredictable, socially stigmatizing, and impact quality of life. While a timely diagnosis reduces the risk of complications and improves health outcomes, diagnostic delays (DDs) are common. Our study used narratives and data from patient-reported outcome measures (PROMs) of individuals diagnosed with IBD to examine: (1) What factors helped or hindered achieving a timely diagnosis of IBD? and (2) how do DDs relate to PROMs?

METHODS

We conducted a mixed-methods study of 296 individuals diagnosed with IBD in Canada. The survey included a set of validated measures that assessed depression, fatigue, satisfaction with life, disease severity, and several open-ended questions.

RESULTS

Thematic analysis of open-ended responses revealed five themes that highlighted the ways a diagnosis was delayed or facilitated: symptom ambiguity, fear and denial, patient-provider communication breakdown, misdiagnosis and self-doubt, and self-advocacy. Quantitative findings revealed that a longer time to receive a diagnosis was significantly correlated with higher levels of depression (r = .26) and fatigue (r = .25), reduced satisfaction with life (r =  - .25), and greater disease severity (r =  - .22). We used the data to generate a framework called the Diagnostic Pathways Model to illustrate the diagnostic process of a chronic disease such as IBD.

CONCLUSION

DDs involve the interacting roles of patient, medical, and communication factors, and a DD can negatively impact a patient's quality of life. Implications for physician-patient communication and public information are discussed.

[Position paper of the Society for Paediatric Gastroenterology and Nutrition (GPGE) on the off-label use of biologics and signal inhibitors in children and adolescents with IBD that have already been approved for adults]

Therapy for children and adolescents with chronic inflammatory bowel disease (IBD) is basically no different from that for adult patients. However, of the steadily increasing number of biologics and signalling inhibitors for adults, only two TNFα antibodies are currently approved in Germany for the treatment of IBD from the age of 6. This means that a large proportion of the drugs authorised for adults with IBD are not available for children and adolescents with moderate to severe disease. The small number of approved drugs also makes it difficult to achieve the prognostically important goal of achieving a sustained remission of IBD soon after diagnosis, which is characterised by the patient being free of symptoms and also the objectifiable goal of mucosa healing. This position paper is intended to present the current study situation on the drug treatment of children and adolescents with IBD outside the age limit and to serve as a basis for information and decision-making for the Medical Service in the assessment of individual case applications as well as for the treating physicians, the cost bearers, health policy and social court decision-makers.

Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study

BACKGROUND

Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals.

METHODS

We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital were analyzed with intraclass correlation coefficients (ICCs) from case mix-adjusted (generalized) linear mixed models.

RESULTS

We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: €8323 per 6 months), mainly attributed to advanced therapies (€6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations.

CONCLUSIONS

Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care.

TRIAL REGISTRATION NUMBER

NL8276.

Induction of Endoscopic Response, Remission, and Ulcer-Free Endoscopy With Upadacitinib Is Associated With Improved Clinical Outcomes and Quality of Life in Patients With Crohn's Disease

BACKGROUND

We evaluated the association of achieving endoscopic outcomes at week 12 of induction with improvements in clinical outcomes and quality of life (QoL) at week 52 of maintenance in patients with moderately to severely active Crohn's disease (CD) treated with upadacitinib (UPA).

METHODS

This post hoc analysis evaluated data from 2 phase 3 induction trials (NCT03345836 and NCT03345849) and 1 maintenance (NCT03345823) trial. Clinical responders to 12-week induction therapy with UPA who also received 52-week maintenance treatment with UPA were included. Endoscopic response, remission, healing, and ulcer-free endoscopy were assessed at week 12. Meaningful improvements in clinical and QoL outcomes were evaluated at week 52.

RESULTS

A significantly greater proportion of patients who achieved an endoscopic response at the end of induction, compared with patients who did not, attained Crohn's Disease Activity Index (CDAI) remission (52.0% vs 34.6%; P ≤ .01), corticosteroid-free CDAI remission (50.0% vs 30.9%), Inflammatory Bowel Disease Questionnaire remission (52.6% vs 30.3%), and meaningful improvements in Functional Assessment of Chronic Illness Therapy-Fatigue response (46.7% vs 25.9%), overall work impairment (47.1% vs 26.5%), and daily activity impairment (53.3% vs 34.1%) (all P < .05) at week 52. Similar findings were observed for patients who achieved endoscopic remission, endoscopic healing, and ulcer-free endoscopy at the end of induction vs those who did not.

CONCLUSIONS

Early improvement in endoscopic outcomes after UPA induction treatment was associated with long-term meaningful improvements in clinical outcomes and QoL in patients with CD.

CLINICAL REGISTRATION NUMBER

U-EXCEED induction trial (NCT03345836), U-EXCEL induction trial (NCT03345849), and U-ENDURE maintenance trial (NCT03345823).

Systematic review: severe endoscopic lesions in inflammatory bowel disease

BACKGROUND

Endoscopy and biopsy are the standard tools for the diagnosis of inflammatory bowel disease (IBD) and the assessment of treatment response. Severe endoscopic lesions (SEL) are commonly observed in IBD, but have been poorly described in the literature. The aim of this review is to provide an overview of the current understanding and gaps in knowledge about these lesions.

METHODS

We performed a systematic review of studies of SEL in patients with IBD. A search was performed in MEDLINE, Embase, and Cochrane CENTRAL databases in July 2024. Studies were eligible if they investigated SEL, its involvement in the disease, its evolution with treatment, and its prognostic implications.

RESULTS

We found 1172 articles in the Pubmed database and 46 were included. Of the various definitions of SEL used in the literature, most of them are based on the most severe endoscopic items from existing endoscopic scores, but none have been validated. Despite the paucity of literature, the prevalence of SEL is estimated to be 33%-75% in acute severe ulcerative colitis (ASUC) and 22.5%-87% in Crohn's disease (CD). In terms of prognosis, SEL are associated with steroid refractoriness in ASUC and do not affect response to infliximab or ciclosporin. In CD, the response to biologics, especially anti-TNF, is not affected by the presence of SEL.

