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Anafy A, Cohen S, Matar M, Shouval DS, Shamir R, Weintraub Y. Sexual health in adolescents with inflammatory bowel disease - The paediatric gastroenterologists' point of view. Acta Paediatr 2024; 113:1965-1971. [PMID: 38850099 DOI: 10.1111/apa.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/04/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
AIM Although sexual health (SH) impairment and sexually transmitted infections (STI) are occasionally encountered in patients with inflammatory bowel disease (IBD), paediatric gastroenterologists (PedGI) do not often discuss these issues. Literature about SH in the paediatric IBD population is limited. We aimed to assess PedGI knowledge and common practice related to sexual advice and STI workups in patients with IBD. METHODS A questionnaire comprising 25 questions addressing sexual activity in youth, SH, recommendations, and workup for STI in adolescents with IBD was sent to all registered PedGI in Israel. RESULTS Fifty-two physicians completed the questionnaire (27 males,52%). Only 50% correctly predicted the mean age that Israeli youth start practicing sex. Seventy-five per cent responded that providers should discuss sexual activity with their patients, but only 19% do so, most often in response to a patient's query. Ninety six percent answered that they do not have enough knowledge about SH in IBD. Finally, only 2% obtain rectal swabs for STI in patients with refractory proctitis. CONCLUSION Sexual issues and recommendations are not routinely discussed by the majority of PedGI in paediatric IBD clinics. Providers should obtain more knowledge in the field and initiate discussion of these issues with adolescent patients with IBD.
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Affiliation(s)
- Adi Anafy
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Tel-Aviv Medical Center, Tel Aviv, Israel
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
| | - Manar Matar
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dror S Shouval
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Raanan Shamir
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yael Weintraub
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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2
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Zhang X, Zhu Z, Tang G, Xu H. The prevalence and risk factors of sexual dysfunction among females with inflammatory bowel disease: a systematic review and meta-analysis. Int J Impot Res 2024; 36:463-473. [PMID: 37759098 DOI: 10.1038/s41443-023-00767-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
In recent years, numerous epidemiological studies have investigated the prevalence of female sexual dysfunction (FSD) in females with inflammatory bowel disease (IBD). However, a comprehensive systematic review with meta-analysis pooling their findings is lacking. This study aimed to determine the pooled prevalence estimates of FSD and its risk factors among females with IBD based on extensive research in electronic databases (PubMed, Embase, and Web of Science) from inception until April 1, 2023. The overall prevalence of FSD among females with IBD, along with its 95% confidence interval (CI), and subgroup-specific prevalence rates, were summarized. Sources of heterogeneity were identified through subgroup analyses and meta-regression. A total of 13 studies were included in this systematic review and meta-analysis. The pooled global prevalence of FSD among females with IBD was 61.4% (95% CI: 52.8-70.1%). Sensitivity analysis, which involved excluding individual studies, indicated no significant variation in the pooled prevalence, confirming the robustness of our results. Additionally, a significant risk factor for FSD among females with IBD was the quality of life (OR = 0.39, 95% CI: 0.19-0.79). In conclusion, our systematic review and meta-analysis revealed a high prevalence of FSD among females with IBD, which warrants attention from health organizations and clinical practitioners. Importantly, the quality of life was identified as a potential risk factor for FSD in this population. Nonetheless, future prospective cohort studies with a large sample size are warranted to confirm these findings.
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Affiliation(s)
- Xiaolong Zhang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Zhirong Zhu
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Guiliang Tang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - Huali Xu
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
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3
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Eidelberg A, Axelrad J, Chedid V, Ballou S, Cheifetz A, Rabinowitz LG. Sexual Health in Sexual and Gender Minority Patients with Inflammatory Bowel Disease. Dig Dis Sci 2024; 69:743-748. [PMID: 38267727 DOI: 10.1007/s10620-023-08253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND In recent years, legislation targeting the sexual and gender minority (SGM) community has been passed at an increasingly alarming rate, affecting access to safe and effective gender-affirming care and forcing many SGM patients, including those with inflammatory bowel disease (IBD), to withhold their identities and health concerns. Additionally, SGM patients with IBD may have unique health considerations that have not yet been well-studied OBJECTIVE: This article aims to explore the intersection of IBD and sexual health in patients who identify as SGM and to identify limitations for gastroenterologists in caring for SGM patients. The article also aims to provide suggestions for improvement in SGM-competent care within gastroenterology METHODS: A thorough literature review was conducted regarding sexual health and the SGM community with IBD. This included a review of surgical considerations in SGM patients, sexually transmitted infections (STIs) and prevention, and sexual dysfunction RESULTS: Overall, little is known about the impact of IBD on patients who identify as sexual and gender minorities. Surgery, medications, and STIs continue to be a concern in the SGM community with IBD and these areas represent opportunities to improve SGM-competent IBD care. Additionally, implementation of an SGM-focused curriculum is urgently needed in medical education to improve provider knowledge and care for this unique group of patients CONCLUSIONS: Patients with IBD who identify as SGM experience challenges that are not well described in prior literature. More research is needed and is actively being pursued to guide provider awareness and improve sexual health for this patient population.
