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Ma S, Knapp P, Galdas P. 'My sexual desires, everything, my normal life just stops'; a qualitative study of male sexual health in inflammatory bowel disease. J Clin Nurs 2024; 33:4034-4047. [PMID: 38797921 DOI: 10.1111/jocn.17292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
AIM To describe and interpret the sexual health experiences of men with IBD. DESIGN Interpretive qualitative study. METHODS In-depth, semi-structured interviews were conducted with 22 men with a diagnosis of Inflammatory Bowel Disease. Interviews were digitally audio-recorded and transcribed verbatim. Data were analysed using constant comparative, thematic analysis. RESULTS Three themes were identified from interview data: (1) the disease shapes intimate connections, (2) the disease thwarts sexual experiences and (3) the disease disrupts male gender norms. Men reported that active disease lowered libido and could change pre-, inter- and post-coital sexual practices. All participants noted that health professionals did not initiate the discussion of sexual health and well-being needs in the outpatient hospital setting. Men who engaged in receptive anal sex reported a lack of disease-specific guidance and understanding from professionals. CONCLUSION Inflammatory bowel disease can negatively impact the sexual well-being, gender identity and activities of men. Further research is required to identify the care preferences of men with IBD and clarify the barriers and facilitators to sexual health assessment so that nurses may better support the health needs of this population. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This study highlights the need for sexual health and well-being support that is specific to disease and gender in IBD. There is a paucity of information and guidance for men with peri-anal disease and proctitis who engage in receptive anal sex, which requires urgent attention. REPORTING METHOD Reporting follows the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION A patient and public involvement group informed the development of the study design. The group reviewed public facing documents and interview guides. One member of the group provided comments on the identified themes.
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Affiliation(s)
- Sara Ma
- School of Science, Technology & Health, York St John University, York, UK
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
- Department of Health Sciences, The University of York, York, UK
| | - Peter Knapp
- Department of Health Sciences, The University of York, York, UK
- Hull York Medical School, York, UK
| | - Paul Galdas
- Department of Health Sciences, The University of York, York, UK
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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; 47:774-792. [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] [MESH Headings] [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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Pan T, Chen D, Yu Z, Liu Q, Chen Y, Zhang A, Kong F. Analysis of current situation and influencing factors of marital adjustment in patients with Crohn's disease and their spouses. Medicine (Baltimore) 2024; 103:e37527. [PMID: 38489689 PMCID: PMC10939668 DOI: 10.1097/md.0000000000037527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
The purpose of this study was to investigate the marital adjustment of patients with Crohn's disease and their spouses, and to analyze its influencing factors. It lays the investigation foundation for the follow-up binary study of Crohn's disease patients and their spouses. Using convenience sampling, 177 pairs of patients and their spouses from a tertiary hospital in Nanjing, China were selected. With face-to-face electronic questionnaires to survey the patient and spouse, the contents include the Lock-Wollance Marriage Adjustment Test, Subjective Well-Being Scale for Chinese Citizens, Couple Support Questionnaire, and Distress Self-Disclosure Scale. The marital adjustment score of patients was (99.03 ± 24.25), and the marital adjustment score of spouses was (99.61 ± 25.39). The proportions of patients with marital disorders and their spouses with marital disorders were 52.5% and 46.9%, respectively. Multiple linear regression showed that the spouse's age, family monthly income, time of diagnosis of Crohn's, distress self-disclosure, marital support, and subjective well-being were important factors influencing the marital adjustment of patients. Self-disclosure of spousal distress, marital support, age, and subjective well-being were important factors that influenced spouses' marital adjustment. Most couples with Crohn's disease have marital disorders, and their marital adjustment affects each other. However, the assessment results of one partner should not be limited to replacing those of the couple. In clinical practice, patient age, monthly family income, self-disclosure of distress, marital support, and subjective well-being should be considered. Spouses should be encouraged to participate in patient care and patient-spouse interventions should be implemented as a whole to improve marital stability.
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Affiliation(s)
- Ting Pan
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Danlei Chen
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhihui Yu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Qing Liu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Chen
- Department of Nursing, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Nanjing Second Hospital), Nanjing, China
| | - Ailing Zhang
- Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing, China
| | - Fang Kong
- Digestive Disease Treatment Center, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Nanjing Second Hospital), Nanjing, China
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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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5
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Fretz KM, Hunker KE, Tripp DA. The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences. Inflamm Bowel Dis 2024; 30:382-394. [PMID: 38206426 PMCID: PMC10906359 DOI: 10.1093/ibd/izad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) can negatively impact sexual well-being, and some patients desire healthcare for these issues. Research capturing the lived experiences of patients in these areas is lacking. The present study investigated the sexual well-being impacts of IBD (objective 1) and patients' experiences accessing support for these concerns in the healthcare system (objective 2) through multimethod analyses. METHODS A total of 480 adults with IBD were recruited for an online survey study. Reflexive thematic analysis was used to analyze responses to 2 open-ended questions (ie, qualitative data; question 1, n = 326, question 2, n = 309). Frequency analyses and contingency tables were used to analyze quantitative data (n = 436). RESULTS Thematic analysis (objective 1) generated 8 themes highlighting the negative impacts of IBD on patients' sexual/intimate lives (eg, sexual activity, intimate relationships) and the influence of broader psychosocial experiences (eg, self-perception, mental health) on patients' sexual well-being. Quantitative analyses (objective 2) indicated that 39.2% of participants wanted sexual health information from a healthcare provider, but only 5.7% of our sample reported both wanting and receiving this information. Thematic analysis generated 5 themes highlighting the lack of support and information available for sexuality concerns in IBD healthcare and detailed patients' perceived barriers to obtaining support in this area. CONCLUSIONS IBD has myriad impacts on patients' sexual lives. However, patients who want healthcare in this area rarely receive satisfactory support.