CONCLUSIONS

There is currently no validated definition of SEL in IBD. When present, they are associated with steroid failure in the setting of ASUC, but do not affect response to anti-TNF in either CD or ASUC.

An online mindfulness-based intervention for adults with Inflammatory Bowel Disease & psychological distress: A feasibility randomized controlled trial of the Mind4IBD program

OBJECTIVE

The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapies, such as mindfulness-based interventions (MBI), for improving biopsychosocial outcomes. Therefore, the aim is to examine the feasibility, acceptability, and preliminary efficacy of an online-delivered, self-directed MBI, adapted to individuals with IBD and psychological distress, in comparison to wait-list control (WLC).

METHODS

50 adults with IBD were randomized to WLC (N = 25) or intervention (N = 25) groups. The intervention (MIND4IBD program) consisted of six, weekly, 15-min videos (with guided meditations). Feasibility was examined through recruitment and retention rates, while acceptability was examined through intervention satisfaction ratings and qualitative feedback. Preliminary efficacy was examined using linear mixed models for group differences in outcomes between baseline and post-intervention.

RESULTS

Primary Outcomes. The retention rate for the WLC group was 92 %, while the retention rate for the intervention group was 48 %. However, 16 % of participants allocated to the intervention group never began the intervention, therefore this resulted in a retention rate of 71 % of participants who began the intervention. Acceptability was high with an average intervention satisfaction rating of 83/100.

SECONDARY OUTCOMES

When compared with the WLC, the MIND4IBD program improved total mindfulness levels (b = 0.29, 95 %CI [0.11,0.47], p = 0.004) with a large effect size (β = 0.54, b = 0.19, 95 %CI [0.04,0.34], p = 0.014). Themes based on participants' intervention feedback included: 1) beginning of journey with mindfulness, 2) the beneficial impact of mindfulness, 3) why adapting the intervention to IBD is important, 4) views on program delivery, and 5) mixed reactions to AI generated presenters.

CONCLUSION

MIND4IBD is feasible and acceptable for individuals with IBD and psychological distress. Participants' total mindfulness levels increased significantly in the intervention group compared to WLC. Most participants provided positive intervention feedback. These findings warrant a full-scale RCT to determine MIND4IBD's efficacy for IBD.

Prevalence of faecal incontinence in patients with inflammatory bowel disease: Severity and its relationship with quality of life

AIMS

To describe the prevalence of faecal incontinence in patients with inflammatory bowel disease, assess its severity, and correlation with quality of life. We adhered to relevant EQUATOR guidelines, STROBE method.

DESIGN

Correlational-descriptive study.

METHODS

Hebrew-speaking patients seen at an inflammatory bowel disease clinic in a large tertiary medical center in Jerusalem between February 2020 and December 2020 completed the Faecal Incontinence Severity Index and the Faecal Incontinence Quality of Life Scale.

RESULTS

Ninety-six patients participated in the study, of which 70 (72.9%) had Crohn's disease, and 26 (27.1%) had ulcerative colitis. Eighty-five (88.5%) reported faecal incontinence with an overall Faecal Incontinence Severity Index mean of 27.66 (SD 15.99), yet only 14 (14.7%) reported that their physician or nurse inquired about faecal incontinence. Quality of life scores for patients with faecal incontinence was the lowest on the coping/behaviour scale (M = 2.44; SD 0.94) and the highest on the depression/self-perception scale (M = 2.86; SD 1.04). Significant correlations were found between faecal incontinence severity and quality of life in all scales except for self-embarrassment. Moderate correlations in the same scales were noted in patients with Ulcerative Colitis, while no significant correlations were found in the Crohn's Disease group.

CONCLUSION

A high proportion of inflammatory bowel disease patients reported faecal incontinence associated with impaired quality of life. Only a few were questioned about faecal incontinence by their physician or nurse.

IMPACT

There is limited literature regarding the prevalence and severity of faecal incontinence in inflammatory bowel disease patients. A high proportion of patients reported faecal incontinence, which negatively correlated with quality of life. Physicians and nurses must inquire about faecal incontinence to improve patient care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Black Race is Associated with Decreased Exposure to Advanced Therapies and Worse Outcomes in Individuals with Ulcerative Colitis

BACKGROUND

For people diagnosed with ulcerative colitis (UC), racial disparities exist both in access to medications and clinical outcomes.

METHODS

We used the TriNetX database for two population-based retrospective analyses with Black (n = 22,519) and Asian (n = 8,626) individuals with UC matched for age, sex, and ethnicity. Outcomes included mortality, medication prescriptions, and clinical encounters at 6 months and 10 years.

RESULTS

At 6 months and 10 years after diagnosis, Black people had increased mortality (2.7% vs. 1.9% and 8.1% vs. 6.9%, p < 0.0001), were prescribed fewer UC-specific therapies (21.3% vs. 26.4% and 30% vs. 36%, p < 0.0001), had higher rates of emergency department visits (22.3% vs. 13.6% and 41.2% vs. 31.5%, p < 0.0001), and higher hospitalisation rates (30.1% vs. 25.8% and 42.6% vs. 39.9%, p < 0.0001). At 6 months, they had more opioid prescriptions (18.5% vs. 15.7%, p < 0.0001). Asian people had lower mortality at 10 years (5.6% vs. 7.7%, p < 0.0001), higher rates of UC-specific medications at 6 months (28.6% vs. 26.5%, p = 0.002), and more hospitalizations (38.8% vs. 27.7%, p < 0.0001 at 6 months and 50% vs. 42.2%, p < 0.0001 at 10 years).

CONCLUSION

Black individuals with UC are prescribed fewer disease-specific therapies compared to White individuals and have increased hospitalizations and mortality. Black individuals have higher rates of opioid prescriptions. Opioids have been associated with increased complication rates in inflammatory bowel disease. These trends are not seen in Asian individuals. This reveals critical disparities in the care of Black people with UC with opportunity for targeted interventions.

