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Riggott C, Fairbrass KM, Black CJ, Gracie DJ, Ford AC. Novel symptom clusters predict disease impact and healthcare utilisation in inflammatory bowel disease: Prospective longitudinal follow-up study. Aliment Pharmacol Ther 2023; 58:1163-1174. [PMID: 37792347 DOI: 10.1111/apt.17735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Predicting adverse disease outcomes and high-volume users of healthcare amongst patients with inflammatory bowel disease (IBD) is difficult. AIMS The aim of this study is to use latent class analysis to create novel clusters of patients and to assess whether these predict outcomes during 6.5 years of longitudinal follow-up. METHODS Baseline demographic features, disease activity indices, anxiety, depression, and somatoform symptom-reporting scores were recorded for 692 adults. Faecal calprotectin (FC) was analysed at baseline in 348 (50.3%) patients (<250 mcg/g defined biochemical remission). Using baseline gastrointestinal and psychological symptoms, latent class analysis identified specific patient clusters. Rates of glucocorticosteroid prescription or flare, escalation, hospitalisation, or intestinal resection were compared between clusters using multivariate Cox regression. RESULTS A three-cluster model was the optimum solution; 132 (19.1%) patients had below-average gastrointestinal and psychological symptoms (cluster 1), 352 (50.9%) had average levels of gastrointestinal and psychological symptoms (cluster 2), and 208 (30.1%) had the highest levels of both gastrointestinal and psychological symptoms (cluster 3). Compared with cluster 1, cluster 3 had significantly increased risk of flare or glucocorticosteroid prescription (hazard ratio (HR): 2.13; 95% confidence interval (CI): 1.46-3.10), escalation (HR: 1.92; 95% CI: 1.34-2.76), a composite of escalation, hospitalisation, or intestinal resection (HR: 2.05; 95% CI: 1.45-2.88), or any of the endpoints of interest (HR: 2.06; 95% CI: 1.45-2.93). Healthcare utilisation was highest in cluster 3. CONCLUSIONS Novel model-based clusters identify patients with IBD at higher risk of adverse disease outcomes who are high-volume users of healthcare.
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Affiliation(s)
- Christy Riggott
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Keeley M Fairbrass
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Mules TC, Swaminathan A, Hirschfeld E, Borichevsky G, Frampton C, Day AS, Gearry RB. The impact of disease activity on psychological symptoms and quality of life in patients with inflammatory bowel disease-results from the Stress, Anxiety and Depression with Disease Activity (SADD) Study. Aliment Pharmacol Ther 2022; 55:201-211. [PMID: 34587655 DOI: 10.1111/apt.16616] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Disease activity may be a risk factor for psychological illness in patients with inflammatory bowel disease (IBD). AIM To correlate objective measures of disease activity with psychological symptoms. METHODS Adult patients with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, psychological symptoms (depression, anxiety, stress), disease activity (symptoms, biomarkers, endoscopy), and quality of life (QoL) data were collected. One-way ANOVA and multivariable analyses examined the associations between disease activity and symptoms of psychological illness, and identified other predictors of mental illness and reduced QoL. RESULTS A total of 172 patients were included, 107 with Crohn's disease (CD) and 65 with ulcerative colitis (UC). There was no significant association between objective disease activity (endoscopic scores, faecal calprotectin or C-reactive protein) and depression, anxiety or stress scores (P > 0.05 for all comparisons). Gastrointestinal symptoms were significantly associated with symptoms of depression, anxiety and stress in patients with CD and UC (P < 0.05). On multivariable analysis, only gastrointestinal symptoms were associated with severe symptoms of depression (OR 20.78 [6.71-92.37], P < 0.001) and anxiety (OR 4.26 [1.70-12.25], P = 0.004). Anti-TNF and corticosteroid use, the presence of severe depressive, moderate-severe stress and gastrointestinal symptoms, and endoscopically active IBD were associated with a reduced QoL (P < 0.05). Longer duration of IBD predicted an improved QoL (P < 0.05). CONCLUSIONS Objective measures of disease activity are not associated with symptoms of psychological illness in patients with IBD. Clinicians should consider underlying mental illness in patients with IBD with active gastrointestinal symptoms.