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Affiliation(s)
| | | | - Dean A Tripp
- Department of Psychology, Queen’s University, Kingston, ON, Canada
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Napolitano D, Vincenzo FD, Orgiana N, Schiavoni E, Germini F, Pugliese D, Scaldaferri F. The inflammatory bowel disease care manager: Italian state of the art. Ann Gastroenterol 2024; 37:37-45. [PMID: 38223251 PMCID: PMC10785024 DOI: 10.20524/aog.2023.0852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024] Open
Abstract
Background In the inflammatory bowel disease (IBD) multidisciplinary team, a key figure is the IBD care manager, usually an independent practice nurse, responsible for evidence-based assessment, care planning, treatment evaluation, and provision of practical information, health education, and emotional support to patients. The objective of this study was to evaluate the profile of this figure in Italy. Methods A team of experienced nurses created a questionnaire based on the Second N-ECCO declaration, which was administered to nurses who worked in an IBD unit for a period of at least 3 years. A definition of IBD care manager was provided to every participant. The questionnaire consisted of 3 sections: behavioral, knowledge and managerial skills that an IBD care manager should exhibit. Results were studied in relation to the benefits for the patient, organizational advantages, clinical advantages and Italian state of the art. Results Fifty-five nurses participated in the study, from 28 Italian centers. In the evaluation of behavioral skills of IBD care managers, "management and support of the pregnant patient" was the lowest scored item, while "patient privacy" obtained higher scores. In the evaluation of knowledge, "knowledge of intimacy and sexuality" obtained the lowest scores, while "knowledge of psychophysical and social impact of the disease" obtained a higher score. In managerial skills "management of pain" obtained the lowest scores. Conclusion Our study confirmed that IBD care managers are invaluable nursing figures within the multidisciplinary team that cares for IBD patients, providing benefits to both patients' clinics and management.
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Affiliation(s)
- Daniele Napolitano
- UOS Malattie Infiammatorie Croniche Intestinali, Centro di Malattie dell’Apparato Digerente (CEMAD), Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma (Daniele Napolitano, Federica Di Vincenzo, Elisa Schiavoni, Daniela Pugliese, Franco Scaldaferri)
| | - Federica Di Vincenzo
- UOS Malattie Infiammatorie Croniche Intestinali, Centro di Malattie dell’Apparato Digerente (CEMAD), Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma (Daniele Napolitano, Federica Di Vincenzo, Elisa Schiavoni, Daniela Pugliese, Franco Scaldaferri)
| | - Nicoletta Orgiana
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma (Nicoletta Orgiana)
| | - Elisa Schiavoni
- UOS Malattie Infiammatorie Croniche Intestinali, Centro di Malattie dell’Apparato Digerente (CEMAD), Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma (Daniele Napolitano, Federica Di Vincenzo, Elisa Schiavoni, Daniela Pugliese, Franco Scaldaferri)
| | - Francesco Germini
- Direttore di distretto SocioSanitario, ASL Bari (Francesco Germini), Italy
| | - Daniela Pugliese
- UOS Malattie Infiammatorie Croniche Intestinali, Centro di Malattie dell’Apparato Digerente (CEMAD), Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma (Daniele Napolitano, Federica Di Vincenzo, Elisa Schiavoni, Daniela Pugliese, Franco Scaldaferri)
| | - Franco Scaldaferri
- UOS Malattie Infiammatorie Croniche Intestinali, Centro di Malattie dell’Apparato Digerente (CEMAD), Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma (Daniele Napolitano, Federica Di Vincenzo, Elisa Schiavoni, Daniela Pugliese, Franco Scaldaferri)
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Bommena S, Goldberg A, Amini M, Alishahi Y. Depression in Women With Inflammatory Bowel Disease: A Multifaceted Approach for a Multidimensional Problem. Inflamm Bowel Dis 2023; 29:1957-1970. [PMID: 36472240 DOI: 10.1093/ibd/izac245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Indexed: 06/17/2023]
Abstract
The prevalence of depression is higher in patients with inflammatory bowel disease (IBD) than in the general population. Women are more significantly affected by depression among those with IBD and in the general population. This review presents evidence on sex-based differences in depression pathogenesis and the effect of depression on various factors associated with IBD that affect women's lives, including sexual dysfunction, body image dissatisfaction, fertility, and overall quality of life. We also discuss sex-specific effects on IBD treatment, disease activity, and health care costs. Interestingly, women with IBD tend to seek and are more receptive to depression-related information. Given the underdiagnosis and undertreated nature of depression in individuals with IBD, effective screening and an optimal integrative treatment approach with relevant sex-specific needs are discussed. Evidence regarding the efficacy of psychotherapy, antidepressant pharmacotherapy, and IBD-specific therapy for depression is discussed. This review summarizes evidence of the effect of depression on both personal and professional aspects of the daily lives of women with IBD, which extends beyond negative moods. It applies this information to screening and integrative treatment, resulting in a holistic approach to this multidimensional problem. We also discuss how depression affects males with IBD differently from females. Finally, we discuss the need for gender-based studies on depression in individuals with IBD.
