Antidepressants and inflammatory bowel disease: a systematic review Development of a core outcome set for clinical trials in inflammatory bowel disease: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial Efficacy, Safety and Immunogenicity of Biosimilars in Inflammatory Bowel Diseases: A Systematic Review. Presenting features of inflammatory bowel disease in Great Britain and Ireland A longitudinal study of the profiles of psychological thriving, resilience, and loss in people with inflammatory bowel disease. Development and Validation of an Inflammatory Bowel Diseases Monitoring Index for Use With Mobile Health Technologies. Self-reported Disability in Patients with Inflammatory Bowel Disease Largely Determined by Disease Activity and Illness Perceptions Clinical Relevance of Transabdominal Ultrasonography and Magnetic Resonance Imaging in Patients With Inflammatory Bowel Disease of the Terminal Ileum and Large Bowel Patient preferences for inflammatory bowel disease treatment objectives. Reduced joint pain after short-term duodenal administration of seal oil in patients with inflammatory bowel disease: comparison with soy oil A stress management programme for inflammatory bowel disease patients. Impact of Depressive Mood on Relapse in Patients With Inflammatory Bowel Disease: A Prospective 18-Month Follow-Up Study Fermentable Carbohydrates [FODMAPs] Exacerbate Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: A Randomised, Double-blind, Placebo-controlled, Cross-over, Re-challenge Trial A new measure of health status for clinical trials in inflammatory bowel disease. Psychological Factors Are Associated with Changes in the Health-related Quality of Life in Inflammatory Bowel Disease Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease. Presence of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease Is Associated with High Rate of Anxiety and Depression Does primary sclerosing cholangitis impact quality of life in patients with inflammatory bowel disease? Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers Effect of Yoga-Based Intervention in Patients with Inflammatory Bowel Disease. Medication-Taking Behavior in a Cohort of Patients with Inflammatory Bowel Disease
Background A number of studies have suggested a link between the patient 's psyche and the course of inflammatory bowel disease ( IBD ) . Although pharmacotherapy with antidepressants has not been widely explored , some investigators have proposed that treating psychological co-morbidities with antidepressants may help to control disease activity . To date a systematic analysis of the available studies assessing the efficacy of antidepressants for the control of somatic symptoms in IBD patients has not been performed . Methods We search ed electronic data bases , without any language restriction . All relevant papers issued after 1990 were examined . Results 12 relevant publications were identified . All of them referred to non-r and omised studies . Antidepressants reported in these publications included paroxetine , bupropion , amitriptyline , phenelzine , and mirtazapine . In 10 articles , paroxetine , bupropion , and phenelzine were suggested to be effective for treating both psychological and somatic symptoms in patients suffering from IBD . Amitriptyline was found ineffective for treating somatic symptoms of IBD . Mirtazapine was not recommended for IBD patients . Conclusion Although most of review ed papers suggest a beneficial effect of treatment with antidepressants in patients with IBD , due to the lack of reliable data , it is impossible to judge the efficacy of antidepressants in IBD . Properly design ed trials are justified and needed based upon the available uncontrolled data Introduction Crohn ’s disease ( CD ) and ulcerative colitis ( UC ) , the main forms of inflammatory bowel disease ( IBD ) , are chronic , progressive and disabling disorders of the gastrointestinal tract . Although data from r and omised controlled trials ( RCTs ) provide the foundation of evidence that vali date s medical therapy for IBD , considerable heterogeneity exists in the measured outcomes used in these studies . Furthermore , in recent years , there has been a paradigm shift in IBD treatment targets , moving from symptom-based scoring to improvement or normalisation of objective measures of inflammation such as endoscopic appearance , inflammatory biomarkers and histological and radiographic end points . The abundance of new treatment options and evolving end points poses opportunities and challenges for all stakeholders involved in drug development . Accordingly , there exists a need to harmonise measures used in clinical trials through the development of a core outcome set ( COS ) . Methods and analysis The development of an IBD-specific COS includes four steps . First , a systematic literature review is performed to identify outcomes previously used in IBD RCTs . Second , semistructured qualitative interviews are conducted with key stakeholders , including patients , clinicians , research ers , pharmaceutical industry representatives , healthcare payers and regulators to identify additional outcomes of importance . Using the outcomes generated from literature review and stakeholder interviews , an international two-round Delphi survey is conducted to prioritise outcomes for inclusion in the COS . Finally , a consensus meeting is held to ratify the COS and