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Affiliation(s)
- Thomas C Mules
- Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand
| | - Akhilesh Swaminathan
- Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand.,University of Otago, Christchurch, New Zealand
| | | | | | | | - Andrew S Day
- Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand.,University of Otago, Christchurch, New Zealand
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3
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Depression and Anxiety Disorders Impact in the Quality of Life of Patients with Inflammatory Bowel Disease. PSYCHIATRY JOURNAL 2021; 2021:5540786. [PMID: 34746297 PMCID: PMC8566083 DOI: 10.1155/2021/5540786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/28/2021] [Accepted: 10/16/2021] [Indexed: 01/08/2023]
Abstract
Objective Anxiety and depression have a negative influence in the quality of life. The aim of the study was to determinate the levels of sensitivity and specificity of the Anxiety and Hospital Depression Scale (HADS) and compare the quality of life in patients with inflammatory bowel disease (IBD) and depression or anxiety. Methods This study included 104 patients with diagnosis of IBD. Each patient received psychiatric intervention with SCID-I (Structured Clinical Interview for DSMIV Axis I Disorders) instrument as a gold standard to stablish the cut-off points of HADS. Quality of life was also evaluated with IBDQ-32. Demographic and clinical variables were collected. Results Most of the patients reported a high quality of life (73.1%, n = 76), while 25.0% (n = 26) express a moderate quality of life. The ROC curves for both psychiatric entities showed an adequate discriminative capacity of the HADS-anxiety dimension (AUC = 0.84, 95%CI = 0.76-0.92) with a limited discriminability of the HADS-depression dimension (AUC = 0.58, 95%CI = 0.46-0.70) using the proposed scoring of 8 as a cut-off point. Conclusions Anxiety and depression impact negatively in the quality of life in Mexican patients with IBD. The Mexican version of HADS had acceptable internal consistency and external validity, with moderate sensitivity and specificity for clearly identifying clinical cases of anxiety and depression in patients with IBD.
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Blackwell J, Alexakis C, Saxena S, Creese H, Bottle A, Petersen I, Hotopf M, Pollok RCG. Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000588. [PMID: 34045238 PMCID: PMC8162076 DOI: 10.1136/bmjgast-2020-000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Animal studies indicate a potential protective role of antidepressant medication (ADM) in models of colitis but the effect of their use in humans with ulcerative colitis (UC) remains unclear. Objective To study the relationship between ADM use and corticosteroid dependency in UC. Design Using the Clinical Practice Research Datalink we identified patients diagnosed with UC between 2005 and 2016. We grouped patients according to serotonin selective reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) exposure in the 3 years following diagnosis: ‘continuous users’, ‘intermittent users’ and ‘non-users’. We used logistic regression to estimate the adjusted risk of corticosteroid dependency between ADM exposure groups. Results We identified 6373 patients with UC. Five thousand two hundred and thirty (82%) use no ADMs, 627 (10%) were intermittent SSRI users and 282 (4%) were continuous SSRI users, 246 (4%) were intermittent TCA users and 63 (1%) were continuous TCA users. Corticosteroid dependency was more frequent in continuous SSRI and TCA users compared with non-users (19% vs 24% vs 14%, respectively, χ2 p=0.002). Intermittent SSRI and TCA users had similar risks of developing corticosteroid dependency to non-users (SSRI: OR 1.19, 95% CI 0.95 to 1.50, TCA: OR 1.14, 95% CI 0.78 to 1.66). Continuous users of both SSRIs and TCAs had significantly higher risks of corticosteroid dependency compared with non-users (SSRI: OR 1.62, 95% CI 1.15 to 2.27, TCA: OR 2.02, 95% CI 1.07 to 3.81). Conclusions Continuous ADM exposure has no protective effect in routine clinical practice in UC and identifies a population of patients requiring more intensive medical therapy. ADM use is a flag for potentially worse clinical outcomes in UC.
