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Fons AB, Asscher VER, Stuyt RJL, Baven-Pronk AMC, van der Marel S, Jacobs RJ, Mooijaart SP, Eikelenboom P, van der Meulen-de Jong AE, Kalisvaart KJ, Jeroen Maljaars PW. Deficits in geriatric assessment are important in relation to fatigue in older patients with Inflammatory Bowel Disease. Dig Liver Dis 2024; 56:1490-1496. [PMID: 38369409 DOI: 10.1016/j.dld.2024.01.196] [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: 09/04/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND No previous study has investigated fatigue in older patients with Inflammatory Bowel Disease (IBD). AIMS To describe the prevalence of fatigue in older patients and compare it to the prevalence in younger patients with IBD, and to determine factors associated with fatigue. METHODS A prospective, multicenter cohort study, including older- (≥ 65 years) and younger patients with IBD (18-64 years). A geriatric assessment was performed in older patients to measure deficits in geriatric assessment (DiG). Fatigue was defined by one item from the short Inflammatory Bowel Disease Questionnaire. Active disease was defined as the presence of clinical or biochemical disease activity. RESULTS Fatigue prevalence in the 405 older patients varied between 45.4% (71/155) in active disease to 23.6% (60/250) in remission. Fatigue prevalence in 155 younger patients was 59.5% (47/79) and 57.4% (89/155), respectively. Female sex, clinical disease activity, use of immunomodulators and presence of DiG were associated with fatigue in older patients with IBD. CONCLUSIONS Fatigue prevalence is lower in older patients with IBD compared to younger patients with IBD, but increases when active disease is present. Clinicians should be aware that fatigue is a relevant symptom in older patients with IBD, as it is associated with DiG.
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Affiliation(s)
- Anne B Fons
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands; Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, Boerhaavelaan 2035RC, the Netherlands.
| | - Vera E R Asscher
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Rogier J L Stuyt
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, Els Borst-Eilersplein 275, The Hague 2545AA, the Netherlands
| | - A Martine C Baven-Pronk
- Department of Gastroenterology and Hepatology, Groene Hart Ziekenhuis, Bleulandweg 10, Gouda 2803 HH, the Netherlands
| | - Sander van der Marel
- Department of Gastroenterology and Hepatology, Haaglanden Medical Centre, Lijnbaan 32, The Hague 2512VA, the Netherlands
| | - Rutger J Jacobs
- Department of Gastroenterology and Hepatology, Alrijne Hospital, Houtlaan 55, Leiden and Leiderdorp 2334CK, the Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Piet Eikelenboom
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC location, Amsterdam, The Netherlands
| | - Andrea E van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Kees J Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, Boerhaavelaan 2035RC, the Netherlands
| | - P W Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
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Cohen-Mekelburg S, Goldstein CA, Rizvydeen M, Fayyaz Z, Patel PJ, Berinstein JA, Bishu S, Cushing-Damm KC, Kim HM, Burgess HJ. Morning light treatment for inflammatory bowel disease: a clinical trial. BMC Gastroenterol 2024; 24:179. [PMID: 38778264 PMCID: PMC11110384 DOI: 10.1186/s12876-024-03263-2] [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: 04/17/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) affects over 3 million Americans and has a relapsing and remitting course with up to 30% of patients experiencing exacerbations each year despite the availability of immune targeted therapies. An urgent need exists to develop adjunctive treatment approaches to better manage IBD symptoms and disease activity. Circadian disruption is associated with increased disease activity and may be an important modifiable treatment target for IBD. Morning light treatment, which advances and stabilizes circadian timing, may have the potential to improve IBD symptoms and disease activity, but no studies have explored these potential therapeutic benefits in IBD. Therefore, in this study, we aim to test the effectiveness of morning light treatment for patients with IBD. METHODS We will recruit sixty-eight individuals with biopsy-proven IBD and clinical symptoms and randomize them to 4-weeks of morning light treatment or 4-weeks of treatment as usual (TAU), with equivalent study contact. Patient-reported outcomes (IBD-related quality of life, mood, sleep), clinician-rated disease severity, and a biomarker of gastrointestinal inflammation (fecal calprotectin) will be assessed before and after treatment. Our primary objective will be to test the effect of morning light treatment versus TAU on IBD-related quality of life and our secondary objectives will be to test the effects on clinician-rated disease activity, depression, and sleep quality. We will also explore the effect of morning light treatment versus TAU on a biomarker of gastrointestinal inflammation (fecal calprotectin), and the potential moderating effects of steroid use, restless leg syndrome, and biological sex. DISCUSSION Morning light treatment may be an acceptable, feasible, and effective adjunctive treatment for individuals with active IBD suffering from impaired health-related quality of life. TRIAL REGISTRATION The study protocol was registered on ClinicalTrials.gov as NCT06094608 on October 23, 2023, before recruitment began on February 1, 2024.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | | | - Muneer Rizvydeen
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Zainab Fayyaz
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Priya J Patel
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey A Berinstein
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kelly C Cushing-Damm
- Division of Gastroenterology and Hepatology, University of Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Hyungjin Myra Kim
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Helen J Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Wang J, Tong S, Lu B. Influential factors on disease activity in Crohn's disease and their Roc curve evaluation: a cross-sectional study. BMC Gastroenterol 2024; 24:126. [PMID: 38570741 PMCID: PMC10993542 DOI: 10.1186/s12876-024-03211-0] [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: 10/11/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the factors influencing disease activity in patients with Crohn's disease (CD) and provide insights and references for the management and prevention of CD. METHODS We recruited CD patients who met the inclusion and exclusion criteria and were treated at the First Affiliated Hospital of Soochow University from November 2022 to June 2023. Generalized linear mixed models were used to analyze the factors affecting disease activity in CD patients. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of these factors for disease activity. RESULTS A total of 268 CD participants aged 18 to 65 were included in the study, with over 68% of them in remission or experiencing mild disease activity, indicating relatively good disease control. The results of the generalized linear mixed models showed that older age, absence of diabetes, high levels of physical activity, and a low dietary inflammatory index (DII) were protective factors for lower disease activity in CD patients (p < 0.05). ROC curve analysis demonstrated that physical activity level, age, and DII all had ROC areas greater than 0.6 in predicting disease activity in CD patients (p < 0.05). CONCLUSION The factors influencing the disease activity of CD patients are numerous and should be given attention. CD patients who are younger, have low levels of physical activity, high DII, and have diabetes are at a higher risk of increased disease activity. By reducing or avoiding the mentioned risk factors and leveraging protective factors, it is possible to mitigate the disease activity of CD to some extent.
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Affiliation(s)
- Jing Wang
- The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Shuping Tong
- The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Bingqing Lu
- The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China.
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