Food-Related Quality of Life in Inflammatory Bowel Disease: Translation and Validation of Food-Related Quality of Life to the Portuguese Language (FR-QoL-29-Portuguese)

Introduction

Food-related quality of life (FR-QoL) has been shown to be an important patient-reported outcome in inflammatory bowel disease (IBD). We aimed to translate and validate a Portuguese version of the FR-QoL-29.

Methods

This was a case-control cross-sectional study undertaken at a tertiary hospital. After obtaining the original authors' authorization, both forward and backward translations of the original FR-QoL-29 were performed by bilingual researchers. After an IBD expert's revision and the input of a small group of patients, a final version was obtained. Portuguese IBD patients were prospectively recruited from the outpatient clinic of a tertiary hospital and completed the questionnaire at two timepoints (0 and 4 weeks). Reliability (internal consistency, test-retest, and intraclass correlation [ICC]), validity (content and convergent validity, and hypothesis testing using Spearman's correlations), and responsiveness (Student t tests) were analysed.

Results

239 patients (mean age 50.1 [SD = 15.3 years], 56.5% female) and 87 (36.4%) patients answered the questionnaire at the first and second timepoints, respectively; 126 controls answered the questionnaire. Overall, the FR-QoL-29-Portuguese showed excellent internal consistency (Cronbach's α = 0.97) and good test-retest reliability (ICC = 0.78 [95% CI: 0.64-0.85]). FR-QoL moderately correlated with health-related quality of life, measured by the SIBDQ-PT (R = 0.49; p < 0.05). Lastly, the questionnaire revealed appropriate responsiveness when patients reported an overall improvement in general well-being (mean improvement 25.88 [SD = 32.50]; p < 0.05).

Discussion/Conclusions

We present an adaptation and validation of the FR-QoL-29 tool for Portuguese IBD patients. The FR-QoL-29-Portuguese is a reliable and valid tool shown to be responsive to changes in general well-being.

Profiling the patient with inflammatory bowel disease in the relationship between physical activity and partner/social network status: A post hoc patient-tailored analysis of the "BE-FIT-IBD" study

INTRODUCTION

Normal quality of life is an ultimate target in the therapeutic approach to inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC) in the context of which regular physical activity (PA) is often a chimeric parameter that is not standardized in terms of quality/quantity. The study aimed to profile a sample of IBD patients about the relationship between PA-partner status and social network support.

PATIENTS AND METHODS

A post hoc analysis of the "BE-FIT-IBD" study was set up by stratifying the data of PA with that of partner status and the support that the patient's social network (i.e., relatives, friends) provided in inciting the patient to practice regular PA.

RESULTS

In the 219 patients included, there was a greater tendency for patients with stable partners to view the risk of reactivation/worsening of IBD as a barrier to conducting regular PA (p<0.0001). Single patients considered PA more as a protective factor (p=0.045). Patients without a PA-supporting social network retained IBD-related treatment as a PA barrier (p=0.016) and PA as a risk for IBD complications (p=0.01), with less confidence that PA could improve the course of IBD (p<0.001). Rectal syndrome was an IBD-related barrier more represented in patients with PA-deterring social network (p<0.0001).

CONCLUSIONS

These factors are potential targets for recovering the IBD patient's adherence to regular PA.

Quality of life of inflammatory bowel diseases patients in france with EQ-5D-5 L: the QALY-MICI study

PURPOSE

This study aimed to document utility values and the Visual Analog Scale (VAS) with the 5-level version of the EQ-5D questionnaire in a large sample of patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC).

METHODS

QALY-MICI was a cross-sectional survey across three sources in France. Data were collected between 2019 and 2022 for patients 18 and over. The EQ-5D-5 L, the EQ-VAS, the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Harvey-Bradshaw Index (HBI) for CD, and the Walmsley Index for UC (SCCAI) were collected.

RESULTS

A total of 2,841 patients aged over 18 were recruited (1785 with CD, 1056 with UC). The mean age was 40.2 (SD 14.3). The time since diagnosis was 6 years and over for 61.9% of patients. The most impacted dimensions were usual activities, anxiety/ depression, and pain/ discomfort. The mean utility value was 0.863 (SD 0.172) versus 0.905 (SD 0.158) in the French population (p = 0.007). The mean VAS value was 68 (SD 19.2) versus 73.4 (SD 22.2) in the general population (p = 0.016). Utility values and VAS were similar for CD and UC and higher for men. There was a strong positive correlation between utility values, the VAS, and the SIBDQ score, and a negative correlation between the HBI and the SCCAI. The SIBDQ score and disease activity were the main predictors of utility and VAS.

CONCLUSION

The QALY-MICI is, to our knowledge, the first study documenting utility values and VAS using the EQ-5D-5 L questionnaire on a large sample, with a comparison to the general population.

Early Surgical Resection in Pediatric Patients with Localized Ileo-Cecal Crohn's Disease: Results of a Retrospective Multicenter Study

Background: Crohn's disease (CD) is an inflammatory bowel disease (IBD) that also affects pediatric patients. It frequently presents as a localized disease, affecting the ileocecal area, ileum, or colon. It requires targeted therapy to achieve a good quality of life and long-term control of disease activity. Despite multiple medical therapies available, several patients benefit from surgical treatment. The aim of our study is to demonstrate how an early surgical approach can bring an improvement in disease activity, evaluating the Simple Endoscopic Score for Crohn's Disease (SES-CD) and the Pediatric Crohn's Disease Activity Index (PCDAI). Methods: A retrospective multicenter study was carried out from 2008 to 2023, including 29 patients, affected by localized CD. These data were analyzed: demographics, SES-CD, and PCDAI, before and after surgery. The differences between groups were analyzed using Student's t-test for continuous variables, and Pearson's Chi-squared test or Fisher's exact test for categorical variables. Results: The SES-CD significantly decreased from 12 (median, range 1-15) to 0 (median, range 0-6) (p < 0.0001) and the PCDAI decreased from 30 (median, range 10-50) to 0 (median, range 0-15) (p < 0.0001). The rate of patients receiving enteral nutrition decreased from 51.7% preoperatively to 0% postoperatively (p = 0.0001). The rate of antibiotic use decreased from 13.8% to 0% (p = 0.0001). The rate of patients receiving ≥2 drugs decreased from 10.3% to 0% (p = 0.0001). Conclusions: The early surgical approach can be considered an excellent therapeutic strategy in patients with localized CD. Both parameters examined, SES-CD and PCDAI, demonstrated a clear improvement in the endoscopic images and in disease activity.