disseminate findings for application in future IBD trials . Ethics and dissemination Given that over 30 novel therapeutic compounds are in development for IBD treatment , the design of robust clinical trials measuring relevant and st and ardised outcomes is crucial . St and ardising outcomes through a COS will reduce heterogeneity in trial reporting , facilitate valid comparisons of new therapies and improve clinical trial quality Introduction Irritable Bowel Syndrome ( IBS ) and Inflammatory Bowel Disease ( IBD ) can profoundly affect quality of life and are influenced by stress and resiliency . The impact of mind-body interventions ( MBIs ) on IBS and IBD patients has not previously been examined . Methods Nineteen IBS and 29 IBD patients were enrolled in a 9-week relaxation response based mind-body group intervention ( RR-MBI ) , focusing on elicitation of the RR and cognitive skill building . Symptom question naires and inflammatory markers were assessed pre- and post-intervention , and at short-term follow-up . Peripheral blood transcriptome analysis was performed to identify genomic correlates of the RR-MBI . Results Pain Catastrophizing Scale scores improved significantly post-intervention for IBD and at short-term follow-up for IBS and IBD . Trait Anxiety scores , IBS Quality of Life , IBS Symptom Severity Index , and IBD Question naire scores improved significantly post-intervention and at short-term follow-up for IBS and IBD , respectively . RR-MBI altered expression of more genes in IBD ( 1059 genes ) than in IBS ( 119 genes ) . In IBD , reduced expression of RR-MBI response genes was most significantly linked to inflammatory response , cell growth , proliferation , and oxidative stress-related pathways . In IBS , cell cycle regulation and DNA damage related gene sets were significantly upregulated after RR-MBI . Interactive network analysis of RR-affected pathways identified TNF , AKT and NF-κB as top focus molecules in IBS , while in IBD kinases ( e.g. MAPK , P38 MAPK ) , inflammation ( e.g. VEGF-C , NF-κB ) and cell cycle and proliferation ( e.g. UBC , APP ) related genes emerged as top focus molecules . Conclusions In this uncontrolled pilot study , participation in an RR-MBI was associated with improvements in disease-specific measures , trait anxiety , and pain catastrophizing in IBS and IBD patients . Moreover , observed gene expression changes suggest that NF-κB is a target focus molecule in both IBS and IBD— and that its regulation may contribute to counteracting the harmful effects of stress in both diseases . Larger , controlled studies are needed to confirm this preliminary finding . Trial Registration Clinical Trials . Gov Abstract Inflammatory bowel disease ( IBD ) is frequently associated with chronic abdominal pain ( CAP ) . Transcranial direct current stimulation ( tDCS ) has been proven to reduce chronic pain . This study aim ed to investigate the effects of tDCS in patients with CAP due to IBD . This r and omized , sham-controlled , double blind , parallel- design ed study included 20 patients with either Crohn disease or ulcerative colitis with CAP ( ≥3/10 on the visual analog scale ( VAS ) in 3/6 months ) . Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days ( 2 mA , 20 minutes ) . Assessment s included VAS , pressure pain threshold , inflammatory markers , and question naires on quality of life , functional and disease specific symptoms ( Irritable Bowel Syndrome – Severity Scoring System [ IBS – SSS ] ) , disease activity , and pain catastrophizing . Follow-up data were collected 1 week after the end of the stimulation . Statistical analyses were performed using analysis of variance and t tests . There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS . This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen . In addition , 1 week after stimulation , pain reduction remained significantly decreased in the right side of the abdomen . There was also a significant reduction in scores on pain catastrophizing and on IBS – SSS when comparing both groups . Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment . Transcranial direct current stimulation proved to be an effective and clinical ly relevant therapeutic strategy for CAP in IBD . The analgesic effects observed are unrelated to inflammation and disease activity , which emphasizes central pain mechanisms in CAP BACKGROUND Anti-tumor necrosis factor ( anti-TNF ) monoclonal antibodies have revolutionized the treatment of inflammatory bowel diseases ( IBD ) . However , because of their complexity , their production is expensive contributing to their high price . As the patent protection of these therapies has expired in several countries , biosimilars have been developed to reduce the healthcare costs . The aim of this article is to review the literature on the safety , efficacy and immunogenicity of biosimilars in IBD . METHODS A PubMed literature search was performed using the following terms until May 2016 :  ' biosimilars ' , ' CT-P13 ' , ' infliximab ' , ' Crohn 's disease ' , ' ulcerative colitis ' , ' inflammatory bowel diseases ' , ' efficacy ' , ' safety ' , ' immunogenicity ' . Additionally , abstract s from international meetings were also review ed . RESULTS A total of eleven studies in IBD patients provided real-world evidence on the efficacy , safety and immunogenicity profile of biosimilars in IBD patients . Based on the available