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Affiliation(s)
- Andrew Eidelberg
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA.
| | | | | | - Sarah Ballou
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA
| | - Adam Cheifetz
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA
| | - Loren G Rabinowitz
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA
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4
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Belei O, Basaca DG, Olariu L, Pantea M, Bozgan D, Nanu A, Sîrbu I, Mărginean O, Enătescu I. The Interaction between Stress and Inflammatory Bowel Disease in Pediatric and Adult Patients. J Clin Med 2024; 13:1361. [PMID: 38592680 PMCID: PMC10932475 DOI: 10.3390/jcm13051361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Inflammatory bowel diseases (IBDs) have seen an exponential increase in incidence, particularly among pediatric patients. Psychological stress is a significant risk factor influencing the disease course. This review assesses the interaction between stress and disease progression, focusing on articles that quantified inflammatory markers in IBD patients exposed to varying degrees of psychological stress. Methods: A systematic narrative literature review was conducted, focusing on the interaction between IBD and stress among adult and pediatric patients, as well as animal subjects. The research involved searching PubMed, Scopus, Medline, and Cochrane Library databases from 2000 to December 2023. Results: The interplay between the intestinal immunity response, the nervous system, and psychological disorders, known as the gut-brain axis, plays a major role in IBD pathophysiology. Various types of stressors alter gut mucosal integrity through different pathways, increasing gut mucosa permeability and promoting bacterial translocation. A denser microbial load in the gut wall emphasizes cytokine production, worsening the disease course. The risk of developing depression and anxiety is higher in IBD patients compared with the general population, and stress is a significant trigger for inducing acute flares of the disease. Conclusions: Further large studies should be conducted to assess the relationship between stressors, psychological disorders, and their impact on the course of IBD. Clinicians involved in the medical care of IBD patients should aim to implement stress reduction practices in addition to pharmacological therapies.
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Affiliation(s)
- Oana Belei
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Diana-Georgiana Basaca
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Laura Olariu
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Manuela Pantea
- Twelfth Department, Neonatology Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (M.P.); (I.E.)
| | - Daiana Bozgan
- Clinic of Neonatology, “Pius Brânzeu” County Emergency Clinical Hospital, 300723 Timișoara, Romania;
| | - Anda Nanu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Children Hospital, 300011 Timișoara, Romania; (A.N.); (I.S.)
| | - Iuliana Sîrbu
- Third Pediatric Clinic, “Louis Țurcanu” Emergency Children Hospital, 300011 Timișoara, Romania; (A.N.); (I.S.)
| | - Otilia Mărginean
- First Pediatric Clinic, Disturbances of Growth and Development on Children Research Center, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (O.B.); (O.M.)
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Ileana Enătescu
- Twelfth Department, Neonatology Clinic, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (M.P.); (I.E.)
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5
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Shah I, Anderson K, Bocchino R, Freedman SD, Carrasquillo R, Sheth SG. Prospective Evaluation of Sexual Dysfunction in Men With Chronic Pancreatitis: A Pilot Study. Pancreas 2024; 53:e187-e192. [PMID: 38127842 DOI: 10.1097/mpa.0000000000002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Our study aimed to determine the prevalence of sexual dysfunction (SD) and its association with quality of life (QOL) in men with chronic pancreatitis (CP). MATERIALS AND METHODS Male patients with CP were prospectively enrolled in our pancreas center and completed the following 4 validated questionnaires: International Index of Erectile Function 5, Erectile Hardness Score, Pancreatitis Quality of Life Instrument, and Short Form Survey. Patients were classified as having mild, moderate, or severe SD based on review of questionnaires. RESULTS Thirty patients were enrolled in the study, of which 18 patients had SD (mild in 9, moderate in 1, and severe in 8 patients). No significant differences were seen demographic or clinical characteristics in patients with and without SD. Patients with SD had more abdominal pain compared with those without SD (94.4% vs 83.3%, P = 0.001). No significant differences were noted in QOL metrics between the 2 groups. CONCLUSIONS This pilot study shows that SD is present in 60% males with CP. No difference was noted in the QOL of patients with and without SD, albeit limited by our small sample size. Physicians caring for CP patients should routinely inquire for symptoms of SD and offer a urology referral if indicated.
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Affiliation(s)
- Ishani Shah
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
| | - Kelsey Anderson
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
| | - Rachel Bocchino
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
| | - Steven D Freedman
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
| | | | - Sunil G Sheth
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston
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Calvo Moya M, Mesonero Gismero F, Suarez Ferrer C, Hernández-Camba A, Vásquez Carlón D, García Benasach F, Aguas Peris M, Delgado Oliva FJ, González-Lama Y, Millán Scheiding M, Alonso Sebastián I, Camacho Martel L, Gallardo Arriero V, Echarri Piudo A, Bella Castillo P, Cano Sanz N, Vera Mendoza MI, Serrano Labajos R, Valdivia Martínez A, Pérez Restoy L, Zabana Abdo Y, Mañosa Ciria M, Rodríguez-Moranta F, Barreiro-de Acosta M, Gutiérrez Casbas A. Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on sexuality and inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00019-0. [PMID: 38218430 DOI: 10.1016/j.gastrohep.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.
