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Liang C, Chen P, Tang Y, Zhang C, Lei N, Luo Y, Duan S, Zhang Y. Venlafaxine as an Adjuvant Therapy for Inflammatory Bowel Disease Patients With Anxious and Depressive Symptoms: A Randomized Controlled Trial. Front Psychiatry 2022; 13:880058. [PMID: 35664492 PMCID: PMC9160994 DOI: 10.3389/fpsyt.2022.880058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS The effect of antidepressant therapy on Inflammatory Bowel Disease (IBD) remains controversial. This trial aimed to assess whether adding venlafaxine to standard therapy for IBD improved the quality of life (QoL), mental health, and disease activity of patients with IBD with anxious and depressive symptoms. METHODS A prospective, randomized, double-blind, and placebo-controlled clinical trial was conducted. Participants diagnosed with IBD with symptoms of anxiety or depression were randomly assigned to receive either venlafaxine 150 mg daily or equivalent placebo and followed for 6 months. Inflammatory Bowel Disease Questionnaire (IBDQ), Mayo score, Crohn's disease activity index (CDAI), Hospital Anxiety and Depression Scale (HADS), and blood examination were completed before the enrollment, during, and after the follow-up. Mixed linear models and univariate analyses were used to compare groups. RESULTS Forty-five patients with IBD were included, of whom 25 were randomized to receive venlafaxine. The mean age was 40.00 (SD = 13.12) years old and 25 (55.6%) were male. Venlafaxine showed a significant improvement on QoL (p < 0.001) and disease course (p = 0.035), a greater reduction in HADS (anxiety: p < 0.001, depression: p < 0.001), Mayo scores (p < 0.001), and CDAI (p = 0.006) after 6 months. Venlafaxine had no effect on IL-10 expression, endoscopic scores, relapse rate, and use rate of biologics and corticosteroids, but did reduce serum level of erythrocyte estimation rate (ESR; p = 0.003), C-reactive protein (CRP; p < 0.001) and tumor necrosis factor-α (TNF-α; p = 0.009). CONCLUSIONS Venlafaxine has a significantly beneficial effect on QoL, IBD activity, and mental health in patients with IBD with comorbid anxious or depressive symptoms. (Chinese Clinical Trial Registry, ID: ChiCTR1900021496).
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Affiliation(s)
- Chang Liang
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Pingrun Chen
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Tang
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Chuheng Zhang
- Institute for Interdisciplinary Information Science, Tsinghua University, Beijing, China
| | - Na Lei
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Luo
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Shihao Duan
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Zhang
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
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Wang H, Zhao X, Cui X, Wang M, Jiao C, Li J, Yang Y, Li Y, Zhang H. A Pilot Study of Clinical Evaluation and Formation Mechanism of Irritable Bowel Syndrome-like Symptoms in Inflammatory Bowel Disease Patients in Remission. J Neurogastroenterol Motil 2021; 27:612-625. [PMID: 34642282 PMCID: PMC8521459 DOI: 10.5056/jnm20151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/02/2021] [Accepted: 02/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Some inflammatory bowel disease (IBD) patients in remission suffer from irritable bowel syndrome (IBS)-like symptoms (IBD-IBS). The pathogenesis has not yet been elucidated. The study aim is to evaluate relationships among quality of life (QOL), psychological status, and visceral sensitivity, and explore the formation mechanism of IBD-IBS. Methods Forty-seven patients with Crohn’s disease in remission, 24 ulcerative colitis in remission, 26 IBS, and 20 healthy controls were included in the study. The abdominal pain, QOL, anxiety, and depression were evaluated through questionnaires. Visceral sensitivity was measured by rectal balloon distension. The serum levels of 5-hydroxytryptamine (5-HT) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay. The expressions of tryptase, 5-HT, NGF, and related receptors in colonic tissues were detected by immunohistochemistry and western blot. Results Prevalence of IBS-like symptoms in Crohn’s disease and ulcerative colitis patients in clinical remission was 29.8% and 50.0%, respectively. The QOL was lower, the anxiety/depression scores were higher in IBD-IBS patients than those without IBS-like symptoms. Additionally, patients with IBD-IBS existed visceral hypersensitivity. Besides, abdominal pain was associated with poor QOL, visceral hypersensitivity, anxiety, and depression in IBD-IBS patients. The number of mast cells (MCs) and expressions of 5-HT, NGF, and related receptors were higher in IBD-IBS patients than those with no such symptoms. The serum levels of 5-HT and NGF positively correlated with abdominal pain and visceral hypersensitivity. Conclusion IBD-IBS patients may have low QOL and psychological abnormalities, as wells as visceral hypersensitivity which may be related to increased 5-HT and NGF levels released from activated mast cells.