evidence , CT-P13 is efficacious and well tolerated in IBD patients in a real-life setting . The vast majority of studies only included IBD patients who had never received biological therapies . Information regarding the interchangeability between CT-P13 and its originator is currently being investigated in the NOR-SWITCH trial . Otherwise , the immunogenicity profile of CT-P13 seems to be similar to the originator . CONCLUSION The infliximab biosimilar seems to be efficacious , safe and with a similar immunogenicity profile as the originator in IBD . Large prospect i ve post-marketing studies are needed to assess the long-term safety profile of CT-P13 . The use of infliximab biosimilars may lead to major healthcare cost savings Background : Reports from individual referral centres suggest that a significant proportion of children with inflammatory bowel disease ( IBD ) present after prolonged delays and with impaired growth . Aims : To prospect ively document the presenting features , delay in presentation , disease localisation , and growth in newly diagnosed cases of IBD . Methods : For 13 months , between June 1998 and June 1999 , 3247 paediatricians , adult gastroenterologists , and surgeons across the UK and Irel and were prospect ively surveyed each month and asked to report every newly diagnosed case of childhood IBD . Results : A total of 739 new IBD cases aged less than 16 years were identified . Only one quarter of Crohn ’s disease ( CD ) cases presented with the “ classic triad ” of diarrhoea , weight loss , and abdominal pain ; nearly half did not report diarrhoea . The median delay from onset of symptoms to diagnosis was 5 months ( mean 11 months ) , with one fifth having symptoms of more than one year . Delays were most common in CD and in younger children .  Short stature was noted only in those with CD and not with ulcerative colitis . One fifth of CD cases had disease activity in the jejunum and this group had significantly reduced stature . Ileo-colonic involvement was documented in most CD cases , with only a small minority having isolated ileal or isolated colonic disease . Pan-colitis was reported in most UC cases , with very few having only an isolated proctitis . Conclusions : Many children are diagnosed after prolonged delays and have growth failure . Improved knowledge of the presenting features of IBD , and earlier investigation of suspected cases , may help reduce the delays noted OBJECTIVES Despite the toll of inflammatory bowel disease ( IBD ) on adjustment , many patients are resilient to the challenges associated with living with IBD , and successfully cope with their illness and thrive . Yet there is little research on why some individuals with IBD enter a trajectory of growth , while others may struggle to adapt . The aim of this study was to investigate the adjustment-related factors that distinguished thriving , resilience , and loss in people with IBD across personal growth , life satisfaction , and relationship quality domains . DESIGN Prospect i ve cohort design with two data collection points , 6 months apart . METHODS From a sample of 420 people with active IBD who completed an online survey , 152 participants completed the follow-up survey and were included in the analyses . Participants completed measures of thriving , and cognitive , affective , social , and disease-related variables known to predict adjustment . RESULTS Time 1 ANCOVAs and pairwise comparisons controlling for demographics distinguished loss from resilience and thriving on the four outcomes - coping efficacy , illness acceptance , depressive symptoms , and perceived social support - for all three domains . Time 2 ANCOVAs and pairwise comparisons controlling for baseline outcomes revealed that the Time thriving categories predicted differences in Time 2 adjustment , mainly for the life satisfaction domain , with those experiencing loss reporting poorer adjustment than those experiencing resilience and thriving . CONCLUSIONS Findings highlight the distinctions among profiles of thriving , resilience , and loss in adjustment to IBD , and suggest that strategies that enhance coping and address depressive symptoms may optimize thriving in the context of IBD . Statement of contribution What is already known on this subject ? Inflammatory bowel disease ( IBD ) is associated with depression , poor coping , and stressful symptoms . Previous research has focused mainly on poor adjustment to IBD rather than on positive growth . There is little research on why some patients with IBD thrive or are resilient , while others struggle to adapt . What does this study add ? This study is the first to longitudinally examine the profiles of thriving , resilience , and loss in individuals with IBD . The thriving profiles differed in coping efficacy , illness acceptance , depressive symptoms , and social support outcomes at Time 1 , and predicted adjustment at T2 mainly for the life satisfaction domain . Strategies that enhance coping and social support may optimize thriving in the context of IBD BACKGROUND & AIMS Mobile health technologies are advancing rapidly as smartphone use increases . Patients with inflammatory bowel disease ( IBD ) might be managed remotely through smartphone applications , but no tools are yet available . We tested the ability of an IBD monitoring tool , which can be used with mobile technologies , to assess disease activity in patients with Crohn 's disease ( CD ) or ulcerative colitis ( UC ) . METHODS We performed a prospect i ve observational study to develop and vali date a mobile health index for CD and UC , which monitors IBD disease activity using patient-reported outcomes . We collected data from disease-specific question naires completed by 110 patients with CD and 109 with UC who visited the University of California , Los Angeles , Center for IBD from May 2013 through January 2014 .  