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Affiliation(s)
- Shoma Bommena
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, Banner University Medical Center-Phoenix, AZ, USA
| | - Aaron Goldberg
- Division of Gastroenterology, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, AZ, USA
| | - Mona Amini
- Psychiatry and Mental Health, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - Yasmin Alishahi
- Division of Gastroenterology, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, AZ, USA
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Gao D, Chen C, Wu Z, Li H, Tang B. Relationship between inflammatory bowel disease and erectile dysfunction: a 2-sample Mendelian randomization study. Sex Med 2023; 11:qfad067. [PMID: 38264202 PMCID: PMC10805346 DOI: 10.1093/sexmed/qfad067] [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: 09/20/2023] [Revised: 11/07/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024] Open
Abstract
Background Observational studies have indicated a high prevalence of erectile dysfunction (ED) among patients with inflammatory bowel disease (IBD), but a definitive causal relationship remains unestablished. Aim The primary aim of this study was to assess the potential causal relationship between IBD and ED using Mendelian randomization (MR) analysis. Methods We obtained statistical data for 2 subtypes of IBD, ulcerative colitis (UC) and Crohn's disease (CD), as well as for ED, from publicly available genome-wide association studies (GWASs). Subsequently, a 2-sample MR analysis was conducted using these datasets. The primary MR analysis utilized the inverse variance-weighted (IVW) method, complemented by secondary analyses employing MR-Egger and weighted median methods. Furthermore, we assessed heterogeneity using Cochran's Q test and evaluated pleiotropy with the MR-Egger intercept test. To identify potential influential single nucleotide polymorphisms, we employed a leave-one-out analysis. Additionally, outliers were identified using the MR-PRESSO method. Outcomes The study outcomes encompassed results from 3 MR analyses, namely IVW, MR-Egger, and weighted median, along with sensitivity analyses involving Cochran's Q test, the MR-Egger intercept test, leave-one-out analysis, and the MR-PRESSO method. Results There was no causal effect of UC and CD on ED in the MR analysis (IVW P > .05). Results of complementary methods were consistent with those of the IVW method. The results of sensitivity analyses supported our conclusion, and no directional pleiotropy was found. Clinical Implications Genetically, despite the absence of a causal link between IBD and ED according to MR analysis, we must emphasize the elevated ED prevalence among IBD patients in observational studies, with particular consideration for the influence of negative emotions on erectile function. Strengths & Limitations This study is the inaugural application of a 2-sample MR analysis using extensive GWAS datasets to evaluate the causal relationship between IBD and ED, effectively mitigating biases stemming from confounding factors and reverse causality often present in observational studies. Nevertheless, it is imperative to exercise caution when drawing conclusions due to inherent limitations in GWAS data, encompassing factors like samples overlap, gender categorization, population ancestry, and the persistent ambiguity surrounding the precise functionality of specific single nucleotide polymorphisms. Conclusions MR analysis did not provide genetic-level evidence supporting a direct causal relationship between IBD (UC and CD) and ED.
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Affiliation(s)
- Dawei Gao
- Clinical School of Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Cheng Chen
- Clinical School of Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
- Traditional Chinese Medicine Department, Chongqing General Hospital, Chongqing 401121, China
| | - Ziliang Wu
- Health Management Center, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Huakang Li
- Clinical School of Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Bo Tang
- Department of Urology, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu 611730, China
- Department of Urology, No.3 Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West District), Chengdu 611730, China
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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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Kim WJ, Iskandarani M, Manzo CA, Pellino G, Gallostra MM, Tekkis PP, Celentano V, Kontovounisios C. Patient-reported outcome measures and surgery for Crohn's disease: systematic review. BJS Open 2023; 7:zrad098. [PMID: 37882628 PMCID: PMC10601451 DOI: 10.1093/bjsopen/zrad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND/AIMS Crohn's disease is an inflammatory bowel disease with up to 50 per cent of patients requiring surgery within 10 years of diagnosis. Patient-reported outcome measures (PROMs) are vital to monitor and assess patient health-related quality of life (HRQoL). This systematic review aims to evaluate PROMs within studies for perioperative Crohn's disease patients. METHODS Articles from MEDLINE, Embase, Emcare and CINAHL databases were searched to find studies relating to the assessment of HRQoL in perioperative Crohn's disease patients using PROMs and patient-reported experience measures (PREMs) from 1st January 2015 to 22nd October 2023. Bias was assessed using the ROBINS-I tool was used for non-randomized interventional studies and the Cochrane RoB2 tool was used for randomized trials. RESULTS 1714 journal articles were filtered down to eight studies. Six studies focused on ileocaecal resection, one on perianal fistulas and one on the effects of cholecystectomy on patients with Crohn's disease. Within these articles, ten different PROM tools were identified (8 measures of HRQoL and 2 measures of functional outcome). Overall improvements in patient HRQoL pre- to postoperative for ileocaecal Crohn's disease were found in both paediatric and adult patients. Outcomes were comparable in patients in remission, with or without stoma, but were worse in patients with a stoma and active disease. CONCLUSION There are significant variations in how PROMs are used to evaluate perioperative Crohn's disease outcomes and a need for consensus on how tools are used. Routine assessments using an internationally accepted online platform can be used to monitor patients and support areas of treatment pathways that require further support to ensure high standards of care. They also enable future statistical comparisons in quantitative reviews and meta-analyses.
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Affiliation(s)
- Whei J Kim
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Carlo A Manzo
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gianluca Pellino
- Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona, UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Marc Martí Gallostra
- Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona, UAB, Barcelona, Spain
| | - Paris P Tekkis
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Valerio Celentano
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust, London, UK
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11
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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: 83] [Impact Index Per Article: 83.0] [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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12
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Impact of Female Gender in Inflammatory Bowel Diseases: A Narrative Review. J Pers Med 2023; 13:jpm13020165. [PMID: 36836400 PMCID: PMC9958616 DOI: 10.3390/jpm13020165] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Inflammatory bowel diseases show a gender bias, as reported for several other immune-mediated diseases. Female-specific differences influence disease presentation and activity, leading to a different progression between males and females. Women show a genetic predisposition to develop inflammatory bowel disease related to the X chromosome. Female hormone fluctuation influences gastrointestinal symptoms, pain perception, and the state of active disease at the time of conception could negatively affect the pregnancy. Women with inflammatory bowel disease report a worse quality of life, higher psychological distress, and reduced sexual activity than male patients. This narrative review aims to resume the current knowledge of female-related features in clinical manifestations, development, and therapy, as well as sexual and psychological implications related to inflammatory bowel disease. The final attempt is to provide gastroenterologists with a roadmap of female-specific differences, to improve patients' diagnosis, management, and treatment.