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Affiliation(s)
- Marta Calvo Moya
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
| | - Francisco Mesonero Gismero
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología. Hospital Universitario Ramón y Cajal, Madrid, España
| | - Cristina Suarez Ferrer
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación Hospital Universitario La Paz, Madrid, España
| | - Alejandro Hernández-Camba
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Danízar Vásquez Carlón
- Centro de Asistencia a la Reproducción Humana de Canarias (FIVAP), San Cristóbal de la Laguna, Tenerife, España
| | - Fátima García Benasach
- Servicio de Ginecología y Obstetricia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Mariam Aguas Peris
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología. Hospital Universitari i Politécnic La Fe, Valencia, España
| | | | - Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Mónica Millán Scheiding
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitari i Politécnic La Fe, Valencia, España
| | - Isabel Alonso Sebastián
- Unidad de Coloproctología, Servicio de Cirugía general y Aparato Digestivo. Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Laura Camacho Martel
- Unidad de Enfermedad Inflamatoria Intestinal, Psicología Clínica, Hospital Virgen de la Victoria, Málaga, España
| | - Vanesa Gallardo Arriero
- Unidad de Enfermedad Inflamatoria Intestinal, Psicología Clínica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Ana Echarri Piudo
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Complejo Hospitalario Universitario de Ferrol, Ferrol, España
| | - Pablo Bella Castillo
- Unidad de Enfermedad Inflamatoria Intestinal, Enfermería, Servicio de Gastroenterología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Noelia Cano Sanz
- Unidad de Enfermedad Inflamatoria Intestinal, Enfermería, Servicio de Gastroenterología, Hospital Universitario de León, León, España
| | - María Isabel Vera Mendoza
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Ruth Serrano Labajos
- Confederación Asociaciones de enfermos de Crohn y Colitis Ulcerosa de España, Madrid, España
| | | | - Lourdes Pérez Restoy
- Sexología, Clínica Bonadea, Granada, España; Neurohábilis Centro de Salud Integral, Granada, Loja y Puerto de Santa María, España
| | - Yamile Zabana Abdo
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitari Mútua de Terrassa, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España
| | - Miriam Mañosa Ciria
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Unidad de Enfermedad Inflamatoria Intestinal, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, España
| | - Francisco Rodríguez-Moranta
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Manuel Barreiro-de Acosta
- Unidad de Enfermedad Inflamatoria Intestinal, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España; Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), A Coruña, España
| | - Ana Gutiérrez Casbas
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España; Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología, Hospital General Universitario Dr. Balmis de Alicante, ISABIAL, Alicante, España
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Khan S, Sebastian SA, Parmar MP, Ghadge N, Padda I, Keshta AS, Minhaz N, Patel A. Factors influencing the quality of life in inflammatory bowel disease: A comprehensive review. Dis Mon 2024; 70:101672. [PMID: 38143196 DOI: 10.1016/j.disamonth.2023.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Inflammatory bowel disease (IBD) is a group of chronic relapsing disorders, including Crohn's disease (CD) and ulcerative colitis (UC), which affects an increasing number of people worldwide. In the last few decades, the scientific world has witnessed many developments in IBD management by controlling debilitating symptoms and remaining in remission for more protracted periods. Even so, we still have a large population suffering from active IBD. An individual's quality of life (QoL) can be severely affected by IBD, like any other chronic illness. In this article, we have reviewed factors influencing the QoL in IBD patients, including chronic pain, diet, physical activity, and psychological factors like depression, anxiety, and stress symptoms. We also discussed the mechanisms of diet-microbial-immune system interaction, currently available dietary therapies for active CD and UC, and early psycho-social interventions that can reduce the disease burden and improve QoL in IBD patients.
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Affiliation(s)
- Samina Khan
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | | | - Nitin Ghadge
- Independent Researcher, Albany, NY, United States of America
| | - Inderbir Padda
- Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States of America
| | | | - Naofel Minhaz
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Coates MD, Dalessio S, Walter V, Stuart A, Tinsley A, Williams ED, Clarke K. Lifestyle Factors Associated with Abdominal Pain in Quiescent Inflammatory Bowel Disease. Dig Dis Sci 2023; 68:4156-4165. [PMID: 37713034 DOI: 10.1007/s10620-023-08075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Lifestyle factors, including diet, exercise, substance use, and sexual activity, have been shown to influence risk of inflammation and complications in inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Little is known about their potential role in abdominal pain generation in IBD. AIMS We performed this study to evaluate for relationships between lifestyle factors and abdominal pain in quiescent IBD (QP-IBD). METHODS We performed a retrospective analysis utilizing data from our institution's IBD Natural History Registry (January 1, 2017-December 31, 2022). Endoscopic evaluation, concurrent laboratory studies and surveys were completed by participants. Demographic and clinical data were also abstracted. RESULTS We identified 177 consecutive patients with quiescent disease (105 females:72 males; 121 with CD:56 with UC) for participation in this study, 93 (52.5%) had QP-IBD. Compared to patients with quiescent IBD without pain (QNP-IBD, patients with QP-IBD exhibited no significant differences in IBD type, location, severity or complication rate. Patients with QP-IBD were more likely to have anxiety/depression (55.9% vs. 32.1%, p = 0.002) and to use antidepressants/anxiolytics (49.5% vs. 21.4%, p < 0.001). They were also less likely to engage in exercise at least three times per week (39.8% vs. 54.8%, p = 0.05) or participate in sexual activity at least monthly (53.8% vs. 69.1%, p = 0.04). On logistic regression analysis, antidepressant and/or anxiolytic use was independently associated with QP-IBD [2.72(1.32-5.62)], while monthly sexual activity was inversely associated [0.48(0.24-0.96)]. CONCLUSION Lifestyle factors, including the lack of sexual activity and exercise, are significantly associated with QP-IBD. Further study is warranted to clarify the relationships between these factors and the development of abdominal pain in quiescent IBD.
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Affiliation(s)
- Matthew D Coates
- Division of Gastroenterology and Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA.