Patient-reported outcomes were compared with clinical disease activity index scores to identify factors associated with disease activity . Index scores were vali date d in 301 patients with CD and 265 with UC who visited 3 tertiary IBD referral centers ( in California or Europe ) from April 2014 through March 2015 . RESULTS We assessed activity of CD based on liquid stool frequency , abdominal pain , patient well-being , and patient-assessed disease control , and activity of UC based on stool frequency , abdominal pain , rectal bleeding , and patient-assessed disease control . The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.90 in patients with CD and 0.91 in patients with UC . They identified endoscopic activity with area under the receiver operating characteristic values of 0.63 in patients with CD and 0.82 in patients with UC . Both scoring systems responded to changes in disease activity ( P < .003 ) . The intraclass correlation coefficient for test-retest reliability was 0.94 for CD and for UC . CONCLUSIONS We developed and vali date d a scoring system to monitor disease activity in patients with CD and UC that can be used with mobile technologies . The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.9 or higher in patients with CD or UC , and endoscopic activity in patients with UC but not CD Background : The inflammatory bowel disease ( IBD ) disability index has recently been introduced to measure patients ' physical , psychological , familial , and social limitations associated with IBD . We assessed factors related to self-reported disability and the relationship between disability and direct health care costs . Methods : A large cohort of patients with Crohn 's disease ( CD ) and ulcerative colitis ( UC ) was prospect ively followed for 2 years by 3 monthly web-based question naires . At 2 years , patients completed the IBD disability index , with lower score indicating more disability . Linear regression analysis was used to examine the impact of demographics , clinical characteristics , and illness perceptions on self-reported disability . Trends in direct health care costs across the disability severity groups minimal , mild , moderate , and severe , were tested . Results : A total of 554 patients with CD and 424 patients with UC completed the IBD disability index ( response rate , 45 % ) . Both clinical characteristics and illness perceptions significantly contributed to self-reported disability ( 45%–47 % , P = 0.000 and 8%–12 % , P = 0.000 , respectively ) . Patients with CD scored lower on the self-reported IBD disability index than patients with UC ( 0.255 versus 3.890 , P < 0.000 ) , indicating more disability in patients with CD . Factors independently associated with higher self-reported disability rates were increased disease activity , illness identity ( higher number of symptoms attributed to IBD ) , and stronger emotional response . Disease duration and disease phenotype were not associated with self-reported disability . Direct health care costs increased with the worsening of self-reported disability ( P = 0.000 ) . Conclusions : More disability was reported by patients with CD than by UC . Self-reported disability in IBD was mainly determined by clinical disease activity and illness perceptions but not by disease duration or disease phenotype Background : Ileocolonoscopy represents the diagnostic st and ard in the work-up of patients with inflammatory bowel diseases ( IBD ) . Patients are often reluctant to be colonoscoped because of the invasiveness and pain sensation during colonoscopy . Aims : To compare the usefulness of transabdominal ultrasound ( US ) and magnetic resonance imaging ( MRI ) in assessing disease extension and activity in patients with IBD restricted to the terminal ileum and large bowel . Patients and Methods : 61 patients with IBD [ 37 Crohn 's disease ( CD ) and 24 ulcerative colitis ( UC ) ] were prospect ively studied . All patients underwent clinical and laboratory assessment , ileocolonoscopy , transabdominal sonography , and MRI within 5 days . Involved bowel segments were defined as those with bowel wall thickness > 3 mm and increased Doppler signal on US or contrast enhancement of the bowel wall on MRI . To compare disease activity endoscopic , MRI and US findings were grade d with newly developed scores . Results : The segment-by-segment analysis revealed an overall accuracy of 89 % for US and 73 % for MRI in identifying active IBD . The accuracy was better in patients with UC than in patients with CD for both US and MRI . The endoscopic activity index ( EAI ) correlated stronger with the US activity index ( r = 0.884 ) than with the MRI activity index ( r = 0.344 ) . The correlation of US and MRI activity indices with EAI was better in patients with UC compared with patients with CD . All three imaging methods showed a significant correlation with clinical disease activity in patients with UC but not in