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13
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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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14
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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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15
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Wang G, Tandon P, Rodriguez N, Ambrosio L, Sutton RT, Dieleman LA, Kroeker KI, Huang V. Impact of Disease Activity and Inflammatory Bowel Disease Subtype on Quality of Life in Preconception and Pregnant Patients. Dig Dis Sci 2022; 68:1156-1166. [PMID: 35930124 DOI: 10.1007/s10620-022-07638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) and pregnancy both impact health-related quality of life (HRQoL). However, little is known about IBD-related HRQoL around pregnancy. AIMS To assess the trajectory and predictors of HRQoL in preconception and pregnant patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Preconception and pregnant patients with IBD were followed prospectively from preconception to twelve months postpartum at a tertiary referral centre. Participants completed the Short IBD Questionnaire (SIBDQ) and were assessed for clinical disease activity (modified Harvey Bradshaw Index or partial Mayo score) and objective disease activity (C-reactive protein [CRP], fecal calprotectin [FCP]). RESULTS A total of 61 patients with IBD (25 CD, 36 UC) were included. During preconception, patients with UC had higher SIBDQ bowel and social sub-scores than those with CD, but this reversed during postpartum. Patients with CD but not UC developed a significant, sustained improvement in SIBDQ upon becoming pregnant, which persisted into 12 months postpartum. In a multivariable linear regression model, clinical disease activity negatively predicted SIBDQ at every pregnancy timepoint and up to 12 months postpartum. SIBDQ was significantly lower in patients with CRP ≥ 8.0 mg/L during trimester 1 (T1), but not later in pregnancy. SIBDQ bowel sub-scores were significantly lower in patients with FCP ≥ 250 mg/kg at T2, T3, and 6 months postpartum. CONCLUSIONS Clinical disease activity is a consistent negative predictor of HRQoL from conception to 12 months postpartum. Patients with UC experience better preconception HRQoL but suffer worse postpartum HRQoL than those with CD.
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Affiliation(s)
- Grace Wang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.
| | - Parul Tandon
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
| | - Nicole Rodriguez
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada
| | - Lindsy Ambrosio
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Reed T Sutton
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Levinus A Dieleman
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Karen I Kroeker
- Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, T6G 2R7, Canada.,Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, 8540 112 St NW, Edmonton, T6G 2X8, Canada
| | - Vivian Huang
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada.,Department of Gastroenterology, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
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16
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Matini L, Ogden J. Early development of a novel scale to measure adaptation in people diagnosed with inflammatory bowel disease - the A-inflammatory bowel disease. Health Psychol Open 2022; 9:20551029221098550. [PMID: 35601977 PMCID: PMC9121467 DOI: 10.1177/20551029221098550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To undergo the preliminary development of a new measure of patient adaptation to
Inflammatory Bowel Disease (IBD): A-IBD. Design Based on a prior conceptualisation of adaptation, a 40-item scale was generated and
completed by 304 people diagnosed with IBD. Main outcome measures Psychometric analysis of the measure. Association with the Brief Illness Perception
Questionnaire (Brief IPQ) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results The 18-item scale consisted of four subscales (patient identity, person identity,
acceptance, expectations). Weak to moderate correlations were found between subscales of
the A-IBD and the Brief IPQ and IBDQ. Conclusion The A-IBD shows potential for assessing adaptation. Further analysis could confirm its
usefulness.
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Affiliation(s)
| | - James Ogden
- School of Psychology, University of Surrey, Guildford, UK
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17
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Guzela V, Sobrado Junior C, Nadal S, Villa L, Mota G, Gonçalves A, Nadal C, Nahas C, Nahas S. Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn's disease patients? Braz J Med Biol Res 2022; 55:e12141. [DOI: 10.1590/1414-431x2022e12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - S.R. Nadal
- Instituto de Infectologia Emilio Ribas, Brasil
| | - L.L. Villa
- Universidade de São Paulo, Brasil; Universidade de São Paulo, Brasil
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18
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Teich N, Schulze H, Knop J, Obermeier M, Stallmach A. Novel Approaches Identifying Relevant Patient-Reported Outcomes in Patients With Inflammatory Bowel Diseases-LISTEN 1. CROHN'S & COLITIS 360 2021; 3:otab050. [PMID: 36776662 PMCID: PMC9802460 DOI: 10.1093/crocol/otab050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Several patient-reported outcomes (PROs) have been established and are widely used in the assessment of patients with inflammatory bowel disease (IBD). However, it has never been investigated which PRO items are experienced by and are considered most relevant for IBD patients. Methods A review of IBD-related disease scores by a steering committee led to the identification of relevant PRO questions and assignment to 16 different PRO categories (9 symptoms and 7 impacts) that characterize patient's disease burden. In a cross-sectional study, a digital patient survey was carried out to determine the self-reported experience by multiple response, the relevance of these PRO categories by pairwise comparison and the suitability of the respective questions and answer possibilities by yes-or-no-question. Results Sixty patients with Crohn's disease (CD) (56.7% women; mean age 40.6 years; mean disease duration 12.4 years) and 60 patients with ulcerative colitis (UC) (51.7% women; mean age 37.3 years; mean disease duration 9.0 years) participated in the patient survey. All predefined symptoms and impacts, with the exception of nausea, were experienced by at least 50% of patients. Stool urgency and pain were rated the 2 most important symptoms in CD patients with similar ratings for relevance. Stool urgency was also the most important symptom in patients with UC, followed by stool frequency. Differences in self-reported experience between CD and UC patients were seen for the symptoms of rectal bleeding, pain, and nausea. Most important impact of symptoms in both patient groups were general wellbeing followed by social activities, while sexual activity was the least relevant impact category. Conclusions Stool urgency was the most relevant and most self-reported symptom for both CD and UC. Relevance and self-reported experience of pain and rectal bleeding differed between the 2 diseases. Therefore, the future collection of PROs should take these disease specificities into consideration.
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Affiliation(s)
- Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany,Medical Faculty of the Friedrich Schiller University Jena, Jena, Germany
| | | | - Jana Knop
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany,Address correspondence to: Jana Knop, PhD, Takeda Pharma Vertrieb GmbH & Co. KG, Jägerstraße 27, 10117 Berlin, Germany ()
| | | | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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19
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Kim SE. [How Should We Do Different Approach to Treat Inflammatory Bowel Disease by Gender Difference?]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:241-247. [PMID: 34035202 DOI: 10.4166/kjg.2021.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/03/2022]
Abstract
Although not as prominent, there are gender/sex differences in incidence/prevalence, clinical manifestation and disease course, comorbidities, therapeutic response, and patients coping strategy to the disease of inflammatory bowel disease (IBD). In this review, current knowledge about gender-specific differences in IBD would be provided and how to apply this in clinical practice be discussed.