- Division of Gastroenterology and Hepatology, Penn State University Hershey Medical Center, 500 University Drive, M.C. HU33, Hershey, PA, 17033, USA.
| | - Shannon Dalessio
- Division of Gastroenterology and Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Vonn Walter
- Department of Public Health Sciences and Department of Biochemistry, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - August Stuart
- Division of Gastroenterology and Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Andrew Tinsley
- Division of Gastroenterology and Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Emmanuelle D Williams
- Division of Gastroenterology and Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kofi Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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9
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Huberts AS, Peeters NJMCV, Kaplan ZLR, van Linschoten RCA, Pastoor H, van der Woude CJ, Koppert LB. Dutch normative data of the sexual distress scale and the body image scale. Qual Life Res 2023; 32:2829-2837. [PMID: 37193810 PMCID: PMC10473982 DOI: 10.1007/s11136-023-03434-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Sexual health is an important contributing factor for health-related quality of life, but research in this domain is scarce. Moreover, normative data are needed to interpret patient-reported outcome measures on sexual health. The aim of this study was to collect and describe normative scores of the Female Sexual Distress Scale (FSDS) and the Body Image Scale (BIS) from the Dutch population and assess the effect of important demographic and clinical variables on the outcome. As the FSDS is also validated in men, we refer to it as SDS. METHOD Dutch respondents completed the SDS and BIS between May and August 2022. Sexual distress was defined as a SDS score > 15. Descriptive statistics were calculated to present normative data per age group per gender after post-stratification weighting was applied. Multiple logistic and linear regression analyses were conducted to assess the effect of age, gender, education, relationship status, history of cancer and (psychological) comorbidities on SDS and BIS. RESULTS For the SDS 768 respondents were included with a weighted mean score of 14.41 (SD 10.98). Being female (OR 1.77, 95% CI [1.32; 2.39]), having a low educational level (OR 2.02, CI [1.37; 2.39]) and psychological comorbidities (OR: 4.86, 95% CI [2.17; 10.88]) were associated with sexual distress. For the BIS, 696 respondents were included. Female gender (β: 2.63, 95% CI [2.13; 3.13]), psychological comorbidities (β: 2.45, 95% CI [1.43; 3.47]), higher age (β: -0.07, 95% CI [-0.09; -0.05]), and a high educational level (β:-1.21, CI: -1.79 to -0.64) were associated with the non-disease related questions of the Body Image Scale. CONCLUSION This study provides age- and gender-dependent normative values for the SDS and the non-disease related questions of the BIS. Sexual distress and body image are influenced by gender, education level, relationship status and psychological comorbidities. Moreover, age is positively associated with Body Image.
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Affiliation(s)
- Anouk S Huberts
- Department of Quality and Patientcare, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands.
| | - Noëlle J M C Vrancken Peeters
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Z L Rana Kaplan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinier C A van Linschoten
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Pastoor
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Quality and Patientcare, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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10
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Torres J, Chaparro M, Julsgaard M, Katsanos K, Zelinkova Z, Agrawal M, Ardizzone S, Campmans-Kuijpers M, Dragoni G, Ferrante M, Fiorino G, Flanagan E, Gomes CF, Hart A, Hedin CR, Juillerat P, Mulders A, Myrelid P, O'Toole A, Rivière P, Scharl M, Selinger CP, Sonnenberg E, Toruner M, Wieringa J, Van der Woude CJ. European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis 2023; 17:1-27. [PMID: 36005814 DOI: 10.1093/ecco-jcc/jjac115] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Joana Torres
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal.,Division of Gastroenterology, Hospital da Luz, Lisboa, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, IIS-Princesa, UAM, CIBEREHD, Madrid, Spain
| | - Mette Julsgaard
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Zuzana Zelinkova
- Department of Internal Medicine, Svet zdravia, Nemocnica Dunajska Streda, Slovakia.,Firstst Department of Internal Medicine of University Hospital and Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Manasi Agrawal
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Sandro Ardizzone
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences. University of Milan, Milan, Italy
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.,Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | - Ailsa Hart
- Inflammatory Bowel Diseases Unit, St Mark's Hospital, Harrow, UK
| | - Charlotte Rose Hedin
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden.,Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.,Crohn's and Colitis Center, Gastroenterology Beaulieu SA, Lausanne, Switzerland
| | - Annemarie Mulders
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Aoibhlinn O'Toole
- Beaumont Hospital, Department of Gastroenterology, Royal College of Surgeons, Dublin, Ireland
| | - Pauline Rivière
- Gastroenterology Unit, Bordeaux University Hospital, Pessac, France
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Elena Sonnenberg
- Charité-Universitätsmedizin Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology, Germany
| | - Murat Toruner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Jantien Wieringa
- Department of Paediatrics, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Janneke Van der Woude
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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11
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Pugliese D, Parisio L, Schepis T, Privitera G, Calvez V, Gasbarrini A, Armuzzi A. Patient-Reported Outcomes for the Assessment of Sexual Health Among Patients Affected by Inflammatory Bowel Disease. Rev Recent Clin Trials 2022; 17:250-258. [PMID: 35786192 DOI: 10.2174/1574887117666220630114054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/07/2022] [Accepted: 05/11/2022] [Indexed: 01/15/2023]
Abstract
Patients affected by inflammatory bowel disease (IBD) frequently report impaired quality of sexual life and complain of sexual dysfunctions. Both disease-specific features and psychological factors can be held responsible for these conditions. However, sexuality and all matters relating to sexual health are often wrongfully considered unrelated to IBD and, therefore, overlooked during medical visits. To overcome these difficulties and to best assess patients' perceptions about their sexual health status, the use of patient-reported outcomes (PROs) could represent a valid strategy. In real-world studies, several non-IBD specific questionnaires, exploring different domains of sexuality, have been applied and validated for the IBD population. This review summarizes the available evidence on sexual health among IBD patients and the data supporting the application of PROs to screen the quality of sexual life, as well as the rate and types of sexual dysfunctions, among IBD patients.