patients with CD . Conclusion : This study provides strong evidence that US should be considered as a first-choice method for follow-up of patients with IBD of the terminal ileum and large bowel 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 Prospect i ve , observational , anonymous study conducted in 117 out patients 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 Background : Rheumatic joint pain is a common extra-intestinal complication of inflammatory bowel disease ( IBD ) . Because the high ratio of n-6 to n-3 fatty acids ( FAs ) of the Western diet might promote rheumatic disorders , we sought to compare the effects of short-term duodenal administration of n-3-rich seal oil and n-6-rich soy oil on IBD-related joint pain . Methods : Nineteen patients with IBD-related joint pain were included in the study ; 9 had Crohn disease and 10 had ulcerative colitis .  Ten millilitres seal oil ( n = 10 ) or soy oil ( n = 9 ) was self-administered through a nasoduodenal feeding tube 3 times daily for 10 days . Results : Compared with soy oil treatment , seal oil significantly reduced the duration of morning stiffness ( P = 0.024 ) , number of tender joints ( P = 0.035 ) , intensity of pain ( P = 0.025 ) and the doctor 's scoring of rheumatic disease activity ( P = 0.025 ) at the end of the 10-day treatment period . Analysis of the effects as area under the curve ( area between the curve and baseline , zero ) for the entire period from start of treatment until 6 months ' post-treatment suggested a long-lasting beneficial effect of seal oil administration on joint pain , whereas soy oil tended ( not significantly ) to aggravate the condition . Consistently , the serum ratios of n-6 to n-3 FAs ( P ≪⃒ 0.01 ) and arachidonic acid to eicosapentaenoic acid ( P ≪⃒ 0.01 ) were reduced after treatment with seal oil . Conclusion : The results suggest distinctive , differential prolonged effects on IBD-related joint pain of short-term duodenal administration of n-3-rich seal oil ( significant improvement ) and n-6-rich soy oil ( tendency to exacerbation ) This r and omized controlled trial was design ed to determine whether practising stress management techniques would decrease activity and promote psychosocial functioning in inflammatory bowel disease patients . Eighty ambulatory adults received a pre-intervention interview , at which time baseline data about disease activity and psychosocial functioning were collected . They were then r and omly assigned to either the intervention or control group . The intervention group received six classes on stress management which included autogenics , personal planning skills and communication techniques . All 80 subjects were followed up at 4-month intervals for 1 year by interviewers who were blind to group design ation . The data collection instruments , which were used at all assessment points , comprised three question naires : the Crohn 's Disease Activity Index ( CDAI ) and the Inflammatory Bowel Disease ( IBD ) Stress Index . These instruments produced scores which decreased with improvement in physical and psychosocial well-being . At all assessment points , both the CDAI and IBD Stress Index scores dropped significantly ( P less than 0.05 ) from baseline in the treatment group . However , there was no significant change in the scores of the control group throughout the study year . There were no significant changes in medications at any assessment point in either group that could account for changes in the scores . The results of this study indicate that stress management techniques may have therapeutic benefits for IBD patients Objective There is evidence of an interaction between psychological factors and activity of inflammatory bowel disease ( IBD ) . We examined the influence of depressive mood and associated anxiety on the course of IBD over a period of 18 months in a cohort of patients after an episode of active disease . Methods In this prospect i ve , longitudinal , observational study , 60 patients ( 37 women and 23 men ) with clinical ly inactive IBD ( Crohn disease , n = 47 , 78 % ; ulcerative colitis , n = 13 , 22 % ) were enrolled after a flare of disease .  Psychological status , health-related quality of life ( HRQOL ) , and disease activity were evaluated at baseline and then every 3 months for a period of 18 months by means of clinical and biological parameters , the Beck Depression Inventory ( BDI ) , the Spielberger State-Trait Anxiety Inventory , the Inflammatory Bowel Disease Question naire , the Perceived Stress Question naire , and the Rating Form of Inflammatory Bowel Disease Patients Concerns .  