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Affiliation(s)
- Haiyang Wang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Gastroenterology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojing Zhao
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiufang Cui
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meifeng Wang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunhua Jiao
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiajia Li
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Yang
- Department of Gastroenterology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi Li
- Department of Gastroenterology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongjie Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Lamers CR, de Roos NM, Koppelman LJM, Hopman MTE, Witteman BJM. Patient experiences with the role of physical activity in inflammatory bowel disease: results from a survey and interviews. BMC Gastroenterol 2021; 21:172. [PMID: 33853535 PMCID: PMC8046271 DOI: 10.1186/s12876-021-01739-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity may affect disease activity in patients with inflammatory bowel disease. We used a survey to investigate this association and performed interviews to get a better understanding of patient experiences, and therefore the nature of this association. METHODS Patients with Crohn's disease (CD, n = 176) and ulcerative colitis (UC, n = 162) completed the short Crohn's Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI) and the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Associations were investigated by multiple linear regression. Semi-structured interviews (7 CD, 7 UC) were conducted to assess patient experiences with the role of physical activity in their disease. RESULTS The majority of survey participants were in remission (70%) and adhered to the Dutch physical activity guidelines (61%). In Crohn's disease, the total physical activity score was inversely associated with disease activity, even after adjustment for confounders (β = - 0.375; p = 0.013). No association between physical activity and disease activity was found in ulcerative colitis. Of the interviewees, 86% experienced beneficial effects of physical activity, such as improved general fitness, quality of life and self-image. However, during periods of active disease they struggled to find the motivation and perseverance to be physically active due to physical barriers. CONCLUSIONS Crohn's disease participants with a higher physical activity level had a lower disease activity. This inverse association was not found in ulcerative colitis. Interviews revealed that IBD patients generally experience beneficial effects from physical activity, although the barriers caused by active disease may put them off to be physically active.
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Affiliation(s)
- Carlijn R Lamers
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands. .,Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Lola J M Koppelman
- Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Philips Van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.,Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
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Turkiewicz J, Bhatt RR, Wang H, Vora P, Krause B, Sauk JS, Jacobs JP, Bernstein CN, Kornelsen J, Labus JS, Gupta A, Mayer EA. Altered brain structural connectivity in patients with longstanding gut inflammation is correlated with psychological symptoms and disease duration. Neuroimage Clin 2021; 30:102613. [PMID: 33823388 PMCID: PMC8050027 DOI: 10.1016/j.nicl.2021.102613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to identify differences in network properties of white matter microstructure between asymptomatic ulcerative colitis (UC) participants who had a history of chronic gut inflammation, healthy controls (HCs) and a disease control group without gut inflammation (irritable bowel syndrome; IBS). DESIGN Diffusion weighted imaging was conducted in age and sex-matched participants with UC, IBS, and HCs (N = 74 each), together with measures of gastrointestinal and psychological symptom severity. Using streamline connectivity matrices and graph theory, we aimed to quantify group differences in brain network connectivity. Regions showing group connectivity differences were correlated with measures showing group behavioral and clinical differences. RESULTS UC participants exhibited greater centrality in regions of the somatosensory network and default mode network, but lower centrality in the posterior insula and globus pallidus compared to HCs (q < 0.05). Hub analyses revealed compromised hubness of the pallidus in UC and IBS compared to HCs which was replaced by increased hubness of the postcentral sulcus. Surprisingly, few differences in network matrices between UC and IBS were identified. In UC, centrality measures in the secondary somatosensory cortex were associated with depression (q < 0.03), symptom related anxiety (q < 0.04), trait anxiety (q < 0.03), and symptom duration (q < 0.05). CONCLUSION A history of UC is associated with neuroplastic changes in several brain networks, which are associated with symptoms of depression, trait and symptom-related anxiety, as well as symptom duration. When viewed together with the results from IBS subjects, these findings suggest that chronic gut inflammation as well as abdominal pain have a lasting impact on brain network organization, which may play a role in symptoms reported by UC patients, even when gut inflammation has subsided.