Chronic enteropathy in dogs affects the quality of life in both dogs and their owners-are veterinarians proficient in handling the caregiver burden?

Introduction

Chronic disease is generally known to affect dogs' quality of life (QoL) as well as being associated with increased strain on their owners. Gastrointestinal (GI) disease is a common problem in companion animal practice, yet little is known about the QoL of dogs with chronic enteropathy (CE) and how their owners and veterinarians assess it.

Methods

The aim of this study was to explore: (i) how dog owners and veterinarians observed and evaluated QoL for dogs with chronic GI disease, (ii) how having a dog with CE affected the owner's QoL, and (iii) characteristics of the communication and relationship between the dog owner and veterinarian. Twenty owners of dogs with CE and 20 companion animal veterinarians were included in this qualitative, interview-based, exploratory study.

Results

Owners evaluated QoL based on their dog's apparent emotional state, the presence of clinical signs, or restrictions in their daily life. In their assessments, veterinarians looked at the presence or absence of normal behavior, but also at disease severity and the emotional state of the dog. The majority of owners experienced many concerns and burdens that impacted their own QoL, including daily logistical challenges, implementing therapeutic regimens such as diet restriction, administering multiple daily medications, and the strain of nursing responsibilities on the owner-dog relationship. Dog owners generally felt that communication with their veterinarians was good, while veterinarians found the communication laborious and time-consuming.

Discussion

In general, owners and veterinarians were aligned in their QoL assessments, and the majority of veterinarians relied heavily on the owners' input and observations. However, assessments were not done in a standardized fashion among either group. Logistical challenges of having a dog with a chronic GI disease often lead to lifestyle changes for the owners, including altering working hours and cancelling holidays or other social arrangements. Having a dog with CE therefore affected the owners' QoL even when the dogs were clinically stable. Providing owners with written material about the condition in addition to medical and feeding regimen instructions may help the owner, improve compliance, and decrease the non-billable hours the veterinarian must spend communicating with the owner about their dog's CE.

Assessing inflammatory protein factors in inflammatory bowel Disease using multivariable mendelian randomization

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), decreases quality of life and causes disability. The underlying processes are not fully understood. This study uses Mendelian randomization (MR) analysis to identify cytokines that may be associated with UC and CD, aiding in early diagnosis and treatment decisions. Methods Genome-wide association study (GWAS) data for inflammatory cytokine levels were obtained from a cohort of 14,824 individuals of European descent. The outcome data were then analyzed using summary-level GWAS data for UC and CD from the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC). The analysis was primarily conducted using inverse-variance weighted (IVW) methods, with MR-Egger and weighted median serving as supplementary analyses. Sensitivity analyses included Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis.The inflammatory cytokines were subjected to additional scrutiny through the application of the Steiger test and reverse Mendelian randomization analysis. Subsequently, multivariable Mendelian randomization (MVMR) was employed to examine the associations of metabolites on UC and CD, in conjunction with linkage disequilibrium score regression (LDSC) and colocalization analysis. After FDR correction, we identified significant genetic associations of two inflammatory proteins (CXCL5 and CXCL9) with UC, and CXCL5 and IL-18R1 with CD. These findings were further validated by MVMR. Colocalization analyses demonstrated substantial genetic overlap between inflammatory proteins and IBD, with CXCL5 showing strong evidence of shared genetic variants with UC, and CXCL9 exhibiting genetic colocalization with CD, suggesting common genetic determinants underlying these inflammatory protein-IBD relationships. The current work presents evidence that presents evidence of significant associations between seven inflammatory protein factors and UC, as well as three inflammatory protein factors and CD. These findings provide novel insights into the biological mechanisms of IBD, and have implications for the screening, prevention, and treatment of IBD.

Correlation Between Rumination, Symptom Clusters, and Quality of Life in Patients With Inflammatory Bowel Disease: A Cross-Sectional Study

Previous studies have demonstrated that individuals with inflammatory bowel disease (IBD) experience distinct symptom clusters and generally have a lower quality of life compared to the general population. Rumination refers to the persistent and repetitive contemplation of the causes, consequences, and intricate details of a negative and stressful event. The multiple symptom clusters of IBD cause great distress, physical and financial stress, and thus may increase the level of rumination in patients. However, the relationship between rumination, symptom clusters, and quality of life in IBD patients remains unclear. Therefore, the objective of this study was to assess the state of rumination and examine its association with symptom clusters and quality of life among individuals with IBD. This study found a significant positive correlation between rumination and symptom clusters, while a significant negative correlation between rumination and quality of life in IBD patients (p < .001). Patients with higher levels of rumination in IBD exhibited more severe symptoms and poorer quality of life. Reducing rumination levels may prove beneficial in alleviating symptoms and improving the quality of life for IBD patients. In daily nursing practice, timely evaluation of rumination and appropriate interventions are essential to achieve better therapeutic outcomes.

Gossypetin Alleviates DSS-induced Colitis by Regulating COX2 and ROS-JNK Signaling

BACKGROUND

Inflammatory Bowel Disease (IBD) represents a chronic and recurrent inflammatory condition affecting the gastrointestinal tract, with a rising global incidence. Current treatment approaches include surgery and drugs. However, surgeries are invasive procedures, while drug treatments often present with various side effects. Gossypetin, a flavonoid found abundantly in plants such as hibiscus, exhibits anti-oxidant and anti-cancer properties. However, its potential impact on IBD remains unexplored.