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Affiliation(s)
- Daniela Pugliese
- CEMAD, Inflammatory Bowel Disease Unit, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Laura Parisio
- CEMAD, Inflammatory Bowel Disease Unit, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Tommaso Schepis
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentin Calvez
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- CEMAD, Inflammatory Bowel Disease Unit, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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12
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Boyd T, de Silva PS, Friedman S. Sexual Dysfunction in Female Patients with Inflammatory Bowel Disease: An Overview. Clin Exp Gastroenterol 2022; 15:213-224. [PMID: 36540885 PMCID: PMC9759977 DOI: 10.2147/ceg.s359367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/22/2022] [Indexed: 09/29/2023] Open
Abstract
Sexual dysfunction is common among females with inflammatory bowel disease and may result in issues involving intimacy, sexual activity, and satisfaction, as well both the formation and preservation of personal relationships. Risk factors for sexual dysfunction include select surgical interventions, medications, mental illnesses, and IBD-related intestinal and extraintestinal comorbidities. In addition, certain demographic factors such as age, disease type and activity may influence the severity of sexual dysfunction. Evaluation of sexual dysfunction may include the use of validated sexual functioning questionnaires, a brief mental health assessment, initial inquiry into vulvovaginal or perineal symptoms, and a gynecologic and GI-focused physical exam. An interdisciplinary care team involving IBD specialists, obstetrician-gynecologists, pelvic floor physical therapists, and primary care physicians may be best suited to provide optimal care and treatment recommendations for patients with sexual dysfunction. Options for management often include pelvic floor physical therapy, biofeedback, and mental health support. Further research is necessary to delineate the impact of IBD activity on sexual dysfunction, to determine if health outcome differences exist depending on surgical approaches utilized during J-pouch operations, and finally to evaluate the care and perceptions of patients with IBD who identify as sexual and gender minorities.
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Affiliation(s)
| | - Punyanganie S de Silva
- Harvard Medical School, Boston, MA, USA
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sonia Friedman
- Harvard Medical School, Boston, MA, USA
- Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Boston, MA, USA
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13
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Bedell A, Friedlander A. Management of Sexual Dysfunction in Gastrointestinal Disorders. Gastroenterol Clin North Am 2022; 51:815-828. [PMID: 36375998 DOI: 10.1016/j.gtc.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with gastrointestinal (GI) disorders are at increased risk of sexual dysfunction (SD) due to a combination of biomedical, psychological, social, and interpersonal factors. While most patients desire information on the impact of their GI disorder on sexual function, few providers initiate this conversation. GI providers should routinely assess their patients for SD, validate these concerns, and provide brief education and a referral for evaluation and/or treatment. Treatment of sexual concerns is often multidisciplinary and may involve a sexual medicine physician, pelvic floor physical therapists, and sex therapists.
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Affiliation(s)
- Alyse Bedell
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, MC 3077, Chicago, IL 60637, USA.
| | - Alana Friedlander
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, MC 3077, Chicago, IL 60637, USA; Department of Psychology, Roosevelt University, 430 South Michigan Avenue, Chicago, IL 60605, USA
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14
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Mules TC, Swaminathan A, Hirschfeld E, Borichevsky GM, Frampton CM, Day AS, Gearry RB. The Impact of Disease Activity on SD and ED in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022:6724308. [PMID: 36166573 PMCID: PMC10393211 DOI: 10.1093/ibd/izac204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Increased disease activity may be a risk factor for sexual dysfunction (SD) in patients with inflammatory bowel disease (IBD). This study investigated associations between objective measures of disease activity and sexual function. METHODS Adults with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, sexual function (Female Sexual Function Index and International Index of Erectile Function), disease activity (endoscopic, biomarker, and symptoms), psychological symptoms, and quality-of-life data were collected. Rates of SD and erectile dysfunction (ED) were compared between patients with active and inactive inflammation and symptoms using the Fisher's exact test. Logistic regression examined associations between SD and ED, and disease characteristics and psychological symptoms. RESULTS A total of 159 participants were included, 97 had Crohn's disease and 85 were women. SD was reported in 36 of 59 and 13 of 59 sexually active women and men, respectively and ED in 22 of 59 sexually active men. Rates of SD and ED were similar between individuals with active and inactive IBD based on endoscopic indices (P > .05) and biomarkers (P > .05). Women with active IBD symptoms experienced significantly higher rates of SD (P < .05), but men did not (P > .05). Multivariable logistic regression identified that symptoms of severe depression (odds ratio, 5.77; 95% confidence interval, 1.59-20.94) were associated with SD in women, and severe anxiety (odds ratio, 15.62; 95% confidence interval, 1.74-140.23) was associated with ED in men. CONCLUSIONS Objective measures of disease activity are not associated with SD or ED in patients with IBD. Clinicians should consider concomitant psychological symptoms contributing to the sexual health of patients with IBD.