Results At baseline , depression ( BDI ≥13 points ) was found in 17 of 60 ( 28 % ) patients . Thirty-two patients ( 59 % ) experienced at least one relapse during the 18 months of follow-up . Regression analysis showed a significant correlation between BDI scores at baseline and the total number of relapses after 12 ( p < .01 ) and 18 months ( p < .01 ) of follow-up . Furthermore , depression scores at baseline correlated with the time until the first recurrence of the disease ( p < .05 ) . Anxiety and low HRQOL were also related with more frequent relapses during follow-up ( p < .05 and p < .01 , respectively ) . Conclusions Psychological factors such as a depressive mood associated with anxiety and impaired HRQOL may exert a negative influence on the course of IBD . Therefore , assessment and management of psychological distress should be included in clinical treatment of patients with IBD Background and Aims Preliminary evidence suggests that fermentable carbohydrate restriction might ameliorate functional gastrointestinal symptoms [ FGS ] in inflammatory bowel disease [ IBD ] . Our aim was to determine whether fermentable carbohydrates exacerbate FGS in IBD using a r and omised , double-blinded , placebo-controlled , re-challenge trial . Methods Patients with quiescent IBD and FGS responsive to a low FODMAP diet  were allocated to a series of 3-day [ d ] fermentable carbohydrate challenges in r and om order [ fructan , 12 g/d ; galacto-oligosaccharides [ GOS ] 6 g/d ; sorbitol , 6 g/d ; and glucose placebo , 12 g/d ] , each separated by a washout period . Symptoms and stool output were measured daily during the challenges . Results Thirty-two patients with IBD , fulfilling criteria for irritable bowel syndrome , functional bloating , or functional diarrhoea , were recruited and data were available for 29 patients completing all arms [ 12 Crohn 's disease , 17 ulcerative colitis ] . Significantly fewer patients reported adequate relief of FGS on the final day day of the fructan challenge [ 18/29 , 62.1 % ] compared with glucose [ 26/29 , 89.7 % ] [ p = 0.033 ] . There was greater severity of pain [ 1.1 vs 0.5 , p = 0.004 ] , bloating [ 1.3 vs 0.6 , p = 0.002 ] , flatulence [ 1.5 vs 0.7 , p = 0.004 ] , and faecal urgency [ 0.9 vs 0.4 , p = 0.014 ] on the final day of fructan challenge compared with glucose . Conclusions At the relatively high doses used , fructans , but not GOS or sorbitol , exacerbated FGS in quiescent IBD . Further research is required to determine whether a low FODMAP diet reduces FGS in IBD and the degree of FODMAP restriction required for symptom improvement We have developed a measure of subjective health status ( quality of life ) for patients with inflammatory bowel disease ( IBD ) . Ninety-seven patients with IBD described problems they had experienced as a result of the disease ; the 32 most frequent and important items were included in the Inflammatory Bowel Disease Question naire ( IBDQ ) . Sixty-one IBD patients were evaluated twice . One month separated the evaluations , at which disease activity indices , the IBDQ , and a number of other question naires were administered . Reproducibility studies in 19 stable patients showed improvement in scores , but also a small within-person st and ard deviation . Responsiveness studies revealed large changes in scores in patients who had improved or deteriorated and suggested that the IBDQ was more responsive than a general health status measure . Responsiveness appeared greater in patients with ulcerative colitis than in those with Crohn 's disease . Predicted and observed correlations between changes in IBDQ score and changes in other measures were similar . We conclude that although further testing is required , particularly in examining the relation between changes in the IBDQ and changes in the activity of Crohn 's disease , the IBDQ shows promise as a measure of health status for clinical trials in IBD Background : The effect of different sociodemographic and clinical variables on the health-related quality of life ( HRQOL ) of patients with inflammatory bowel disease ( IBD ) is currently known , but the influence of psychological factors has not been sufficiently explored . The objective of this study was to identify psychological predictors of HRQOL in patients with IBD . Methods : A cross-sectional prospect i ve study was undertaken including 875 consecutive IBD patients . Independent variables were measured using a  sociodemographic and clinical question naire , the Hospital Anxiety and Depression Scale ( HADS ) question naire , the Perceived Stress Scale ( PSS ) question naire , and the COPE question naire . Dependent variables were measured using the  Short Form 36 Health Survey ( SF-36 )  and the  Inflammatory Bowel Disease Question naire ( IBDQ-36 ) .  Logistic regression was performed to identify factors associated with HRQOL . Results : The participation rate was 91.3 % . Patients with IBD had a poorer HRQOL than the general population except on the Physical Function , Social Function , and Emotional Function Scale . Moreover , high levels of anxiety , depression , and stress were found to be associated with low levels in all quality of life measurements . No significant relationship was found between HRQOL and coping strategies . Conclusions : In patients with IBD , stress , anxiety and depression are important determinants of HRQOL and should therefore be considered in the management of this patient population OBJECTIVE To investigate the relationship between inflammatory bowel disease ( IBD ) patients ' disease-related worries and concerns and their disease-related data , sociodemographic variables and perceived information level with respect to IBD . STUDY DESIGN Prospect i ve evaluation of disease-related concerns . SETTING Out-patient IBD clinic of a university hospital . STUDY POPULATION The study included 105 patients with IBD ( 72 with Crohn 's disease and 33 with ulcerative colitis ) . MEASUREMENTS Worries and concerns were measured using the st and ardized 25-item rating form of IBD patient concerns ; actual disease activity was assessed by physicians using the Crohn 's disease and clinical activity indices . Sociodemographic