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Affiliation(s)
- Joanna Turkiewicz
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; University of California, Irvine School of Medicine, United States
| | - Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School Medcine at USC, University of Southern California, 4676 Admiralty Way, Marina Del Rey, CA 90292, USA
| | - Hao Wang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, China
| | - Priten Vora
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States
| | - Beatrix Krause
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States
| | - Jenny S Sauk
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States
| | - Jonathan P Jacobs
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States; Division of Gastroenterology, Hepatology and Parenteral Nutrition, United States
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Canada
| | - Jennifer Kornelsen
- University of Manitoba IBD Clinical and Research Centre, Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Canada
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States.
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Zhao L, Xiong Q, Stary CM, Mahgoub OK, Ye Y, Gu L, Xiong X, Zhu S. Bidirectional gut-brain-microbiota axis as a potential link between inflammatory bowel disease and ischemic stroke. J Neuroinflammation 2018; 15:339. [PMID: 30537997 PMCID: PMC6290529 DOI: 10.1186/s12974-018-1382-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/28/2018] [Indexed: 12/16/2022] Open
Abstract
Emerging evidence suggests that gut-brain-microbiota axis (GBMAx) may play a pivotal role linking gastrointestinal and neuronal disease. In this review, we summarize the latest advances in studies of GBMAx in inflammatory bowel disease (IBD) and ischemic stroke. A more thorough understanding of the GBMAx could advance our knowledge about the pathophysiology of IBD and ischemic stroke and help to identify novel therapeutic targets via modulation of the GBMAx.
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Affiliation(s)
- Liang Zhao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qiutang Xiong
- Diabetes Research Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Creed M. Stary
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | | | - Yingze Ye
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijuan Gu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoxing Xiong
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Zhang Zhidong Rd, Wuhan, 430060 Hubei China
| | - Shengmei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000 Zhejiang China
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Ferman M, Lim AH, Hossain M, Siow GW, Andrews JM. Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes. Intern Med J 2018; 48:1102-1108. [DOI: 10.1111/imj.13965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/05/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Mutaz Ferman
- Department of Gastroenterology; Royal Adelaide Hospital; Adelaide, South Australia Australia
| | - Amanda H. Lim
- Department of Gastroenterology; Royal Adelaide Hospital; Adelaide, South Australia Australia
| | - Monowar Hossain
- Gastroenterology Unit; Lyell McEwin Hospital; Adelaide, South Australia Australia
| | - Glenn W. Siow
- Discipline of Medicine; University of Adelaide; Adelaide, South Australia Australia
| | - Jane M. Andrews
- Department of Gastroenterology; Royal Adelaide Hospital; Adelaide, South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide, South Australia Australia
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Tarricone I, Regazzi MG, Bonucci G, Rizzello F, Carini G, Muratori R, Poggioli G, Campieri M. Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review. J Psychosom Res 2017; 101:68-95. [PMID: 28867427 DOI: 10.1016/j.jpsychores.2017.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/23/2017] [Accepted: 07/01/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Higher prevalence of psychiatric disorders, such as anxiety and depression, has been found in people with Crohn's disease and Ulcerative Colitis compared to the general population. Nowadays, international guidelines advocate psychotherapy and psycho-pharmacological treatments as playing an important role in IBD care. The main goal of this systematic literature review was summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD. METHODS A systematic literature review was conducted using three different electronic databases: MEDLINE, PsychINFO, and EMBASE to identify studies reporting the prevalence and efficacy of psycho-pharmacological and psychotherapeutic treatments for IBD. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also performed. RESULTS Forty-three studies were included. Although a high rate of psychoactive drug use was found in people with IBD, a low proportion of IBD patients have access to psychiatric referral. 1/3 of the studies found that psychotherapy was effective for improving the quality of life, perception of stress, anxiety and depression as well as disease. Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression. CONCLUSION Our results suggest that psychiatric treatment should be implemented in IBD care. However, further studies are needed to confirm the findings of our systematic review.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Department of Psychiatry and Psychological Addictions, Local Health Authority, Bologna, Italy.