OBJECTIVE

This study aimed to investigate the therapeutic potential of gossypetin on colitis.

METHODS

We employed the DSS-induced colitis model to evaluate the therapeutic potential of gossypetin on colitis. The efficacy of gossypetin was assessed within this model using the Disease Activity Index (DAI) score and histological analysis. Additionally, we utilized qRT-PCR to measure the levels of inflammatory cytokines and Superoxide Dismutase (SOD). Immunohistochemistry confirmed the expression of tight junction markers, COX-2, and phosphorylated JNK protein, normally associated with disease progression. Furthermore, Western blot analysis was conducted to examine the SOD levels and anti-apoptotic effects of gossypetin.

RESULTS

In DSS-induced colitis mice, gossypetin treatment ameliorated weight loss and reduced colon length caused by DSS treatment. Additionally, gossypetin-treated groups exhibited DAI scores and reduced histological damage. Moreover, gossypetin treatment increased tight junction expression, decreased inflammatory responses, reduced ROS levels, attenuated JNK signaling, and decreased apoptosis.

CONCLUSION

Gossypetin shows therapeutic potential for mitigating the symptoms and progression of colitis by targeting ROS-JNK signaling involved in inflammation and tissue damage. This highlights the potential of natural compounds such as gossypetin for targeted therapies with reduced side effects and improved efficacy.

Real-World Impact of Uncontrolled Symptoms and Suboptimal Treatment Response in Patients With Crohn's Disease in the United States and Europe

Background

Despite a wide range of available treatments, there is limited evidence as to why significant numbers of Crohn's disease (CD) patients do not achieve disease remission or continue to have residual symptom burden. We aimed to quantify the impact of this suboptimal treatment on patient symptom incidence and severity, quality of life (QoL), and work impairment.

Methods

Data were derived from the Adelphi Real World CD Disease Specific Programme, a cross-sectional survey of CD patients and their treating physicians in France, Germany, Italy, Spain, the United Kingdom, and the United States between January 2020 and March 2021. Physicians reported on patients' clinical history, disease status, symptom load, and treatment. Patients reported their QoL and activity impairment using the EQ-5D-5L and Work Productivity and Activity Impairment measures. Patients were divided into remitters, partial remitters, and non-remitters. Multivariate regression models were used to assess the impact of remission status on clinical and QoL outcomes.

Results

Of 1786 patients, 24.1% were remitters, 53.2% were partial remitters, and 22.7% were non-remitters. Partial remitters and non-remitters had a significantly higher symptom load than remitters (P < .05), and non-remitters were up to 15 times more likely to experience key symptoms than remitters. Both non-remitters and partial remitters were also significantly more likely to have increased symptom severity (P < .05). Non-remitters were more likely to have switched treatment and received more treatment lines, as well as having significantly worse QoL, than remitters.

Conclusions

Suboptimal treatment response was associated with increased symptoms and QoL burden. Despite the increased burden experienced, partial remitters were not more likely to switch or receive more treatment lines than remitters, demonstrating the need to initiate effective therapy.

Patient Advisory Groups in Inflammatory Bowel Disease: A Collaborative Relationship Between Patients and Researchers

Background

Patient advisory groups are key to guiding research studies through meaningful engagement with the population of interest. Although patient advisory groups are greatly valuable to research studies, they are underutilized in inflammatory bowel disease research. Thus, this study aims to describe the development and implementation of a patient advisory group and evaluate the perspectives of researchers and members.

Methods

The Comprehensive Self-Management for inflammatory bowel disease study patient advisory group was created in 2022. The patient advisory group members and researchers completed the Public and Patient Engagement Evaluation Tool via an online survey. Thematic analysis of responses was used to identify common themes, and descriptive statistics were reported.

Results

The patient advisory group comprised of patients with inflammatory bowel disease met quarterly. Eight members and three researchers evaluated the patient advisory group. The five emerging themes were (1) lived experience of patient advisory group members; (2) diversity and representation; (3) purposeful engagement; (4) positives of patient advisory group; and (5) improvements to patient advisory group. All members agreed or strongly agreed that the meetings were a good use of their time, and all researchers strongly agreed that the group added value to the research study.

Conclusion

Patient advisory groups can create unique and positive experiences for both members and researchers when feedback is meaningfully sought, intentional, and incorporated into the study. There is a need to continue creating and using patient advisory groups with the intention of identifying problems and finding solutions alongside the inflammatory bowel disease community.

Assessment of the quality of life of patients with inflammatory bowel disease

INTRODUCTION

Ulcerative colitis (UC) and Crohn's disease (CD) are diseases that cause a significant impact on patients' quality of life. The aim of this study is to assess the impact of inflammatory bowel disease (IBD) on health-related quality of life (HRQoL).

MATERIAL AND METHODS

Observational, descriptive, cross-sectional study, carried out at Torrecárdenas Hospital (Almería). Patients over 14 years of age diagnosed with CD or UC were included. For the assessment of HRQoL, the reduced 9-item IBDQ-9 questionnaire was used.

RESULTS

106 patients with a mean age of 44 years were included, with a female predominance. Forty-five percent of the patients in the sample had UC compared to 55% with CD. Of the patients, 69.8% were in clinical remission. The median questionnaire score was 60.8 points out of 100. Statistically significant differences were observed between sexes, with worse HRQoL for females. No differences were observed between patients with UC and CD. Differences were also detected between patients who underwent surgery and those who did not. A negative association was observed between the number of flares and the questionnaire score.

CONCLUSIONS

In our study population, there is an acceptable HRQoL, with no differences observed between CD and UC. Female sex, absence of clinical remission, number of previous outbreaks, and surgery have a negative association with HRQoL.

Geographical and sociodemographic epidemiology of inflammatory bowel disease in young females from 2010 to 2019

BACKGROUND AND AIMS

Inflammatory Bowel Disease (IBD) represents a significant health threat worldwide. However, there are deficiencies in large-scale epidemiological research focusing on these issues, especially among young women. We aim to examine the trend of IBD in young females globally.