and other disease-related data were collected using a structured question naire . Patients '  perceived information level was measured using a visual analogue scale . RESULTS The issues of greatest concern to our patients were , in descending order of importance , having an ostomy bag ( mean score + /- SD 63.6 + /- 38 ) , the effects of medication ( 53.1 + /- 34 ) , having surgery ( 51.6 + /- 36 ) , the uncertain nature of the disease ( 46.5 + /- 32 ) and energy level ( 41.5 + /- 34 ) . Patients with ulcerative colitis scored higher with respect to concern about loss of bowel control ( P < 0.03 ) . Disease-related worries and concerns correlated poorly with disease-related data ( actual disease activity , severity of the course of IBD , diagnosis , disease duration or location , medication ) but showed a significant negative correlation with patients ' perceived information level about IBD ( t = 0.2 , P < 0.004 ) . Lower information-level scores were associated with greater concerns . CONCLUSION We conclude that the patients ' information level about IBD and disease-related concerns have to be considered in clinical practice . Better information about IBD and psychosomatic counselling for patients who show high levels of concern may improve their quality of life and clinical care Background Inflammatory bowel disease ( IBD ; Crohn ’s disease , CD and Ulcerative colitis , UC ) and irritable bowel syndrome ( IBS ) have overlapping symptoms . Few prevalence studies of IBS in quiescent IBD have used colonoscopy with histology to confirm inactive disease . The aims were ( 1 ) to determine the percentage of IBD patients in deep remission whose persistent IBS-like symptoms ( IBD/IBS+ ) would cause them to be classified as having active disease , based on the calculation of Harvey Bradshaw Index ( HBI ) or UC disease activity index ( UCDAI ) ; ( 2 ) to identify demographic and disease characteristics that are associated with IBD/IBS+ . Methods This was a prospect i ve study at a single tertiary care IBD center . 96/112 patients with colonoscopy and histology confirmed quiescent disease consented and completed Rome III criteria for IBS Survey  , and the  hospital anxiety and depression scale ( HADS ) . Other demographic and disease specific data were collected . Results 36 % ( 28/77 ) and 37 % ( 7/19 ) of CD and UC patients , respectively , met diagnostic criteria for IBS . Significantly higher HBI/UCDAI scores ( p = 0.005 ) and low short inflammatory bowel disease question naire ( SIBDQ ) scores ( p ≤ 0.0001 ) were seen in IBD/IBS+ patients . 29 % of patients in deep remission were mis-categorized by HBI/UCDAI as having active disease when they fulfilled Rome III criteria for IBS . Psychiatric diagnosis ( OR 3.53 95 % CI 1.2–10.2 ) and earlier onset of IBD ( OR 1.056 95 % CI 1.015–1.096 ) were associated with IBD/IBS+ . Patients fulfilling IBS criteria had higher hospital anxiety and depression scale ( HADS ) . Conclusion IBD/IBS+ affect scoring of IBD disease activity scales and become less useful in guiding treatment plans Background : Impairment of health‐related quality of life ( HRQoL ) is an important concern in inflammatory bowel disease ( IBD ; ulcerative colitis [ UC ] , Crohn 's disease [ CD ] ) . Between 2%–10 % of patients with IBD have primary sclerosing cholangitis ( PSC ) . There has been limited examination of the disease‐specific HRQoL in this population compared to non‐PSC IBD controls . Methods : This was a retrospective , case – control study performed at a tertiary referral center . Cases comprised 26 patients with a known diagnosis of PSC and IBD ( 17 UC , 9 CD ) . Three r and om controls were selected for each case after matching for IBD type , gender , age , and duration of disease . Disease‐specific HRQoL was measured using the Short Inflammatory Bowel Disease Question naire ( SIBDQ ) . Disease activity for CD was measured using the Harvey – Bradshaw index ( HB ) and using the UC activity index for UC . Independent predictors of HRQoL were identified . Results : There was no significant difference in the age , gender distribution , or disease duration between PSC‐IBD and controls . There was no difference in use of immunomodulators or biologics between the 2 groups . Mean SIBDQ score was comparable between PSC‐IBD patients ( 54.5 ) and controls ( 54.1 ) , both for UC and CD . Likewise , the disease activity scores were also similar ( 2.8 versus 3.1 , P = 0.35 ) . On multivariate analysis , higher disease activity score ( −1.33 , 95 % confidence interval [ CI ] 95 % CI −1.85 to −0.82 ) and shorter disease duration were predictive of lower HRQoL. Coexisting PSC did not influence IBD‐related HRQoL. There was a higher proportion of permanent work disability in PSC‐IBD ( 7.7 % ) compared to controls ( 0 % ) . Conclusions : PSC does not seem to influence disease‐specific HRQoL in our patients with IBD but is associated with a higher rate of work disability . ( Inflamm Bowel Dis 2010 Abstract Objective . The present population based adult cohort was part of a new prospect i ve study of patients with inflammatory bowel disease ( IBD ) in South-Eastern Norway , the Inflammatory Bowel South-Eastern Norway II study , investigating disease characteristics in an attempt to improve our knowledge regarding factors related to early clinical phenotype and disease activity . Material and methods . Patients suspected to have IBD on the basis of predefined symptoms , including abdominal pain , diarrhea , and /or blood in stool for more than 10 days were examined at the local hospital .  