| | | | - Giulia Bonucci
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | - Giovanni Carini
- Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | | | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
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Zabihi M, Hajhashemi V, Talebi A, Minaiyan M. Evaluation of central and peripheral effects of doxepin on acetic acid-induced colitis in rat and the involved mechanisms. EXCLI JOURNAL 2017; 16:414-425. [PMID: 28694747 PMCID: PMC5491921 DOI: 10.17179/excli2016-727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/01/2017] [Indexed: 12/16/2022]
Abstract
Anti-colitis effect of antidepressants has been demonstrated recently. Doxepin, a tricyclic antidepressant drug (TCA), with potent H1, H2, alpha1 adrenergic and muscarinic receptor blocking effects could be a good candidate for investigation for its anti-colitis activity. Moreover high prevalence of depression in patients who suffer from IBD (inflammatory bowel disease), defends this idea that adjuvant therapy with an antidepressant drug which has anti-inflammatory effect, may exert favorable effects in the control of the disease. In this study colitis was induced by acetic acid instillation into rat's colon. Doxepin was injected by intraperitoneal (10, 20, 40 mg/kg, twice daily, i.p.) or intracerebroventricular (50 and 100 microgram/rat, i.c.v.) routes to separate the mechanisms are absolutely exerted centrally or mediated both centrally and peripherally prior to induction of colitis. Dexamethasone (2 mg/kg/day, i.p.) was used as reference drug. All the treatments continued for three successive days. The effectiveness of drug was evaluated by determination of cytokines (TNFα, IL6 and IL1β) and myeloperoxidase (MPO) activity as well as macroscopic scores and histopathological parameters. Doxepin after i.p. administration was effective to reduce colitis severity through reduction in the macroscopic and microscopic colonic parameters, MPO activity and cytokines levels. Intracerebroventricular administration of the drug in contrast, did not show any significant protective effect suggesting no important central mechanisms for anti-colitis activity of doxepin. Doxepin as an ancient antidepressive drug has anti-colitis and anti-inflammatory properties which are mainly exerted peripherally so it could be introduced as a good candidate for depressed people who suffered from IBD disorders.
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Affiliation(s)
- Mohsen Zabihi
- School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Hajhashemi
- Department of Pharmacology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ardeshir Talebi
- Department of Clinical Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Minaiyan
- Department of Pharmacology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
BACKGROUND Antidepressants are commonly used to treat symptoms of anxiety and depression in inflammatory bowel disease (IBD). Recent studies suggest a link between IBD activity and an individual's emotional state which raises the possibility that antidepressants may potentially modify the disease course of IBD. This systematic review thus primarily aims to evaluate the efficacy of antidepressants on IBD activity, and secondarily, on anxiety and depression. METHODS MEDLINE, EMBASE, Cochrane (IBD Group), CINAHL, AMED, PsycINFO, and OpenGrey were searched from 1990 onward with no restrictions on study design. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also conducted. RESULTS Fifteen eligible studies included in the review (1 randomized controlled trial, 2 cohorts, 1 case-control, 1 cross-sectional survey, 1 qualitative, 2 audits, 1 case series, and 6 case reports) examined a range of antidepressants. Twelve studies suggested that antidepressants have a positive impact on IBD course. Nine studies reported anxiety and depression as an outcome, of these 8 reported beneficial effects of antidepressants. Most of the studies were deemed to be at low risk of bias, apart from the case reports, which were at high risk of bias. CONCLUSIONS This research indicates that antidepressants may have a beneficial effect on IBD course. However, it is currently not possible to determine their efficacy for certain because of the lack of randomized trials. Further trials using objective measures of IBD activity, longer follow-up periods, and larger sample sizes are needed.
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Fan YH, Wang SY. Art of therapy: Focus on psychological health among patients with inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2016; 24:2445-2453. [DOI: 10.11569/wcjd.v24.i16.2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, recurrent and idiopathic intestinal disorder whose pathogenesis remains unclear. An increasing amount of evidence has shown that psychological factors are closely related to the progression and recurrence of IBD. Psychotherapy can be an important supplement therapy to traditional IBD treatment. In this article we will briefly review the advances in research of IBD-related psychological factors and the corresponding intervention approaches. Clinicians should strengthen their awareness of IBD-related psychological disorders and put emphasis on psychotherapy.