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Affiliation(s)
- Thomas C Mules
- Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand
| | - Akhilesh Swaminathan
- Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
| | - Esther Hirschfeld
- Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
| | - Grace M Borichevsky
- Centre for Free Radical Research, University of Otago, Christchurch, Canterbury, New Zealand
| | - Chris M Frampton
- Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Richard B Gearry
- Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
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15
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Chen B, Zhou B, Song G, Li H, Li R, Liu Z, Wei C, Wang T, Wang S, Ma D, Liu J, Yuan X, Liu X. Inflammatory bowel disease is associated with worse sexual function: a systematic review and meta-analysis. Transl Androl Urol 2022; 11:959-973. [PMID: 35958893 PMCID: PMC9360519 DOI: 10.21037/tau-22-190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Several studies report that sexuality is often affected by inflammatory bowel diseases (IBD). The aim of this meta-analysis was to investigate the association between IBD and sexual function. Methods A literature search was conducted in PubMed, Web of Science, and EMBASE databases (up to September 1, 2020). Scores of sexual functions with a standard deviation and odds ratio (OR) or relative risk (RR) with a 95% CI were used to analysis the association between IBD and sexual function. Results Eleven studies with 7,018 male IBD cases and 1,803 female IBD cases were included in the meta-analysis. In male individuals, the pooled results revealed that IBD was significantly associated with impaired erectile function and poor sexual satisfaction (RR for erectile function =1.50, 95% CI: 1.22 to 1.84, P<0.0001; standard mean difference for sexual satisfaction =−0.24, 95% CI: −0.33 to −0.15, P<0.0001). And among female individuals, IBD had impact on most sub-domains of sexual function, except pains. Conclusions IBD is associated with worse sexual function. It has significant impact on erectile function and satisfaction for male individuals and has impact on most sub-domains of sexual function for female individuals.
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Affiliation(s)
- Bingliang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingyan Zhou
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Clinical Center of Hirschsprung's disease and Allied Disorders, Wuhan, China
| | - Guoda Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Delin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyi Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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16
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Clephane K, O'Loughlin JI, Bodnar TS, Wilson MC, Stariha JT, Craig AN, Weinberg J, Brotto LA, Lorenz TK. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022; 19:745-760. [PMID: 35296386 PMCID: PMC9064911 DOI: 10.1016/j.jsxm.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammation has been linked to a variety of mental and physical health outcomes that disproportionately impact women, and which can impair sexual function; thus, there is reason to expect a link between inflammation and women's sexual functioning. AIM To test the hypothesis that higher concentrations of C-reactive protein (CRP), a general biomarker of inflammation, would predict women's lower sexual desire. METHOD As 2 independent research teams, we conducted 3 separate studies (total n = 405) that assessed salivary CRP and various measurements of sexual desire in different women populations. OUTCOMES Female Sexual Function Index, Sexual Desire Inventory-2, Decreased Sexual Desire Screener, and Sexual Interest and Desire Inventory. RESULTS Regardless of the way sexual desire was measured (e.g., state vs trait; general desire vs. desire functioning) and the population sampled (i.e., healthy vs. clinically diagnosed with sexual dysfunction), all the studies revealed null results. CLINICAL IMPLICATIONS While exploratory, the convergence of these null results across studies and researchers suggests that if there is an association between inflammation and women's sexual desire, it is likely very subtle. STRENGTHS & LIMITATIONS Across 2 independent research teams, 3 unrelated studies, and various measurements of sexual desire, results were consistent. These points lend to the generalizability of the results. However, study designs were cross-sectional. CONCLUSIONS Future research may reveal (i) a non-linear threshold effect, such that inflammation does not begin to impact women's sexual desire until it is at a high level, (ii) inflammatory biomarkers other than CRP might be more sensitive in detecting associations between inflammation and desire, should they exist, or (iii) the mechanisms underlying sexual dysfunction may differ between sexes. Clephane K, et al. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022;19:745-760.
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Affiliation(s)
- Kirstin Clephane
- University of Nebraska - Lincoln, Center for Brain, Biology and Behavior, Lincoln, NE, USA; University of Nebraska - Lincoln, Psychology Department, Lincoln, NE, USA
| | - Julia I O'Loughlin
- University of British Columbia, Department of Educational and Counselling Psychology, and Special Education, Vancouver, British Columbia, CA, USA
| | - Tamara S Bodnar
- University of British Columbia, Department of Cellular and Physiological Sciences, Vancouver, British Columbia, CA, USA
| | - M Claire Wilson
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Jordan Tb Stariha
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, CA, USA
| | - Amber N Craig
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Milwaukee, WI, USA
| | - Joanne Weinberg
- University of British Columbia, Department of Cellular and Physiological Sciences, Vancouver, British Columbia, CA, USA
| | - Lori A Brotto
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, CA, USA; University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, CA, USA
| | - Tierney K Lorenz
- University of Nebraska - Lincoln, Center for Brain, Biology and Behavior, Lincoln, NE, USA; University of Nebraska - Lincoln, Psychology Department, Lincoln, NE, USA.
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17
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Zhang J, Nie J, Zou M, Zeng Q, Feng Y, Luo Z, Gan H. Prevalence and Associated Factors of Sexual Dysfunction in Patients With Inflammatory Bowel Disease. Front Endocrinol (Lausanne) 2022; 13:881485. [PMID: 35573991 PMCID: PMC9094619 DOI: 10.3389/fendo.2022.881485] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sexual dysfunction (SD) in patients who suffer from inflammatory bowel disease (IBD) has not attracted widespread attention, and thus research studies are scarce. OBJECTIVE This study aims to evaluate the rates of SD in IBD compared with healthy individuals and elucidate the associated factors. METHODS In this cross-sectional study, the Female Sexual Function Index (FSFI) and the simplified version of the International Index of Erectile Function (IIEF-5) were filled by IBD patients, as well as healthy control individuals. RESULTS A total of 208 IBD patients, including 133 with Crohn's disease (CD) and 75 with ulcerative colitis (UC), and 190 healthy individuals filled out the questionnaires. In women, SD rates were 61.9% in the patients with IBD vs. 24.4% in the healthy controls (p < 0.01). In men, the rates of erectile dysfunction (ED) were 43.5% in the patients with IBD vs. 12.5% in the healthy controls (p < 0.01). Anxiety (OR, 3.092; 95%CI: 1.033-9.252, p = 0.044) and active perianal disease (OR, 4.481; 95%CI: 1.055-19.029, p = 0.042) were independent risk factors for SD in female IBD patients. age (OR, 1.050; 95%CI: 1.007-1.095, p = 0.022), depression (OR, 5.763; 95%CI: 1.864-17.821, p = 0.002) and active perianal disease (OR, 7.117; 95%CI: 1.747-28.983, p = 0.006) were independent risk factors for ED in male patients. CONCLUSIONS In the IBD patients, 62% of women reported having SD, and 44% of men reported having ED. These higher rates, as compared to the healthy controls, are mostly driven by active perianal disease and psychological factors.
