Ulcerative colitis from patients' viewpoint: a review of two Internet surveys

The lived experiences of people with inflammatory bowel diseases: A phenomenological hermeneutic study

AIM

The aim of this research was to provide an in-depth study about the life experiences of patients with inflammatory bowel diseases.

METHODS

The phenomenological (hermeneutic) method was used to analyse data. The data were collected between March 25 and July 1, 2019. A homogeneous group of 25 patients were included as participants by purposeful sampling methods. Interviews were conducted in the hospital patient-education room.

RESULTS

The results of this study emphasize the importance of understanding the fears, worries, difficulties and life experiences of patients with inflammatory bowel diseases. Three main themes were identified: a flare phase of the disease, a remission period and coping behaviours. Study findings included the experiences of social isolation; inability to perform daily activities of living and to work; stress in the flare phase of the disease; concerns about the future in the remission phase and physical and spiritual strategies used for coping.

CONCLUSION

Coping with the physical symptoms and emotional difficulties of inflammatory bowel diseases can prevent patients from living a normal life. The results of this article highlight the importance of understanding the fear, anxiety, difficulties and life experiences of these patients.

SUMMARY STATEMENT

What is already known about the topic? Some research on inflammatory bowel disease exists, but patient experiences differ. IBD patients may not be able to maintain a normal life due to the effects of the disease. What does this paper add? It enables nurses to know and understand the life experiences of IBD patients. The implications of this paper: Knowing and understanding the experiences of IBD patients, nurses can provide personalized care and support tailored to each patient's needs and concerns.

Patient preferences for inflammatory bowel disease treatment objectives

BACKGROUND

There is currently little evidence about what treatment objectives most interest patients with inflammatory bowel disease (IBD).

AIMS

To determine patient preferences regarding IBD treatment objectives, specially the attributes they value most and the symptoms to be controlled as a priority.

METHODS

Prospective, observational, anonymous study conducted in 117 outpatients with Crohn's disease or ulcerative colitis.

RESULTS

The most important treatment objectives from the patients' perspective were: improving quality of life (40.2% of patients), and completely resolving symptoms (33.3%). Only 12.8% of patients indicated having a completely normal colonoscopy as a preferred objective. The symptoms the patients considered to be most important when prioritizing their control were: abdominal pain (23.1% of patients), and bowel movement urgency (17.1%). The preferred treatment objectives were similar for Crohn's disease and ulcerative colitis patients.

CONCLUSIONS

Improving quality of life and completely controlling symptoms are the priority treatment objectives for IBD patients, with abdominal pain being the most important symptom. Conversely, therapeutic objective target goals proposed by physicians, such as healing the mucosal lesions, are not a priority for most patients. This indicates that there are discrepancies between patient and physician expectations, which should be taken into account if a patient-centered care model is to be implemented.

The Social Construction of Inflammatory Bowel Disease Using Social Media Technologies

Many people with inflammatory bowel disease (IBD), sometimes lacking adequate face-to-face sources of support, turn to online communities to meet others with the disease. These online communities are places of support and education, but through the use of social media communication technologies, people with IBD are redefining what it means to live with the disease. This ethnographic study followed 14 online communities to understand how people with IBD used social media technologies to construct their own meanings about living with the disease. The following redefinitions were observed: the refiguring of the body is beautiful; inflammatory bowel disease is serious and deadly; inflammatory bowel disease is humorous; the disease makes one stronger; and the disease is invisible, but needs to be made visible. This study will help health communication scholars understand how technology is appropriated by patients, and will help practitioners understand how their patients conceptualize their disease.

Eldelumab [Anti-IP-10] Induction Therapy for Ulcerative Colitis: A Randomised, Placebo-Controlled, Phase 2b Study

BACKGROUND AND AIMS

Interferon-γ-inducible protein-10 [IP-10] mediates immune cell trafficking from the circulation to the inflamed colon and decreases gut epithelial cell survival. IP-10 expression is increased in patients with ulcerative colitis [UC]. We report efficacy and safety results from a dose-ranging induction study of eldelumab, a fully human monoclonal antibody to IP-10, in moderately to severely active UC.