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Comorbidity between depression and inflammatory bowel disease explained by immune-inflammatory, oxidative, and nitrosative stress; tryptophan catabolite; and gut-brain pathways. CNS Spectr 2016; 21:184-98. [PMID: 26307347 DOI: 10.1017/s1092852915000449] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The nature of depression has recently been reconceptualized, being conceived as the clinical expression of activated immune-inflammatory, oxidative, and nitrosative stress (IO&NS) pathways, including tryptophan catabolite (TRYCAT), autoimmune, and gut-brain pathways. IO&NS pathways are similarly integral to the pathogenesis of inflammatory bowel disease (IBD). The increased depression prevalence in IBD associates with a lower quality of life and increased morbidity in IBD, highlighting the role of depression in modulating the pathophysiology of IBD.This review covers data within such a wider conceptualization that better explains the heightened co-occurrence of IBD and depression. Common IO&NS underpinning between both disorders is evidenced by increased pro-inflammatory cytokine levels, eg, interleukin-1 (IL-1) and tumor necrosis factor-α, IL-6 trans-signalling; Th-1- and Th-17-like responses; neopterin and soluble IL-2 receptor levels; positive acute phase reactants (haptoglobin and C-reactive protein); lowered levels of negative acute phase reactants (albumin, transferrin, zinc) and anti-inflammatory cytokines (IL-10 and transforming growth factor-β); increased O&NS with damage to lipids, proteinsm and DNA; increased production of nitric oxide (NO) and inducible NO synthase; lowered plasma tryptophan but increased TRYCAT levels; autoimmune responses; and increased bacterial translocation. As such, heightened IO&NS processes in depression overlap with the biological underpinnings of IBD, potentially explaining their increased co-occurrence. This supports the perspective that there is a spectrum of IO&NS disorders that includes depression, both as an emergent comorbidity and as a contributor to IO&NS processes. Such a frame of reference has treatment implications for IBD when "comorbid" with depression.
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Experience With and Attitudes Toward Psychotherapy and Antidepressants Among Patients With Inflammatory Bowel Disease and Functional Gastrointestinal Disorders. Gastroenterol Nurs 2016; 39:278-86. [DOI: 10.1097/sga.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Daghaghzadeh H, Naji F, Afshar H, Sharbafchi MR, Feizi A, Maroufi M, Tabatabaeeyan M, Adibi P, Tavakoli H. Efficacy of duloxetine add on in treatment of inflammatory bowel disease patients: A double-blind controlled study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:595-601. [PMID: 26600836 PMCID: PMC4621655 DOI: 10.4103/1735-1995.165969] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Treating inflammatory bowel disease (IBD) with antidepressants might be of utility to improve patient's condition. The aim of this study was to assess the efficacy of Duloxetine on depression, anxiety, severity of symptoms, and quality of life (QOL) in IBD patients. Materials and Methods: In a randomized, double-blind, controlled clinical trial on 2013-2014, in Alzahra Hospital (Isfahan, Iran), 44 IBD patients were chosen to receive either duloxetine (60 mg/day) or placebo. They were treated in a 12 weeks program, and all of the participants also received mesalazine, 2-4 g daily. We assessed anxiety and depression with Hospital Anxiety and Depression Scale, the severity of symptoms with Lichtiger Colitis Activity Index and QOL with World Health Organization Quality of Life Instruments, before and just after the treatment. The data were analyzed using Paired sample t-test and ANCOVA. Results: In 35 subjects who completed the study, the mean (standard error [SE]) scores of depression and anxiety were reduced in duloxetine more than placebo group, significantly (P = 0.041 and P = 0.049, respectively). The mean (SE) scores of severity of symptom were also reduced in duloxetine more than the placebo group, significantly (P = 0.02). The mean (SE) scores of physical, psychological, and social dimensions of QOL were increased after treatment with duloxetine more than placebo group, significantly (P = 0.001, P = 0.038, and P = 0.015, respectively). The environmental QOL was not increased significantly (P = 0.260). Conclusion: Duloxetine is probably effective and safe for reducing depression, anxiety and severity of physical symptoms. It also could increase physical, psychological, and social QOL in patients.