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Affiliation(s)
- Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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20
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Barello S, Guida E, Leone S, Previtali E, Graffigna G. Does patient engagement affect IBD patients' health-related quality of life? Findings from a cross-sectional study among people with inflammatory bowel diseases. Health Qual Life Outcomes 2021; 19:77. [PMID: 33678181 PMCID: PMC7938585 DOI: 10.1186/s12955-021-01724-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background Patients diagnosed with inflammatory bowel disease (IBD) are required to deal with the unpredictability of this clinical condition, which is associated with poorer health-related quality of life (HRQoL) compared to other clinical conditions. Patient engagement is currently demonstrated to relate with chronic patients’ HRQoL, but few studies have been conducted among this population. Methods A cross-sectional study was conducted among 1176 IBD patients. Data were collected on participants’ HRQoL (SIBD-Q) and patient engagement (PHE-s®). Regression analysis was used to examine the effects of patient engagement on HRQoL. Results About the half of the sample (47%) reported a low patient engagement level. 30% of the sample reported a low level of HRQoL. Psycho-emotional functioning resulted to be the aspect of HRQoL most impacted in the 37% of the sample. The regression model showed that PHE-s® is significantly related to the SIBD-Q total score (B = .585; p < .001; R squared = .343) and to the subscales’ scores—systemic symptoms (B = .572; p < .001; R squared = .327), bowel symptoms (B = .482; p < .001; R squared = .232), social (B = .485; p < .001; R squared = .234) and psycho-emotional (B = .607; p < .001; R squared = .369) functioning. Conclusions Patients who are engaged in their IBD care pathway are more likely to report higher level of HRQoL, thus offering clues to potential therapeutic approaches to ameliorating IBD patients’ wellbeing. As this is a modifiable factor, screening for patient health engagement levels, coupled with appropriate interventions, could improve care, and ultimately improve HRQoL outcomes among IBD patients.
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Affiliation(s)
- Serena Barello
- EngageMinds Hub, Consumer, Food and Health Engagement Research Center, Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
| | - Elena Guida
- EngageMinds Hub, Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Guendalina Graffigna
- EngageMinds Hub, Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Piacenza, Italy
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Abstract
Inflammatory bowel disease (IBD) is associated with significant psychological comorbidities, with associated impacts on patient quality of life, disease course, and health care costs. The present article reviews the latest evidence on the etiology of psychological comorbidities in IBD, with a focus on shared inflammatory pathways. The current state of practice in managing and understanding psychological comorbidities from the perspective of both gastroenterology practice and psychological treatment is reviewed, with a focus on evidence-based treatments shown to be effective in managing depression, anxiety, stress, and improving IBD-related health outcomes.
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Tack LJ, Springer A, Riedl S, Tonnhofer U, Weninger J, Hiess M, Van Laecke E, Hoebeke P, Spinoit AF, Cools M, Van Hoecke E. Psychosexual Outcome, Sexual Function, and Long-Term Satisfaction of Adolescent and Young Adult Men After Childhood Hypospadias Repair. J Sex Med 2020; 17:1665-1675. [DOI: 10.1016/j.jsxm.2020.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
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Hong L, Zhang C, Fan R, Wang L, Wang Z, Zhang T, Zhong J. Infliximab for Crohn's Disease Patients with Perianal Fistulas: Better Image, Better Life. Med Sci Monit 2020; 26:e925018. [PMID: 32785211 PMCID: PMC7444618 DOI: 10.12659/msm.925018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Patients with Crohn’s disease (CD) experience physical impairments, poor quality of life and negative body image. These factors are exacerbated in CD patients with active perianal fistulas. Material/Methods Baseline characteristics were compared in retrospectively enrolled CD patients with and without active perianal fistulas. The relationships between improvements in perianal fistulas and quality of life, body image, and self-esteem were determined. The effects of infliximab treatment on improvement of psychological-social status were assessed in CD patients with active perianal fistulas. Results Of the 301 CD patients included in our institution’s database. 91 (30.2%) had active perianal fistulas. After adjustment by propensity score matching, CD patients with active perianal fistulas had lower self-esteem and more severe body image dissatisfaction than CD patients without active perianal fistulas (P<0.01 each). Perianal fistula response was closely associated with improvements in quality of life, body image dissatisfaction and self-esteem (P<0.01 each). Patients with perianal fistula treated with infliximab showed a response rate of 68.3%, significantly higher than the rate in patients with perianal fistula not treated with infliximab (P=0.005). Furthermore, improvements of life quality, body image and self-esteem were significantly greater in patients with perianal fistula who were than were not treated with infliximab (P<0.05 each). Conclusions CD patients with active perianal fistulas experience body image dissatisfaction, low self-esteem and poor quality of life. Treatment of these patients with infliximab could improve their body image, self-esteem and quality of life.
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Affiliation(s)
- Liwen Hong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Chen Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Rong Fan
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Lei Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Zhengting Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Tianyu Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
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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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Gklavas A, Kyprianou C, Exarchos G, Metaxa L, Dellis A, Papaconstantinou I. Sexual function after proctectomy in patients with inflammatory bowel disease: A prospective study. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:943-950. [PMID: 31767548 DOI: 10.5152/tjg.2019.18676] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC) show a multifactorial impact on patients' quality of life, including sexual function (SF). The need for surgical intervention remains high, whereas proctectomy is frequently required in these patients. We tried to evaluate the impact of pelvic dissection during proctectomy in IBD patients' SF. MATERIALS AND METHODS We conducted a prospective study, examining the pre- and postoperative (at 6 months) SF of 57 IBD patients that underwent proctectomy in our surgical department, in the period between 2010 and 2016. The 5-item International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index were our research tools for men and women, respectively. We tried to evaluate the impact of gender, age, type of the disease, and surgical procedure on postoperative outcome. RESULTS Ileal pouch-anal anastomosis (IPAA) was offered to 45 patients, whereas 12 patients underwent total proctocolectomy with permanent end ileostomy (TPC). Men showed a non-significant improvement in median IIEF-5 score after proctectomy (22.0 vs 23.0, p=0.152). The majority of men had no erectile dysfunction either before (56.4%) or after (51.3%) surgery (p=0.599). Changes remained insignificant for subgroup analysis according to age, disease and surgical procedure. Female patients had also a non-significant improvement in overall median score (23.0 vs 24.1, p=0.856). Women's score remained below the cut-off value of 26.5 for almost every subgroup analyzed. CONCLUSIONS Proctectomy did not affect SF of IBD patents six months after surgery. Female patients seem to face more frequently a poor SF compared to men.