METHODS

We utilized data from the Global Burden of Disease (GBD) study between 2010 and 2019 to conduct a comprehensive analysis of the prevalence, mortality, and disability-adjusted life years (DALYs) from IBD in young females (15-49 years), stratified by region, nation, and sociodemographic index (SDI).

RESULTS

Globally, there were 1.27 million (95 % UI 1.10 to 1.45 million) cases and 314,120 (95 % UI 240,880 to 395,420) DALYs from IBD in young females in 2019. Geographically, Europe had the highest burden of IBD in young females (n = 421,320). From 2010 to 2019, the prevalence rate increased in Africa (APC 0.34 %, 95 % CI 0.25 to 0.44 %), the Eastern Mediterranean (APC 0.77 %, 95 % CI 0.74 to 0.81 %), Europe (APC 0.48 %, 95 % CI 0.44 to 0.51 %) and the Western Pacific region (APC 1.01 %, 95 % CI 0.89 to 1.14 %). Countries with lower SDI exhibited higher DALYs to prevalence ratio. Over the study period, the percentage of young women with IBD compared to young adults increased by 0.24 %. This percentage varies significantly between countries, from 26 % to 62 %.

CONCLUSION

The burden of IBD in young females is high and increasing. Countries with lower SDIs generate higher disability per case. This necessitates immediate and inclusive measures to tackle the rising burden of IBD in this vulnerable group.

LAY SUMMARY

From 2010 to 2019, in the largest global epidemiology database, prevalence rates of inflammatory bowel disease in young females increased in many regions. Countries with lower socioeconomic development, as indicated by sociodemographic index, generated a higher burden compared to countries with higher development.

Health-care resource use and costs associated with inflammatory bowel disease in northwest London: a retrospective linked database study

BACKGROUND

With 20-40% of patients who have inflammatory bowel disease (IBD) not responding to therapy, resource use and costs can be high. We performed a descriptive analysis of health-care data for IBD management in the National Health Service to explore potential areas for improvement.

METHODS

In this exploratory study, we analysed real-world data from the Discover dataset for adults with a diagnosis of incident IBD recorded in northwest London, UK, between 31 March, 2016, and 31 March, 2020. We compared mean visit numbers and primary and secondary care costs per patient to examine resource use and costs for active disease versus remission.

RESULTS

We included 7,733 patients (5,872 with ulcerative colitis [UC], 1,427 with Crohn's disease [CD], and 434 with codes for both [termed IBD-undefined in this study]). Remission was recorded in 19,218 (82%) of 23,488 observations for UC, 4,686 (82%) of 5,708 for CD, and 1,122 (65%) for IBD-undefined observations. Health-care resource use was significantly higher with active disease in all settings except primary care for UC. Total health-care costs were greater with active disease than remission for all diagnoses (all p < 0.0001). The main driver of costs was inpatient hospital care among those with active disease; elective inpatient costs were high among patients with UC and IBD-undefined in remission.

CONCLUSIONS

Higher health-care resource use and costs were observed with active disease, which underscores the importance of early induction and maintenance of remission in UC and CD. Updated strategies that incorporate treat to target may offer cost benefits by the offsetting of biologic drug costs with a reduction in costly inpatient hospital stays.

TRIAL REGISTRATION

This trial was not registered as it used pseudonymised retrospective data.

Effectiveness of Telemedicine in Inflammatory Bowel Disease in Russia: TIGE-Rus (Telemonitoring for IBD Goodness Examination in Russia) Study Protocol of a Randomized Controlled Trial

Background: Inflammatory bowel diseases (IBD), associated with a significant burden on patients' lives, are becoming increasingly common. Patients with IBD need continuous treatment and lifelong monitoring, which could be achieved by telemonitoring. Telemonitoring has been shown to be effective in improving outcomes for patients with IBD, and can provide a more convenient and accessible way for patients to receive care. However, the certainty of evidence remains low. This article outlines the methodology of a randomized control study that aims to assess the efficacy of telemonitoring compared to face-to-face follow-up for patients with IBD in Russia, hypothesizing that the implementation of telemonitoring will lead to improvement in clinical, social, and organizational areas. Methods: The TIGE-Rus study is a randomized controlled trial. The study consists of three stages, including selection of patients and random assignment into two groups with a ratio of 1:1, follow-up care using telemonitoring or face-to-face appointments, and evaluation and comparison of follow-up efficacy in both groups. In the first stage, all patients will undergo laboratory tests and instrumental examinations, and fill out questionnaires to measure disease activity, quality of life, medication adherence, psychological well-being, and satisfaction with medical care. In the second stage, the control group will receive standard care while the telemonitoring group will have access to a web platform where they can report their clinical activity, fill out questionnaires, and have online consultations with gastroenterologists. The gastroenterologists will also make monthly phone calls to each patient in the telemonitoring group to monitor their progress. In the third stage of the study, both the telemonitoring group and the control group will be re-hospitalized after six months of monitoring. IBD activity will be evaluated through laboratory and instrumental examinations. Additionally, all the participants will complete questionnaires to assess the disease activity, medication adherence, quality of life, psychological well-being, and satisfaction with medical care in both groups. Conclusions: The trial will explore whether telemonitoring is effective in improving clinical, social, and organizational aspects in the management of patients with IBD in the setting of the Russian healthcare system.

Impact of Nursing Interventions via Telephone and Email on the Quality of Life of Patients with Inflammatory Bowel Disease: Preliminary Results of a Comparative Observational Study

BACKGROUND

Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn's disease, is a heterogeneous chronic condition characterized by periods of relapse and remission. Ulcerative colitis involves inflammation of the colon and rectum mucosa, while Crohn's disease causes deeper, transmural inflammation affecting all four gut layers from the mouth to the anus and can lead to complications such as fistulation. IBD significantly impacts patients' physical and psychological well-being, thus reducing their quality of life (QoL). We aimed to evaluate the effectiveness of nursing intervention facilitated through telephone and email support in improving the quality of life (QoL) of Inflammatory Bowel Disease (IBD) patients.