METHODS

A total of 252 adults with UC [Mayo score ≥ 6 and endoscopic subscore ≥ 2] were randomised 1:1:1 to placebo or eldelumab 15 or 25 mg/kg administered intravenously on Days 1 and 8 and every other week thereafter. The primary endpoint was clinical remission [Mayo score ≤ 2; no individual subscale score > 1] at Week 11. Key secondary endpoints included Mayo score clinical response and mucosal healing at Week 11.

RESULTS

Neither eldelumab 15 or 25 mg/kg resulted in significant increases vs placebo in the proportion of patients achieving Week 11 clinical remission. Remission and response rates were 17.6% and 47.1% with eldelumab 25mg/kg, 13.1% and 44.0% with eldelumab 15mg/kg, and 9.6% and 31.3% with placebo. Clinical remission and response rates were higher in anti-tumour necrosis factor [TNF]-naïve patients treated with eldelumab compared with placebo. Eldelumab treatment was well tolerated and no immunogenicity was observed.

CONCLUSIONS

The primary endpoint was not achieved with induction treatment with eldelumab 15 or 25 mg/kg in patients with UC. Trends towards clinical remission and response were observed in the overall population and were more pronounced in anti-TNF naïve patients. Eldelumab safety signals were consistent with those reported previously [ClinicalTrials.gov number, NCT01294410].

Patients' perceptions, attitudes, and experiences about the management of mild-to-moderate ulcerative colitis

OBJECTIVE

To establish the perceptions, attitudes, experiences, and satisfaction with clinical management of ulcerative colitis (UC) patients, particularly in aspects related to treatment.

METHODS

A qualitative, descriptive, exploratory study. A discussion group was performed in patients who were in remission according to the criteria of the Mayo index, who had never taken biologics or corticosteroids in the past year. They were selected by: course (mild/moderate), time since onset (under 5 years/ 5 to 9 years/ 10 years or more), follow-up area (primary care [PC]-hospital/PC-specialist care/hospital), treatment (yes/no), UC care unit (yes/no), belongs to patient associations (yes/no) and sex. A descriptive-interpretative content analysis was performed to detect emerging categories, providing them with an explanatory framework.

RESULTS

Diagnostic delay was detected due to lack of clinical suspicion from PC and delayed diagnostic tests. For follow-up, patients prefer care on demand, channeled through remote care, which helps to resolve questions, problems with treatment, or when a relapse occurs, minimizing visits to the hospital. They demand more information, both about UC and treatment. The expectations about treatments are limited, so they mainly requested efficacy and safety.

CONCLUSION

The results suggest the importance of developing strategies to facilitate care on demand and remote care, and to investigate on effective and safe treatments to minimize the detriment to quality of life of patients. These strategies should guarantee fast care and, together with safe and effective treatments, optimize the management of UC patients.

Disease status, patient quality of life and healthcare resource use for ulcerative colitis in the UK: an observational study

BACKGROUND

Ulcerative colitis is a lifelong, chronic, relapsing-remitting disease.

OBJECTIVE

To assess the relationship between ulcerative colitis disease status and patient quality of life, and to determine the impact of ulcerative colitis on healthcare costs and work productivity, in the UK.

METHODS

Clinicians assessed 173 adult patients' current disease status at a single study visit using the partial Mayo (pMayo) instrument. Patients completed the Euro Quality of Life 5-dimension, 5-level (EQ-5D-5L) questionnaire, the Work Productivity and Activity Impairment (WPAI) questionnaire. Healthcare resource use was determined from questionnaires and from patients' medical charts.

RESULTS

Patients in remission had a significantly higher EQ-5D-5L scores (mean (SD) 0.86 (0.15)) than patients with active disease (0.71 (0.20); p<0.001). Patients with mild disease had significantly higher mean (SD) EQ-5D-5L scores than patients with moderate/severe disease: 0.77 (0.11) and 0.66 (0.24), respectively (p<0.001). The mean percent productivity impairment was greater for patients with active disease than for patients in remission on all items of the WPAI questionnaire: 24.6% vs 1.8% for work time missed, 34.1% vs 12.9% for impairment while working, 40.8% vs 14.4% for overall work impairment and 42.7% vs 13.0% for activity impairment (p<0.001 for all comparisons). The mean (SD) total cost of healthcare for ulcerative colitis in the prior 3 months was £1211 (1588).

CONCLUSIONS

When compared with patients in remission, patients with active ulcerative colitis have significantly worse quality of life and significantly more work impairment. The healthcare costs of ulcerative colitis are considerable.