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Affiliation(s)
- Antonios Gklavas
- 2nd Surgical Department, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christofis Kyprianou
- 2nd Surgical Department, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Exarchos
- 2nd Surgical Department, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Linda Metaxa
- Department of Radiology, St Bartholomew's Hospital, London, UK
| | - Athanasios Dellis
- 2nd Surgical Department, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Papaconstantinou
- 2nd Surgical Department, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus. Gastroenterol Res Pract 2019; 2019:3108025. [PMID: 31565051 PMCID: PMC6745180 DOI: 10.1155/2019/3108025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background The lifelong and remitting nature of ulcerative colitis results in considerable disability and a substantial negative impact on quality of life. The major goal of the therapy of ulcerative colitis is considered to be the modification of the course of the disease, so that the patient's quality of life can be improved while minimising disease-related disability. Although considerable progress in understanding the molecular pathways involved in ulcerative colitis has led to improved treatment options, there is currently no definitive cure for ulcerative colitis, there remain considerable unmet needs in terms of long-term efficacy and safety, and there are many patients who continue to be burdened by physical and psychological symptoms. Defining unmet needs can help to increase the awareness of the shortcomings of current therapeutic management and highlight the need to achieve not only a control of clinical symptoms but also control of mucosal healing, in order to attain the best possible long-term outcomes. Methods With the aim of providing a better understanding of the unmet needs of patients towards improving overall care, a Delphi process was used to obtain consensus among a group of Italian ulcerative colitis experts. The consensus group met with a major focus of delineating the unmet needs of current treatment strategies and overall management of ulcerative colitis, while also focusing on quality of life and patient care. Results Three main areas were identified: (i) treatment, (ii) monitoring and risk management, and (iii) patient-related issues. A high level of consensus was reached on all but one of the statements identified. Conclusions The findings arising from the Delphi process provide valuable insights into the unmet needs in the management of moderate-to-severe ulcerative colitis from the clinician's perspective, while emphasising the benefits of therapeutic individualization and suggesting areas that need additional study with the aim of optimising the treatment of patients with ulcerative colitis.
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Pihl Lesnovska K, Münch A, Hjortswang H. Microscopic colitis: Struggling with an invisible, disabling disease. J Clin Nurs 2019; 28:3408-3415. [PMID: 31090966 PMCID: PMC7328780 DOI: 10.1111/jocn.14916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Background and aims Microscopic colitis causes chronic or recurrent nonbloody, watery diarrhoea, which is associated with urgency, faecal incontinence and abdominal pain. The patient's health‐related quality of life is often impaired. In microscopic colitis, health‐related quality of life has been studied using questionnaires originally constructed and validated for patients with inflammatory bowel disease. The aim of this study was to explore the impact of microscopic colitis on everyday life. Methods and results Inductive, qualitative, semi‐structured interviews were performed with 15 persons suffering from microscopic colitis. Content analysis was used to explore the impact of the condition on everyday life. The study followed the consolidated criteria for reporting qualitative research. The qualitative inductive content analysis generated one theme and five subthemes. The theme was “struggling with an invisible, disabling disease.” The five subthemes were as follows: physical experience of bowel function; associated symptoms affecting quality of life; impact of the disease on everyday life; disease‐related worry; and strategies for managing everyday life. Conclusions The semi‐structured interviews with persons suffering from microscopic colitis provided a wide spectrum of answers to the question of how everyday life is affected. Microscopic colitis can be a disabling life experience, and patients develop different strategies to adapt, cope and regain their previous performance level. Relevance to clinical practice There are new and interesting findings in our study that everyday life still remains affected even when patients are in remission. These findings have relevance in clinical practice and may create a better understanding of the patient's symptoms and situation.
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Affiliation(s)
- Katarina Pihl Lesnovska
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Münch
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Mota RL, Fonseca R, Santos JC, Covita AM, Marques N, Matias P, Simões H, Ramos C, Machado D, Cardoso J. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019; 16:1018-1028. [PMID: 31010779 DOI: 10.1016/j.jsxm.2019.03.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION 10% of the world's population suffers from chronic kidney disease. Kidney transplants provide an improvement in the quality of life of those patients. Sexual dysfunction is common after kidney transplantation, and its etiology is presumed to be multifactorial. It has a negative impact on sexual satisfaction and health-related quality-of-life. The integration of a new organ into the body can imply an adjustment of body image, which may eventually have a negative influence on intimacy and sexual behaviors. AIM To evaluate male sexual function, sexual satisfaction, and body image satisfaction among a convenience sample of patients who have had a kidney transplant. METHODS This is a cross-sectional study that included 460 patients, from a single healthcare center, who had undergone a kidney transplant procedure >4 weeks ago. A total of 112 respondents (mean = 55.5 years, SD = 11.4) answered the questionnaires properly. MAIN OUTCOME MEASURES All recruited patients answered a self-reported sociodemographic questionnaire, in addition to the International Index of Erectile function, the New Scale of Sexual Satisfaction, the Brief Symptom Inventory, and the Body Image Scale. RESULTS A correlation was found between sexual function and sexual satisfaction (r = 0.598, P < .001, n = 112), as well as between body image satisfaction and sexual function (r = -0.193, P = .042, n = 112). The length of time after a kidney transplant (≤ or >36 months) was not associated with a difference in sexual functioning or sexual satisfaction. CLINICAL IMPLICATIONS This study showed the obvious implications of sexual function on sexual satisfaction, which should alert healthcare professionals to the importance of identifying and managing sexual dysfunction in patients with chronic kidney disease, to optimize their global and sexual health satisfaction. STRENGTH & LIMITATIONS This study identified a high prevalence of sexual dysfunction among kidney transplant recipients. This should reinforce the need for the medical community to evaluate the quality-of-life domains of patients with chronic disease. There is still a lack of information concerning any longitudinal evaluation of kidney transplant patients' sexual function and the effects that this surgery has on sexuality. CONCLUSIONS This study corroborated the severe effects that kidney transplant patients often report regarding their sexuality. Among the patients who participated in the study, sexual function proved to be relevant in relation to sexual satisfaction. Mota RL, Fonseca R, Santos JC, et al. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019;16:1018-1028.