METHODS

A pilot comparative observational design with pre-test and post-test assessments was employed, involving 50 participants assigned to either an intervention group (Group A, n = 26) or a control group (Group B, n = 24). Group A received regular telephone consultations and prompt email responses from trained nurses; Group B received standard care. Data were collected at baseline and six months post-intervention (T1) using the Patient-Reported Outcomes Measurement Information System (PROMIS®) and Pittsburgh Sleep Quality Index.

RESULTS

Group A showed significant improvements in anxiety, depression, fatigue, and sleep quality, with p-values indicating the significance of these findings.

CONCLUSIONS

Tailored nursing support via remote communication significantly benefits IBD patients by alleviating psychological distress and enhancing their overall well-being, underscoring the importance of integrating such interventions into standard IBD care practices.

Patient Preferences for Treatment Attributes in Inflammatory Bowel Disease: Results From a Large Survey Across Seven European Countries Using a Discrete Choice Experiment

BACKGROUND

Inflammatory bowel disease requires long-term treatment; therefore, understanding patient preferences is important in aiding informed treatment decision making. This study explored patients' preferences for treatment attributes of available inflammatory bowel disease therapies.

METHODS

Adult patients from 7 European countries who self-reported previous/current treatment for Crohn's disease (CD) or ulcerative colitis (UC) participated in an online survey via the Carenity platform. In a discrete choice experiment, the relative importance of treatment attributes for CD and UC was estimated using conditional logit models. Latent class analysis was conducted to estimate heterogeneous treatment preferences based on patient profiles. Patients' perspectives and preferences regarding their quality of life were assessed.

RESULTS

Across 686 completed survey responses (CD, n = 360; UC, n = 326), the mean patient age was 48 and 50 years, respectively. Patients with CD ranked route of administration as the most important attribute (attribute importance: 32%), preferring subcutaneous over intravenous treatment (P < .001). Patients with UC ranked route of administration and frequency of serious adverse events as the most important attributes (attribute importance: 31% and 23%, respectively), preferring oral (P < .001) and subcutaneous (P < .001) over intravenous treatment and treatment that minimized the risk of serious adverse events (P < .001) or mild adverse events (P < .01). Latent class analyses confirmed the impact of patients' sociodemographic profile on their preferences. All patients prioritized general well-being, energy level, and daily activities as the most important aspects for improvement through treatment.

CONCLUSIONS

Patient preferences for treatment attributes varied among patients with CD or UC, highlighting the importance of personalized care and shared decision making to maximize treatment benefits.

Transition to Subcutaneous Infliximab vs Vedolizumab in Inflammatory Bowel Disease: A Prospective Multicenter Study

BACKGROUND AND AIMS

Transition from intravenous (IV) to subcutaneous (SC) administration is an option in inflammatory bowel disease (IBD) with Infliximab (IFX) or Vedolizumab (VDZ). The aim was to compare the adherence, the persistence in therapy, and quality of life (QoL) at baseline, at 6, at 12 months of SC IFX versus SC VDZ.

METHODS

This was a prospective, observational, multicenter study on patients with IBD in treatment with IV IFX or VDZ who switched to SC. All patients investigated the QoL by the short IBD Questionnaire (sIBDQ) and the concerns and expectations by a 6-item survey. Any adverse events, local and systemic, were reported. Safety, concerns, and satisfaction were evaluated.

RESULTS

One hundred and eight out of 93 patients were replaced, 51 to SC IFX and 42 to SC VDZ. The majority accepted the SC route. Persistence in therapy was similar between the two groups. The QoL improved after 6 months (p = 0.004), but at T12 both groups show a significant decline in QoL. SC administration has not caused any concern for patients. As safety, both groups reported a similar number of local reactions (IFX 19.60% vs VDZ 19.04%). In the IFX group were reported more systemic reactions (IFX 11.6% vs VDZ 7.14%) without the need for hospitalization.

CONCLUSION

The transition from IV to SC administration is an appropriate and safe option for treatment with IFX or VDZ. It is very important to consider the patient's choice and preference. The SC administration led to a significant benefit in QoL, especially in the first 6 months of therapy.

Acceptability, feasibility, and impact of the MyGut digital health platform in the monitoring and management of inflammatory bowel disease

Background

Digital health monitoring may help facilitate self-management strategies when caring for patients with inflammatory bowel disease (IBD).

Aims

This study investigated the feasibility of implementing the MyGut health application when caring for patients with IBD and evaluated whether its use improved health outcomes.

Methods

We conducted a prospective trial in 2 Canadian hospitals from 2020 to 2023. Patients with IBD were recruited from gastroenterology clinics, and the MyGut application was installed onto their mobile devices. Metrics such as acceptability, satisfaction, feasibility, quality-of-life scores (measured through the short IBD questionnaire [SIBDQ]), and resource utilization were collected throughout the 1-year follow-up period.

Results

Of the 84 patients enrolled, 58 patients (69%) continued to use the app until the study completion. At recruitment, all 84 patients (100%) were willing to use the MyGut application after a brief tutorial. There was a significant improvement in the SIBDQ scores after 1 year of MyGut use (mean = 56.0, SD 8.85 vs 52.0, SD 9.84) (P = .012). However, only 42.9% (21/49) of the patients were willing to continue using the application after 1 year, a significant decrease compared with the 71.4% (35/49) who were willing to continue after 2 months (P = .001). No differences were observed in the number of emergency room visits/hospitalizations (P = .78) before and after 1 year of MyGut use.

Conclusions

This study demonstrates that patients are willing to use digital health monitoring platforms and this may lead to improved quality of life. However, sustained efforts must be made to optimize its long-term feasibility.

Inflammatory biomarkers and psychological variables to assess quality of life in patients with inflammatory bowel disease: a cross-sectional study

BACKGROUND

Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition. While inflammatory biomarkers are valuable for diagnosing and monitoring the disease, their correlation with patients' quality of life (QoL) is not well-established.