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Affiliation(s)
- Hamed Daghaghzadeh
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Naji
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Maroufi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Behavioral Science Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahshid Tabatabaeeyan
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Tavakoli
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Alarhayem A, Achebe E, Logue AJ. Psychosocial Support of the Inflammatory Bowel Disease Patient. Surg Clin North Am 2015; 95:1281-93, vii-viii. [PMID: 26596928 DOI: 10.1016/j.suc.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic, debilitating disease whose effects spread far beyond the gut. IBD does not generally result in excess mortality; health care providers should thus focus their efforts on improving health-related quality of life and minimizing associated morbidity. A bidirectional relationship exists between IBD and psychiatric conditions; chronic inflammation can produce neuromodulatory effects with resultant mood disorders, and the course of IBD is worse in patients with anxiety and depression. Screening for the early signs of depression or anxiety and initiating appropriate treatment can lead to improved functioning and positively impact disease course.
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Affiliation(s)
- Abdul Alarhayem
- Department of Surgery, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
| | - Ebele Achebe
- Department of Surgery, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Alicia J Logue
- Department of Surgery, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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Palant A, Koschack J, Rassmann S, Lucius-Hoene G, Karaus M, Himmel W. "And then you start to loose it because you think about Nutella": The significance of food for people with inflammatory bowel disease - a qualitative study. BMC Gastroenterol 2015; 15:93. [PMID: 26219642 PMCID: PMC4518859 DOI: 10.1186/s12876-015-0322-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many patients with inflammatory bowel disease strongly believe that food or certain food products heavily influence the symptoms or even trigger acute flare-ups. Unfortunately, there is no generalizable information for these patients, and therefore no effective diet has been identified to date. METHODS The narrative interviews we used for this study provide the basis for the German website www.krankheitserfahrungen.de . Maximum-variation sampling was used to include a broad range of experiences and a variety of different factors that might influence people's experiences. The sample included men and women of different age groups and social and ethnic backgrounds from across Germany. The interviews were analyzed using grounded theory. RESULTS Four interrelated categories emerged: managing uncertainty, eating: between craving and aversion, being different and professional help as a further source of uncertainty. The most important issue for our responders was the handling of uncertainty and to find a way between desire for, and aversion against, eating. Many participants described difficulties during formal social occasions such as weddings, birthdays, or when going out to a restaurant. CONCLUSIONS Many of the experiences the participants reported in their daily struggle with food and their illness, such as cravings for and abstaining from certain foods, were rather unusual and often stressful. Because they decided not to go out in public any longer, some of the interviewees experienced even more social isolation than they did before. Health professionals need to become more involved and not only advice about food and eating, but also help their patients find strategies for avoiding social isolation.
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Affiliation(s)
- Alexander Palant
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Janka Koschack
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Simone Rassmann
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | | | - Michael Karaus
- Evangelic Hospital Göttingen-Weende, Göttingen, Germany.
| | - Wolfgang Himmel
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
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Tamara VDS. "Role of Psychosocial Factors on the Course of Inflammatory Bowel Disease and Associated Psychotherapeutic Approaches. A Fresh Perspective and Review". ACTA ACUST UNITED AC 2015. [DOI: 10.15406/ghoa.2015.02.00038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Li MJ, Niu JK, Miao YL. Relationship between brain-gut axis and inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2015; 23:1097-1103. [DOI: 10.11569/wcjd.v23.i7.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic relapsing inflammatory disease affecting the gastrointestinal tract. The incidence of IBD has increased dramatically year by year in China. Currently, the IBD research is focused on genetically predisposed factors, immune response, environmental triggers and infections. However, the etiology of IBD is still unclear. Recently, more attention has been paid to the research of neural regulation affecting the progression of IBD. Previous research has revealed that psycho-neuro-endocrine-immune modulation through the brain-gut axis plays a crucial role in the pathogenesis of IBD. It is important to explore other psychotherapies applied to adjutant therapy in IBD. This review reviews the recent advances in understanding the relationship between the brain-gut axis and inflammatory bowel disease.