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Affiliation(s)
- Jinzhi Zhang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiao Nie
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Min Zou
- Laboratory of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Qishan Zeng
- Laboratory of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Feng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyi Luo
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Huatian Gan
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Huatian Gan,
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18
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Domislovic V, Brinar M, Cukovic-Cavka S, Turk N, Mikolasevic I, Krznaric Z. Prevalence, predictors and age-related sexual and erectile dysfunction in patients with inflammatory bowel disease: A tertiary centre experience. Int J Clin Pract 2021; 75:e14486. [PMID: 34107145 DOI: 10.1111/ijcp.14486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/29/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The impact of sexuality and quality of life (QOL) is one of the main concerns of IBD. Despite the obvious relevance of this problem, knowledge of the extent of sexual dysfunction (SD) in IBD is limited. Aim of this study was to assess the prevalence of SD and erectile dysfunction (ED), QOL their predictors, and their age-related dynamic in IBD patients. METHODS In this cross-sectional study, 202 IBD patients [122 male, 80 female, 133 Crohn's disease (CD), 69 ulcerative colitis (UC)] fulfilled International Index of Erectile Function (IIEF) or Female Sexual Functioning Index (FSFI). QOL was assessed using IBDQ-32 through bowel, systemic, emotional and social domains. RESULTS Prevalence of SD in men was 18%, ED 30.3% and SD in women 75%. Low QOL was present in 34.6% without gender difference (P = .253). In men, SD and ED were highest among 21-30 years and raising after 51 years of age. In women, SD was constantly highly prevalent, showing no decline over time. In multivariate analysis significant predictors of SD in men were CD phenotype, disease duration and emotional domain of IBDQ, of ED depression, emotional and bowel domain of IBDQ, and of SD in women emotional IBDQ domain. CONCLUSION Quality of sex life is a serious concern among IBD patients and is age related. Components that play a role in sexual functioning in IBD require more clarification and further development of screening and treatment guidelines for SD to provide better care in the IBD population.
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Affiliation(s)
- Viktor Domislovic
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Silvija Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivana Mikolasevic
- Clinical Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Zeljko Krznaric
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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19
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Perez de Arce E, Quera R, Ribeiro Barros J, Yukie Sassaki L. Sexual Dysfunction in Inflammatory Bowel Disease: What the Specialist Should Know and Ask. Int J Gen Med 2021; 14:2003-2015. [PMID: 34079340 PMCID: PMC8163621 DOI: 10.2147/ijgm.s308214] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic condition that globally affects the health of people who suffer from it, deteriorating their quality of life (QoL). An aspect rarely explored by healthcare providers is the influence of the disease on the sexual functioning of individuals. This discretion is mainly due to an unconscious resistance when asking our patients about their sexual functioning because of a lack of knowledge and skills to tackle this topic or disinterest on the part of professionals, and fear or shame on the part of patients. Sexual function is a constant concern in IBD patients that has been reflected in several studies, especially if we consider that the prevalence of sexual dysfunction (SD) in IBD is higher than that reported in the general population. The etiology of SD in patients with IBD remains unclear but is likely to be multifactorial, where biological, psychosocial, and disease-specific factors are involved. Currently, there are no formal recommendations in the IBD clinical guidelines on how to manage SD in these patients. The use of validated clinical scales could improve the detection of SD and allow the treatment of the underlying causes in order to improve the QoL of patients with IBD. This review aims to illustrate the different aspects involved in SD in IBD patients and the importance of the participation of a multidisciplinary team in the early detection and treatment of SD at different stages of the disease.
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Affiliation(s)
- Edith Perez de Arce
- Department of Gastroenterology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Rodrigo Quera
- Inflammatory Bowel Disease Program, Gastroenterology, Medicine Department, Clinica Universidad de los Andes, Santiago, Chile
| | - Jaqueline Ribeiro Barros
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, Brazil
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20
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Ma S, Veysey M, Ersser S, Mason-Jones A, Galdas P. The impact of inflammatory bowel disease on sexual health in men: A scoping review. J Clin Nurs 2020; 29:3638-3651. [PMID: 32668025 DOI: 10.1111/jocn.15418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/09/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To review the literature on the impact of inflammatory bowel disease on the sexual health of men and make recommendations for nursing practice and research. BACKGROUND Inflammatory bowel disease is a chronic condition of the gastrointestinal tract, causing symptoms that may impact upon sexual health. Specialist nurses are well positioned to assess and manage sexual health, but there is a lack of clinical guidance, especially in relation to men. DESIGN A systematic scoping review following the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework reported in line with the PRISMA-ScR checklist (Tricco et al., Annals of Internal Medicine, 169, 2018, 467). METHODS OVID MEDLINE ALL [R], OVID EMBASE [R], OVID PsychINFO, EBSCO CINAHL Complete, The Cochrane Library and ProQuest were searched. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible studies. RESULTS Thirty-one studies met the inclusion criteria. These were synthesised under three categories: mediators, moderators and descriptors of sexual health. Depression, disease activity and surgery were the most commonly cited disease-related factors to affect sexual health in men. The most commonly used assessment tool was The International Index of Erectile Function. Descriptors of function included frequency of intercourse, libido and the ability to maintain a desired sexual role. CONCLUSIONS The effect of inflammatory bowel disease on sexual health in men involves a complex interaction of physical and psychosocial factors. Researchers must explore areas outside of erectile function to understand how the disease impacts sexuality, sexual well-being and masculinity. This can be achieved through qualitative exploration of patient, partner and health professional experiences. RELEVANCE TO CLINICAL PRACTICE A holistic nursing assessment of men with inflammatory bowel disease should include sexual health. Developing understanding of how the disease influences sexual interaction and expression will facilitate support that is relevant, accessible and of value to men living with the disease.