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Affiliation(s)
- Renato Lains Mota
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal.
| | - Rita Fonseca
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - José Carlos Santos
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Ana Mateus Covita
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | | | - Patricia Matias
- Nephrology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal
| | - Hélder Simões
- Endocrinology Department at Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Catarina Ramos
- Instituto Universitário Egas Moniz, ISPA- Instituto Universitário; ISPA - Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
| | - Domingos Machado
- Nephrology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal
| | - Jorge Cardoso
- Instituto Universitário Egas Moniz, ISPA- Instituto Universitário; ISPA - Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
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Beese SE, Harris IM, Dretzke J, Moore D. Body image dissatisfaction in patients with inflammatory bowel disease: a systematic review. BMJ Open Gastroenterol 2019; 6:e000255. [PMID: 30899537 PMCID: PMC6398870 DOI: 10.1136/bmjgast-2018-000255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS Little is known about the relationship between inflammatory bowel disease (IBD) and body image. The aim of this systematic review was to summarise the evidence on body image dissatisfaction in patients with IBD across four areas: (1) body image tools, (2) prevalence, (3) factors associated with body image dissatisfaction in IBD and (4) association between IBD and quality of life. METHODS Two reviewers screened, selected, quality assessed and extracted data from studies in duplicate. EMBASE, MEDLINE, PsycINFO and Cochrane CENTRAL were searched to April 2018. Study design-specific critical appraisal tools were used to assess risk of bias. Narrative analysis was undertaken due to heterogeneity. RESULTS Fifty-seven studies using a body image tool were included; 31 for prevalence and 16 and 8 for associated factors and association with quality of life, respectively. Studies reported mainly mean or median scores. Evidence suggested female gender, age, fatigue, disease activity and steroid use were associated with increased body image dissatisfaction, which was also associated with decreased quality of life. CONCLUSION This is the first systematic review on body image in patients with IBD. The evidence suggests that body image dissatisfaction can negatively impact patients, and certain factors are associated with increased body image dissatisfaction. Greater body image dissatisfaction was also associated with poorer quality of life. However, the methodological and reporting quality of studies was in some cases poor with considerable heterogeneity. Future IBD research should incorporate measurement of body image dissatisfaction using validated tools.
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Affiliation(s)
| | | | - Janine Dretzke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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de Silva PS, O’Toole A, Marc LG, Ulysse CA, Testa MA, Julsgaard M, Ngyuen D, Ananthakrishnan A, Laursen T, Højgaard A, Christensen LA, Korzenik J, Friedman S. Development of a Sexual Dysfunction Scale for Women With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2350-2359. [PMID: 30165525 PMCID: PMC6185125 DOI: 10.1093/ibd/izy202] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Indexed: 12/11/2022]
Abstract
Background Women with inflammatory bowel disease (IBD) may have decreased sexual function. To understand how common this condition is in our female patients, we developed a new IBD-specific Female Sexual Dysfunction Scale (the IBD-FSDS). Methods We performed a prospective cross-sectional study of 454 female IBD patients ≥18 years of age attending 1 of 3 IBD clinics in the United States or Denmark. We gathered information on sexual function via a de novo 23-item scale. General sexual functioning was measured with the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Medical history and sociodemographic data were collected via chart review. Exploratory factor analyses (EFAs) of the English language version of IBD-FSDS assessed unidimensionality, factor structure, reliability, criterion validity, and construct validity. Results EFAs suggested retaining 15-items creating a unidimensional scale with strong internal consistency reliability (α = 0.93). Validity of the English language IBD-FSDS was measured using Spearman's coefficient, demonstrating significant criterion validity with the FSDS-R (P < 0.05) and the FSFI (P < 0.05) and significant construct validity with the composite for cases of active IBD (P < 0.05) and PHQ-9 (P < 0.05). Sexual dysfunction in women with IBD was significantly associated with depression (P = 0.042), active IBD (P = 0.002), and no history of surgery (P = 0.044). Conclusions We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD in women. This novel screening questionnaire may help health care providers recognize factors contributing to impaired sexual function in their female patients.
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Affiliation(s)
| | | | - Linda G Marc
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Christine A Ulysse
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Marcia A Testa
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Mette Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Deanna Ngyuen
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Tine Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Højgaard
- Sexological Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbet A Christensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Liu JB, Berian JR, Temple LK. T he value of patient-reported outcomes in colon and rectal surgery. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
OBJECTIVE The aim of the study was to detect sexual impairment in male hepatitis C virus patients and determine its associations. PATIENTS AND METHODS A total of 61 male hepatitis C virus patients were enrolled in this cross-sectional study. Sexual functioning was assessed using the International Index of Erectile Function. Health-related quality of life (HRQOL) was evaluated using the Greek version of the Short Form 36 Health Survey, and the presence and severity of anxiety and depression were assessed using the Greek version of the Hospital Anxiety and Depression Scale. RESULTS Noncirrhotic patients showed clinically significant dysfunction, mainly in intercourse (59.6%) and overall satisfaction (57.4%). Erectile functioning and desire were correlated with depression (r=-0.520, P=0.000 and r=-0.473, P=0.000), anxiety (r=-0.443, P=0.000 and r=-0.428, P=0.001), physical (r=0.427, P=0.001 and r=0.329, P=0.012), and mental (r=0.379, P=0.003 and r=0.432, P=0.001) HRQOL, platelet count (r=-0.357, P=0.012 and r=0.366, P=0.010), and international normalized ratio (INR) levels (r=-0.373, P=0.013 and r=-0.440, P=0.003). Erection was also correlated with albumin levels (r=0.310, P=0.032). Orgasmic functioning was associated significantly with platelet count (r=0.322, P=0.024) and INR levels (r=-0.425, P=0.004). Intercourse satisfaction was significantly related to depression (r=-0.435, P=0.001) and anxiety (r=-0.335, P=0.008) levels, physical (r=0.374, P=0.004) and mental (r=0.300, P=0.022) HRQOL, platelet count (r=0.333, P=0.020), and INR levels (r=-0.373, P=0.013), and overall satisfaction was significantly correlated with depressive (r=-0.435, P=0.001) and anxiety (r=-0.278, P=0.033) symptoms, mental HRQOL (r=0.340, P=0.010), platelet count (r=0.316, P=0.029), and INR levels (r=-0.332, P=0.030). CONCLUSION Hepatitis C is accompanied by poor sexual functioning even in the absence of cirrhosis and different correlations emerge for distinct subdomains of male sexuality.