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18
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Srinath A, Young E, Szigethy E. Pain management in patients with inflammatory bowel disease: translational approaches from bench to bedside. Inflamm Bowel Dis 2014; 20:2433-49. [PMID: 25208108 DOI: 10.1097/mib.0000000000000170] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) that negatively affects quality of life and can lead to increased health-seeking behavior. Although abdominal pain has been traditionally attributed to inflammation, there is growing literature demonstrating the existence of functional abdominal pain in patients with IBD, of which there are a variety of potential causes. Thus, when approaching a patient with IBD who has abdominal pain, in addition to IBD-related complications (e.g., inflammation/stricture), it is important to screen for related contributors, including peripheral factors (visceral hypersensitivity, bacterial overgrowth, and bowel dysmotility) and centrally mediated neurobiological and psychosocial underpinnings. These central factors include psychological symptoms/diagnoses, sleep disturbance, and stress. Opioid-induced hyperalgesia (e.g., narcotic bowel syndrome) is also growing in recognition as a potential central source of abdominal pain. This review draws from clinical studies and animal models of colitis and abdominal pain to consider how knowledge of these potential etiologies can be used to individualize treatment of abdominal pain in patients with IBD, including consideration of potential novel treatment modalities for the future. Accurate assessment of the source(s) of pain in patients with IBD can help guide appropriate diagnostic workup and use of disease-modifying therapy.
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Affiliation(s)
- Arvind Srinath
- *Department of Pediatric Gastroenterology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania; †Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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19
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Abstract
PURPOSE OF REVIEW Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are classically viewed as dichotomous conditions. The former is perceived as a typical organic disease, and the latter is regarded as a disorder of gut function driven by mood. Recent research identified some shared contributing factors, which will be discussed here. RECENT FINDINGS Mounting evidence shows the importance in both IBD and IBS of genetic, microbiological, epithelial, and immunological factors. In some instances, these factors overlap in the two conditions as shown by: involvement of brain-gut axis dysfunction in IBD, implication of TNFSF gene in Crohn's disease and IBS, evidence of abnormal microbiota and its impact on host functions, identification of low-grade inflammation in subsets of IBS patients, and development of IBS symptoms in patients with IBD in remission. SUMMARY IBD and IBS remain separate conditions although there are some overlapping mechanisms. Both research and clinical management would benefit from considering a functional approach for certain manifestations of IBD and accepting an organic view in subsets of IBS patients.
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20
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Filipovic BR, Filipovic BF. Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease. World J Gastroenterol 2014; 20:3552-3563. [PMID: 24707138 PMCID: PMC3974522 DOI: 10.3748/wjg.v20.i13.3552] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 12/20/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis and Crohn’s disease, commonly known as inflammatory bowel disease (IBD), draw attention from specialists of various disorders, including gastroenterology, psychiatry, and radiology. The involvement of a cortical influence in the brain-gut axis as well as the interaction of the hypothalamic-pituitary-adrenal axis and the peripheral nervous system provide an initial explanation of the psychological symptoms associated with IBD. The involvement of structures the limbic system, such as the anterior cingulate cortex, the prefrontal cortex, and the amygdala, paves the way for the discovery of the mechanisms underlying depression depression, anxiety, alexithymia, personality traits, and other psychological impairments following the onset of IBD. Psychiatric therapy in IBD patients is almost as important as the gastroenterological approach and consists of pharmacological treatment and psychotherapy. Neither of the available psychiatric treatment methods is considered the golden standard because both methods have side effects, and psychotropic medication can provoke the worsening of IBD symptoms. Thus, both approaches must be applied with awareness of the possibility of side effects. We suggest that psychiatrists and gastroenterologists work together to reach a consensus on IBD therapy to ensure success and to reduce side effects and relapse to the lowest possible rates.