Colonoscopy with biopsies was performed and blood and stool sample s were taken . Results . In ulcerative colitis ( UC ) patients , the median Simple Clinical Colitis Activity Index ( SCCAI ) was 4 ( range 0–10 ) in mild and 6 ( range 0–14 ) in patients with moderate or severe endoscopic activity of inflammation ( p = 0.002 ) . The calprotectin concentration in feces was significantly related to the SCCAI ( p = 0.034 ) and the Mayo endoscopic subscore ( p = 0.031 ) . There was a significant association between the C-reactive protein ( CRP ) value , leucocytes and thrombocytes and the SCCAI , but only leucocytes were significantly associated with the Mayo endoscopic subscore . In Crohn 's disease ( CD ) patients , there was no statistical significant association between the Harvey-Bradshaw Index ( HBI ) and the endoscopic grade of mucosal inflammation ( p = 0.8 ) . The calprotectin concentration in feces was significantly related to the endoscopic activity score ( p = 0.004 ) , but not to the HBI ( p = 0.5 ) . HBI was significantly related to the CRP value ( p = 0.047 ) and thrombocytes ( p = 0.03 ) . Conclusions . In UC , both biochemical and fecal markers are related to disease activity and extent of disease , whereas in CD , the fecal calprotectin concentration is a reliable marker of mucosal affection , but not for systemic disease activity BACKGROUND Inflammatory bowel disease ( IBD ) is a chronic illness characterized by gross inflammation in the gastrointestinal tract that can result in symptoms such as abdominal pain , cramping , diarrhea , and bloody stools . IBD is believed to be influenced by psychological factors such as stress and anxiety . Therefore , a yoga intervention that reduces stress and anxiety may be an effective complementary treatment for these disorders . MATERIAL AND METHODS A total of 100 IBD patients [ ulcerative colitis ( UC ) n = 60 and Crohn 's disease ( CD ) n = 40 ] during the clinical remission phase of disease were included in the study . These patients were allocated r and omly to either the yoga group that underwent an 8-week yoga intervention ( physical postures , pranayama , and meditation ) 1- hour/day in addition to st and ard medical therapy ( UC , n = 30 ; CD , n = 20 ) or the control group ( UC , n = 30 ; CD n = 20 ) , which continued with st and ard medical therapy alone . The main outcome measures were cardiovascular autonomic functions , serum eosinophilic cationic protein , interleukin- 2 soluble receptors , Speilberger 's State Trait Anxiety Inventory ( STAI ) scores , and clinical symptoms . RESULTS Before the intervention , all the outcome measures were comparable in the two groups . After the 8-week yoga intervention , fewer UC patients reported arthralgia . The number of patients reporting intestinal colic pain in the control group was higher . State and trait anxiety levels were significantly reduced in patients with UC . However , no significant changes were observed in cardiovascular autonomic functions , eosinophilic cationic proteins , or interleukin-2 soluble receptors . CONCLUSIONS A simplified yoga-based regimen is a safe and effective complementary clinical treatment modality for patients with inflammatory bowel disease during the clinical remission phase Recent studies have shown a low adherence rate to maintenance treatment in patients with inflammatory bowel disease ( IBD ) . We sought to assess the medication-taking behavior in a cohort of patients with IBD . We prospect ively included IBD patients from the outpatient clinic who agreed to answer a question naire about prescribed treatment and adherence . Physicians registered clinical data including prescribed medications . Two hundred fourteen patients ( 115 Crohn 's disease/99 ulcerative colitis ) were included . The most prescribed medications were oral mesalazine ( 56.5 % ) and immunomodulators ( 41.1 % ) . Forty-three percent of patients admitted to occasionally forgetting to take their medication but only 7.5 % of them did it voluntary . Oral mesalazine and azathioprine were the drugs with the poorest compliance , with nonadherence rates of 45 % and 25 % of the total prescribed doses , respectively . The only factor associated with a better adherence was a more complicated course of the disease — steroid dependency , steroid refractoriness , need for infliximab treatment , hospitalization , or surgery ( P=.02 ) . Twenty percent of patients admitted to self-medicating . An important proportion of patients with IBD admit to forget some doses of the prescribed medication in the setting of a specialized unit of a referral centre
Psychosocial factors associated with pain-related interference included depression , catastrophising , fear avoidance , lower self-efficacy and worse mental well-being .
Conclusions Pain in IBD is significantly associated with cognitive and behavioural factors as well as low mood .
Objective Pain is frequently reported by patients with inflammatory bowel disease ( IBD ) .
Pain in IBD is not fully explained by disease activity or other clinical findings , and a recent systematic review suggested that psychosocial factors have an important role in IBD-pain .
The aim of this study was to investigate psychosocial factors associated with pain in IBD .