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Affiliation(s)
- Sara Ma
- Department of Health Sciences, University of York, York, UK.,Gastroenterology Department, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Martin Veysey
- Gastroenterology Department, York Teaching Hospital NHS Foundation Trust, York, UK.,Hull York Medical School, University of Hull, Hull, UK
| | - Steven Ersser
- Department of Nursing Science, Bournemouth University, Poole, UK
| | | | - Paul Galdas
- Department of Health Sciences, University of York, York, UK
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21
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Men With Inflammatory Bowel Disease: Sexual Function, Fertility, Medication Safety, and Prostate Cancer. Am J Gastroenterol 2020; 115:526-534. [PMID: 32022719 DOI: 10.14309/ajg.0000000000000515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Half of patients with inflammatory bowel disease (IBD) are men, yet less attention has been focused on their sexual issues despite higher rates of sexual dysfunction and infertility than the general population. Depression and IBD disease activity are the most consistently reported risk factor for sexual dysfunction among men with IBD. Methotrexate and sulfasalazine have been rarely associated with impotence. Sulfasalazine reversibly reduces male fertility. No other medications used in IBD significantly affect fertility in humans. There is no increase in adverse fetal outcomes among offspring of fathers with IBD. Patients with IBD seem to be at a higher risk for prostate cancer; therefore, screening as recommended for high-risk patients should be considered.
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22
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Clarke K. Addressing Sexual Dysfunction in Patients with Inflammatory Bowel Disease-We Can Do Better. CROHN'S & COLITIS 360 2020; 2:otaa007. [PMID: 36777958 PMCID: PMC9802403 DOI: 10.1093/crocol/otaa007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kofi Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA,Address correspondence to: Kofi Clarke, MD, FACP, FRCP (Lond), AGAF, 500 University Drive, Hershey, PA 17033 ()
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23
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Leenhardt R, Rivière P, Papazian P, Nion-Larmurier I, Girard G, Laharie D, Marteau P. Sexual health and fertility for individuals with inflammatory bowel disease. World J Gastroenterol 2019; 25:5423-5433. [PMID: 31576090 PMCID: PMC6767981 DOI: 10.3748/wjg.v25.i36.5423] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility aspects of IBD patients and their daily management. Modern IBD healthcare management should include appropriate communication on sexuality and consider psychological, physiological, and biological issues. Patients with IBD have less children than the general population, and voluntary childlessness is frequent. The most influential factors reported by IBD patients who experience fertility alteration are psychological and surgery-related problems. Pregnancy is a major concern for patients, and any pregnancy for IBD patients should be closely followed-up to keep the chronic disease in a quiescent state. Preconceptional consultation is of great help.
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Affiliation(s)
- Romain Leenhardt
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| | - Pauline Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux 33604, Pessac, France
| | - Patrick Papazian
- Hôpital Bichat, Service des maladies infectieuses et tropicales, APHP, Paris 75018, France
| | - Isabelle Nion-Larmurier
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| | - Guillaume Girard
- Service de gynécologie obstétrique, Hôpital Armand Trousseau, Paris 75012, Ile-de-France, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux 33604, Pessac, France
| | - Philippe Marteau
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
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24
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Beyond pregnancy, women's health in inflammatory bowel disease. Curr Opin Gastroenterol 2019; 35:288-295. [PMID: 33216483 DOI: 10.1097/mog.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Women's health includes comprehensive physical, mental and preventive care. This section will provide an overview of some of the most common disorders that can impact the health and quality of life (QOL) of women with inflammatory bowel diseases (IBDs). RECENT FINDINGS Women with IBD are at higher risk for cervical dysplasia compared to healthy controls with most cases preventable with vaccination. Current rates of cervical cancer screening and human papilloma virus vaccination remain low. Irritable bowel syndrome is highly prevalent among women with IBD and may present with similar symptoms. In addition, gastrointestinal symptoms may worsen during the menstrual cycle. Evaluation for active inflammation and infection should be undertaken prior to changing IBD medications. Fecal incontinence is prevalent but highly underreported in women with IBD. Further, sexual dysfunction is ubiquitous in women with IBD. Many aspects of IBD impact sexual function, including side-effects of medications, changes in body image and surgical interventions. SUMMARY Understanding other disorders that may cause symptoms in women with IBD is important for providers to obtain a clear history, provide the appropriate treatment and improve QOL. Caring for women with IBD involves more comprehensive care beyond the treatment of active luminal inflammation.
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25
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Friedman S. A Meta-analysis of Sexual Function in Patients With Inflammatory Bowel Disease: Examining a Small Piece of the Puzzle. Inflamm Bowel Dis 2019; 25:708-710. [PMID: 30476086 DOI: 10.1093/ibd/izy348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Sonia Friedman
- Harvard Medical School, Harvard University, Boston, Massachusetts.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Chestnut Hill, Massachusetts
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