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21
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Mikocka-Walus A, Andrews JM. Attitudes towards antidepressants among people living with inflammatory bowel disease: an online Australia-wide survey. J Crohns Colitis 2014; 8:296-303. [PMID: 24074632 DOI: 10.1016/j.crohns.2013.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/20/2013] [Accepted: 09/03/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Little research has been conducted on antidepressants (ADs) in inflammatory bowel disease (IBD) despite their widespread use and evidence that they may improve immunoregulatory activity. The present study aimed 1) To explore the use and type(s) of ADs currently prescribed to people living with IBD and to collect evidence with respect to any observed effect of ADs on the course of IBD, and 2) To explore experiences and opinions regarding the effect of ADs on IBD course and attitudes towards future trials with ADs. METHODS A cross-sectional exploratory Australia-wide online survey was conducted. Numerical results of the survey were summarised using descriptive statistics and open-ended questions using a simple content analysis. RESULTS Overall, 98 IBD respondents participated in the survey, 50% with Crohn's disease, and 79% females. Sixty five (66%) participants reported current and 46 (47%) reported past AD use. Of the current AD users, 51 (79%) reported that the symptoms ADs were prescribed for improved. Psychological well-being improved in 87% of participants. The majority of respondents observed no change in IBD activity while on ADs, however, 16 (25%) believed that ADs improved their IBD. Most (84%) respondents would recommend ADs to other people living with IBD, and 81% reported willingness to participate in clinical trials with ADs. CONCLUSIONS Future clinical trials on ADs are warranted and likely to be accepted by people living with IBD in need of mental health care; however, it is yet unknown whether ADs will have a specific impact on long-term IBD activity.
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Affiliation(s)
- Antonina Mikocka-Walus
- School of Nursing and Midwifery, University of South Australia, Adelaide, Australia; Department of Health Sciences, University of York, York, United Kingdom.
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia
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22
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Affiliation(s)
- Young Jae Byun
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Chang Soo Eun
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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23
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Triantafillidis JK, Merikas E, Gikas A. Psychological factors and stress in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2013; 7:225-38. [PMID: 23445232 DOI: 10.1586/egh.13.4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The role of psychological distress and personality as predisposing factors for the development of inflammatory bowel disease (IBD) remains controversial. Attempts to investigate the role of psychological factors in IBD exhibited rather conflicting results. Among the studies concerning the effects of stress or depression on the course of IBD, the majority suggest that stress worsened IBD, the rest giving either negative or inconclusive results. However, application of strategies, including avoidance of coping and training patients in problem solving or emotion-oriented, could influence the course of IBD. Large controlled clinical trials are needed in order to clarify the impact of psychological interventions on the quality of life and the course of disease.
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Affiliation(s)
- John K Triantafillidis
- Department of Gastroenterology, Center for Inflammatory Bowel Disease, Saint Panteleimon General Hospital, Nicea, Greece.
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24
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Bonaz BL, Bernstein CN. Brain-gut interactions in inflammatory bowel disease. Gastroenterology 2013; 144:36-49. [PMID: 23063970 DOI: 10.1053/j.gastro.2012.10.003] [Citation(s) in RCA: 440] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/23/2012] [Accepted: 10/01/2012] [Indexed: 12/13/2022]
Abstract
Psycho-neuro-endocrine-immune modulation through the brain-gut axis likely has a key role in the pathogenesis of inflammatory bowel disease (IBD). The brain-gut axis involves interactions among the neural components, including (1) the autonomic nervous system, (2) the central nervous system, (3) the stress system (hypothalamic-pituitary-adrenal axis), (4) the (gastrointestinal) corticotropin-releasing factor system, and (5) the intestinal response (including the intestinal barrier, the luminal microbiota, and the intestinal immune response). Animal models suggest that the cholinergic anti-inflammatory pathway through an anti-tumor necrosis factor effect of the efferent vagus nerve could be a therapeutic target in IBD through a pharmacologic, nutritional, or neurostimulation approach. In addition, the psychophysiological vulnerability of patients with IBD, secondary to the potential presence of any mood disorders, distress, increased perceived stress, or maladaptive coping strategies, underscores the psychological needs of patients with IBD. Clinicians need to address these issues with patients because there is emerging evidence that stress or other negative psychological attributes may have an effect on the disease course. Future research may include exploration of markers of brain-gut interactions, including serum/salivary cortisol (as a marker of the hypothalamic-pituitary-adrenal axis), heart rate variability (as a marker of the sympathovagal balance), or brain imaging studies. The widespread use and potential impact of complementary and alternative medicine and the positive response to placebo (in clinical trials) is further evidence that exploring other psycho-interventions may be important therapeutic adjuncts to the conventional therapeutic approach in IBD.
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Affiliation(s)
- Bruno L Bonaz
- Stress et Interactions Neuro-Digestives, Grenoble Institut des Neurosciences, Centre de Recherche INSERM 836 UJF-CEA-CHU, Grenoble, France.
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