PURPOSE

This study aims to investigate the correlations between inflammatory biomarkers and the quality of life (QoL) variables of individuals diagnosed with IBD in clinical remission.

METHODS

The sample of this cross-sectional study included 74 patients (80% women; 45 ± 11 years old) diagnosed with IBD. Outcome variables included faecal calprotectin (FC), C-reactive protein (CRP), cortisol levels from hair samples, and anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), alongside QoL evaluated with the Inflammatory Bowel Disease Questionnaire 32 (IBDQ-32). Bivariate correlations were calculated using the Pearson correlation coefficient, and stepwise linear regression analyses were conducted to identify independent factors contributing to IBDQ-32 scores.

RESULTS

The IBDQ-32 did not significantly correlate with any biomarkers. However, it exhibited a large and statistically significant negative correlation with HADS-A (r = -0.651) and HADS-D (r = -0.611) scores (p < 0.001). Stepwise linear regression analyses indicated that HADS-A was a significant and independent predictor for IBDQ-32 scores (Adjusted R2 = 0.41, β = -0.65, p < 0.001).

CONCLUSIONS

Inflammatory markers such as CRP, FC, or cortisol in hair do not play a decisive role in assessing the QoL of IBD patients. These findings emphasize the significance of considering psychological factors in evaluating and managing QoL in IBD patients in order to identify severity, suggesting that instruments like HADS should be integral to comprehensive patient assessments.

Effects of an anti-inflammatory diet (AID) on maternal and neonatal health outcomes in pregnant Chinese patients with inflammatory bowel disease treated with infliximab (IFX)

OBJECTIVE

This study aimed to evaluate the effects of an anti-inflammatory diet (AID) combined with Infliximab (IFX) therapy on maternal and neonatal health outcomes in pregnant Chinese patients with inflammatory bowel disease (IBD).

METHODS

IBD patients treated with steady IFX maintenance therapy at the time of conception were randomly assigned to either the IBD-AID group (n = 49), which received an anti-inflammatory diet intervention during the third trimester, or the habitual diet group (n = 49). Primary outcomes included assessments of disease activity, inflammatory markers, and neonatal health. Secondary outcomes included health-related quality of life (HRQoL) in patients and functional gastrointestinal disorders (FGIDs) in infants.

RESULTS

The IBD-AID intervention significantly reduced disease activity scores in IBD patients at 4 weeks post-intervention and 1 month postpartum compared to the habitual diet group, and also improved HRQoL. Serum C-reactive protein (CRP) and fecal calprotectin (FC) levels were significantly lower in the IBD-AID group at these times, with a trend towards lower levels at 6 months postpartum. Birth weight and Apgar scores were higher in the IBD-AID group but did not reach statistical significance. The incidence of at least one FGID in infants was significantly lower in the IBD-AID group (24.5%) compared to the habitual diet group (46.9%, p = 0.034).

CONCLUSION

The IBD-AID intervention combined with IFX therapy significantly improved disease activity, inflammatory markers, and QoL in maternal IBD patients, and was associated with a lower incidence of FGIDs in infants, indicating benefits for both maternal and neonatal health.

Microfibrillar-associated protein 4 as a predictive biomarker of treatment response in patients with chronic inflammatory diseases initiating biologics: secondary analyses based on the prospective BELIEVE cohort study

BACKGROUND

Currently, there are no reliable biomarkers for predicting treatment response in chronic inflammatory diseases (CIDs).

OBJECTIVE

To determine whether serum microfibrillar-associated protein 4 (MFAP4) levels can predict the treatment response to biological therapy in patients with CIDs.

METHODS

The BELIEVE study was originally designed as a prospective, multi-center cohort study of 233 patients with either rheumatoid arthritis, psoriatic arthritis, psoriasis, axial spondyloarthritis, Crohn's disease, or ulcerative colitis, initiating treatment with a biologic agent (or switching to another). Clinical assessment and blood sample collection were performed at baseline and 14-16 weeks after treatment initiation. The primary analyses included participants with available blood samples at baseline; missing data were handled as non-responders. The patients were stratified into the upper tertile of serum MFAP4 (High MFAP4) versus a combined category of middle and lower tertiles (Other MFAP4). The primary outcome was the proportion of patients with clinical response to biologic therapy after 14-16 weeks.

RESULTS

211 patients were included in the primary analysis population. The mean age was 43.7 (SD: 14.8) years, and 120 (59%) were female. Positive treatment response was observed in 41 (59%) and 69 (49%) for High MFAP4 and Other MFAP4, respectively. When adjusting for pre-specified variables (CID, age, sex, smoking status, and BMI), the adjusted OR was 2.28 (95% CI: 1.07 to 4.85) for a positive treatment outcome in the High MFAP4 group.

CONCLUSION

A high MFAP4 status before initiating biological treatment is associated with a positive clinical response, when adjusting for confounding factors.

Using Participatory Narrative Inquiry to Assess Experiences and Self-Experimentation with Diet Interventions in Inflammatory Bowel Disease Patients

BACKGROUND AND AIMS

To improve quality of life (QoL), patients with inflammatory bowel diseases (Crohn's disease and ulcerative colitis) often self-experiment with lifestyle changes such as dietary modifications. The nature (e.g., type of interventions, expectations, perceived efficacy) of these single-subject experiments has not been systematically investigated.

METHOD

We used Participatory Narrative Inquiry (PNI), a structured qualitative method, to obtain information about these experiments through patient stories.

RESULTS

We demonstrate that PNI can be a method to collect and analyze IBD patient ideas and experiences regarding lifestyle and nutritional factors in a structured manner to reveal valuable insights for personal and scientific follow-up research. Patients report rest, (psychological) balance, and a change in diet when describing times when they experienced a better QoL. When focusing on diet, patients reported a considerable number of food products that were experienced as beneficial by one person but detrimental by another.

CONCLUSIONS

PNI is a suitable method to obtain information about self-experimentation. An insight that was attained was that personalized (dietary) guidance that supports the individual is needed.