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Abstract
Chronic hepatitis C virus (HCV) infection is a systematic disease that affects several aspects of patients' well-being, including physical, mental, social, and sexual quality of life. In recent years, there has been a growing body of literature focusing on HCV patients' sexual health, providing evidence of clinically significant and enduring disturbances that disrupt everyday living, but commonly evade clinicians' attention. Relevant studies are characterized by considerable methodological heterogeneity and their findings should be interpreted using a systematic and integrative approach. In this context, we performed a systematic literature review on the topic of HCV patients' sexual functioning aiming at identifying high-quality investigations reporting scientifically sound and clinically useful data. We performed a thorough search of PudMed, ScienceDirect, and GoogleScholar according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Twenty-five articles were included to the review, reporting data from over 5300 chronic HCV patients. Sexual dysfunction, predominantly in the domains of sexual desire, drive, and satisfaction, is commonly reported by HCV patients at rates ranging between 19 and 88%. The current review yielded three distinct patterns of sexual impairment, namely, precirrhotic sexual impairment, cirrhosis-induced sexual decline, and interferon-associated sexual difficulties. Our search yielded significant findings on the prevalence, the characteristics, and the determinants of HCV-associated sexual dysfunction. In addition, we detected several areas of scientific controversy and inadequate information, thus highlighting novel directions for future research.
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Feagan BG, Patel H, Colombel J, Rubin DT, James A, Mody R, Lasch K. Effects of vedolizumab on health-related quality of life in patients with ulcerative colitis: results from the randomised GEMINI 1 trial. Aliment Pharmacol Ther 2017; 45:264-275. [PMID: 27859410 PMCID: PMC5215718 DOI: 10.1111/apt.13852] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/02/2016] [Accepted: 10/11/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is often diminished in patients with ulcerative colitis. AIM To evaluate the effects of vedolizumab on HRQL in patients with ulcerative colitis. METHODS Using maintenance phase data from the GEMINI 1 study, an analysis of covariance model was used to calculate mean differences between the vedolizumab and placebo groups in changes from baseline to week 52 for 3 HRQL instruments: The Inflammatory Bowel Disease Questionnaire (IBDQ), 36-Item Short Form Health Survey (SF-36), and EQ-5D. Proportions of patients meeting minimal clinically important difference (MCID) thresholds for changes on these instruments were compared between treatment groups for the overall population and for clinically important subgroups. Concordance between clinical remission and remission defined using IBDQ scores was examined. RESULTS Compared with placebo-treated patients, vedolizumab-treated patients had greater improvements (152-201%) in IBDQ, EQ-5D visual analogue scale (VAS), and EQ-5D utility scores. Greater proportions (6.9-19.9%) of vedolizumab-treated patients than placebo-treated patients met MCID thresholds for all the instruments. Vedolizumab-treated patients with lower baseline disease activity and those without prior tumour necrosis factor (TNF) antagonist failure had greater HRQL improvements. Among 127 patients with clinical remission based on complete Mayo Clinic scores, >80% also had IBDQ remission; >70% of the 150 patients with IBDQ remission demonstrated clinical remission. CONCLUSIONS Vedolizumab therapy was associated with significant improvements in HRQL measures compared with placebo. Benefits were greater in patients with lower disease activity and no prior TNF antagonist failure.
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Affiliation(s)
- B. G. Feagan
- Robarts Clinical TrialsRobarts Research InstituteUniversity of Western OntarioLondonONCanada
| | - H. Patel
- Immensity Consulting, Inc.ChicagoILUSA
| | | | - D. T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease CenterChicagoILUSA
| | - A. James
- Takeda Development Centre Europe Ltd.LondonUK
| | - R. Mody
- Takeda Development Center Americas, Inc.DeerfieldILUSA
| | - K. Lasch
- Takeda Pharmaceuticals USA, Inc.DeerfieldILUSA
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Sanders JN, Gawron LM, Friedman S. Sexual satisfaction and inflammatory bowel diseases: an interdisciplinary clinical challenge. Am J Obstet Gynecol 2016; 215:58-62. [PMID: 26849974 DOI: 10.1016/j.ajog.2016.01.188] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel diseases (IBD), most commonly Crohn's disease and ulcerative colitis, have the highest incidence during the reproductive years. IBD and its treatments increase the risk of sexual dysfunction for both men and women with these diseases. Women with IBD often seek care from their gynecologist and may preferentially discuss sexual experiences with them over other providers. An understanding of IBD and its impact on sexual functioning and satisfaction will improve screening, evaluation, and management for these patients. Identifying interdisciplinary providers for referrals, such as pelvic floor physical therapists and health psychologists, is a key component to long-term improvements in sexual satisfaction for women with IBD.
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Affiliation(s)
- Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
| | - Sonia Friedman
- Division of Gastroenterology, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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Abstract
Ulcerative colitis and Crohn disease are chronic inflammatory diseases with typical onset in early adulthood. These diseases, therefore, can affect a woman throughout the many stages of her life, including menstruation, sexuality, pregnancy, and menopause. Unique health issues face women during these stages and can affect the course of their inflammatory bowel disease as well as treatment strategies and health maintenance. This article covers the non-pregnancy-related issues that are important in caring for women with inflammatory bowel disease. The topics of pregnancy and fertility are covered in a separate review.
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Affiliation(s)
- Linda A Feagins
- Division of Gastroenterology and Hepatology, VA North Texas Healthcare System, University of Texas Southwestern Medical Center, 4500 S. Lancaster Rd (111B1), Dallas, TX 75216, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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