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Affiliation(s)
- Jonathan Blackwell
- Imperial College London Department of Primary Care and Public Health, London, UK .,Department Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.,The POP-IBD study group, London, UK
| | - Christopher Alexakis
- The POP-IBD study group, London, UK.,Gastroenterology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Sonia Saxena
- Imperial College London Department of Primary Care and Public Health, London, UK.,The POP-IBD study group, London, UK
| | - Hanna Creese
- Imperial College London Department of Primary Care and Public Health, London, UK.,The POP-IBD study group, London, UK
| | - Alex Bottle
- The POP-IBD study group, London, UK.,Primary Care and Public Health, Imperial College, London, UK.,Dr Foster Unit, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Irene Petersen
- The POP-IBD study group, London, UK.,Department of Primary Care & Population Health, University College London, London, UK
| | - Matthew Hotopf
- The POP-IBD study group, London, UK.,Division of Academic Psychiatry, Institute of Psychiatry Psychology and Neuroscience, London, UK.,South London and Maudsley Mental Health NHS Trust, London, London, UK
| | - Richard C G Pollok
- Department Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.,The POP-IBD study group, London, UK.,Institute for Infection and Immunity, St George's University of London, London, UK
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Tran F, Schirmer JH, Ratjen I, Lieb W, Helliwell P, Burisch J, Schulz J, Schrinner F, Jaeckel C, Müller-Ladner U, Schreiber S, Hoyer BF. Patient Reported Outcomes in Chronic Inflammatory Diseases: Current State, Limitations and Perspectives. Front Immunol 2021; 12:614653. [PMID: 33815372 PMCID: PMC8012677 DOI: 10.3389/fimmu.2021.614653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 01/20/2023] Open
Abstract
Chronic inflammatory diseases (CID) are emerging disorders which do not only affect specific organs with respective clinical symptoms but can also affect various aspects of life, such as emotional distress, anxiety, fatigue and quality of life. These facets of chronic disease are often not recognized in the therapy of CID patients. Furthermore, the symptoms and patient-reported outcomes often do not correlate well with the actual inflammatory burden. The discrepancy between patient-reported symptoms and objectively assessed disease activity can indeed be instructive for the treating physician to draw an integrative picture of an individual's disease course. This poses a challenge for the design of novel, more comprehensive disease assessments. In this mini-review, we report on the currently available patient-reported outcomes, the unmet needs in the field of chronic inflammatory diseases and the challenges of addressing these.
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Affiliation(s)
- Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jan Henrik Schirmer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ilka Ratjen
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Helliwell
- UK and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Johan Burisch
- Gastrounit, Medical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - Juliane Schulz
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Schrinner
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Charlot Jaeckel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Kerckhoff-Klinik GmbH, Giessen, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bimba F. Hoyer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
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DiRenzo D, Russell J, Bingham CO, McMahan Z. The Relationship Between Autonomic Dysfunction of the Gastrointestinal Tract and Emotional Distress in Patients With Systemic Sclerosis. J Clin Rheumatol 2021; 27:11-17. [PMID: 31524844 PMCID: PMC7065966 DOI: 10.1097/rhu.0000000000001144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES We hypothesized that emotional distress in systemic sclerosis (SSc) patients with moderate to severe gastrointestinal (GI) dysfunction is associated with dysautonomia. We sought to determine (1) the clinical characteristics associated with emotional distress in SSc, (2) the odds of having dysautonomia in those with emotional distress, and (3) whether GI dysautonomia, as measured by the Survey of Autonomic Symptoms (SAS), correlates with GI dysautonomia on the Composite Autonomic Symptom Score-31 (COMPASS-31). METHODS Clinical and demographic features from our prospective cohort study were compared among SSc patients with and without GI-associated emotional distress (University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 well-being subscale >0.5 or ≤0.5) in cross-sectional analysis. Covariates/confounders independently associated with emotional distress were used to construct multivariable logistic regression models. The COMPASS-31 and SAS GI subdomains were compared with Spearman correlation. RESULTS Forty-six patients with SSc were enrolled in the study. In univariate analyses, age (odds ratio [OR], 1.06; p = 0.026), severity of GI dysautonomia (COMPASS-31: OR, 1.41; p = 0.003), anti-centromere (A/B) antibodies (OR, 3.60; p = 0.044), and anti-PM-Scl (75/100) antibodies (OR, 0.15; p = 0.035) were associated with emotional distress. In the adjusted model, those with more severe GI dysautonomia remained more likely to have emotional distress (OR, 1.85; p = 0.026); those with anti-PM-Scl (75/100) antibodies were less likely to have emotional distress (OR, 0.03; p = 0.031). The SAS and COMPASS-31 GI subdomains moderately correlated (ρ = 0.68, p < 0.001). CONCLUSIONS In SSc, increased symptom burden related to GI dysautonomia is associated with emotional distress. Multidisciplinary approaches addressing both the physical and emotional needs of the SSc patient may be warranted to optimize patient care.
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Affiliation(s)
- Dana DiRenzo
- Johns Hopkins University School of Medicine, Division of Rheumatology
| | | | | | - Zsuzsanna McMahan
- Johns Hopkins University School of Medicine, Division of Rheumatology
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Naeck-Boolauky P, Adio J, Burch J. Review of normal gastrointestinal tract, ulcerative colitis, proctitis and rectal medication adherence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:805-811. [PMID: 32697644 DOI: 10.12968/bjon.2020.29.14.805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The gastrointestinal (GI) tract has a number of functions-ingestion, digestion, absorption and elimination. When the GI tract is working normally, it is efficient. However, this can change when disease, such as inflammatory bowel disease (IBD) occurs. IBD is a long-term relapsing and remitting autoimmune disease; it incorporates ulcerative colitis (UC). In UC, part or all the mucosa lining the rectum and colon becomes inflamed and ulcerated. UC that affects the rectum only is called proctitis. Effective treatment is essential. It is better to target the rectal mucosa directly in proctitis, using topical rectal medications in enemas or suppositories, as these have fewer side-effects and resolve symptoms more quickly than systemic drugs. However, patients may not feel clear about aspects of their IBD care and can find it difficult to initiate and comply with treatment and maintenance regimens. Nurses need to educate and support them to achieve optimal therapeutic outcomes in both the immediate and long terms.
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Affiliation(s)
| | - Jitka Adio
- Inflammatory Bowel Disease Clincial Nurse Specialist, St Mark's Hospital, Harrow, Middlesex
| | - Jennie Burch
- Head of Gastrointestinal Nurse Education, St Mark's Hospital, Harrow, Middlesex
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Li SH, Wu QF. Emotional dysfunction and inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2019; 27:727-733. [DOI: 10.11569/wcjd.v27.i12.727] [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] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a group of inflammatory conditions which arise as a result of the interactions of susceptible genetic factors, environment, and intestinal microbiota, which lead to abnormal immunological responses and inflammation in the colon and small intestine. The exact pathogenesis of IBD is still unclear. Studies have shown that the existence of emotional dysfunction such as depression or anxiety contributes to the onset and development of IBD. It has been proposed that emotional changes may mediate or influence the gut microbiota-brain axis, thereby influencing intestinal motility, hormone secretion, and immunity, aggravating the intestinal immune inflammatory response, and increasing the clinical symptoms and recurrent risk of IBD. Giving psychological treatments when necessary will be beneficial to patients with IBD. In this paper, we discuss the relationship between emotional dysfunction and IBD.
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Affiliation(s)
- Si-Hui Li
- College of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China,Institute of Acupuncture and Internal Steady State Adjustment, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China
| | - Qiao-Feng Wu
- College of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China,Institute of Acupuncture and Internal Steady State Adjustment, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China
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Alexakis C, Kumar S, Saxena S, Hotopf M, Pollok R. Editorial: depression in the setting of inflammatory bowel disease means we have failed to provide early, effective, psychosocial care-authors' reply. Aliment Pharmacol Ther 2017; 46:554-555. [PMID: 28776734 DOI: 10.1111/apt.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- C Alexakis
- Department of Gastroenterology, St George's University NHS Hospitals Trust, London, UK
| | - S Kumar
- Department of Gastroenterology, St George's University NHS Hospitals Trust, London, UK
| | - S Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - M Hotopf
- Department of Psychological Medicine, King's College Hospital, London, UK
| | - R Pollok
- Department of Gastroenterology, St George's University NHS Hospitals Trust, London, UK
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