P037 APPLICABILITY OF THE VISCERAL SENSITIVITY INDEX (VSI) AS A MEASURE OF GI SYMPTOM-SPECIFIC ANXIETY IN INFLAMMATORY BOWEL DISEASE PATIENTS
Authors: Trieschmann Kimberly , Park Sarah , Naliboff Bruce , Joshi Swapna , Emerson Natacha , Sauk Jenny , Labus Jennifer , Limketkai Berkeley , Yeh Joanna , Mayer Emeran , Chang Lin 
Published: January 2020

Abstract

Background
Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are characterized by recurrent abdominal pain, altered bowel habits, and psychological distress. Gastrointestinal (GI) symptom-specific anxiety (GSA) is the cognitive, affective, and behavioral response stemming from anxiety and fear of GI symptoms. The Visceral Sensitivity Index (VSI) measures GSA and is validated in IBS but may also be a useful measure in IBD. We previously showed that VSI scores (increased GSA) are significantly higher in adult IBD patients with mild disease activity vs. healthy controls (HC) and are associated with decreased health related quality of life. The aim of this study was to further assess the reliability and validity of the VSI in IBD.

Methods
We administered the VSI (15 items; range 0–75) to adult IBD patients. Cronbach’s α and factor analysis were used to assess internal consistency and inter-item relationships. We also performed structured standardized cognitive interviews to assess comprehension and applicability of the VSI in adolescents and adults diagnosed with IBD until data saturation was achieved. Following the cognitive interviews, the VSI was revised based on participant feedback.

Results
74 adult IBD patients (UC=53, CD=21) completed the VSI (mean age=29y, SD=9.2, 40% F). Internal consistency was very good (Cronbach’s α= 0.86). Factor analysis (with verimax rotation) revealed one main factor accounting for 48% of the variance and a second and third factor accounting for 11% and 7% of variance, respectively (Table 1). The presence of a prominent first factor and a much smaller second factor was similar to that found in prior IBS samples. However, the items and their weightings differed between IBS and IBD suggesting there are differences in how these two groups respond to VSI questions. For the cognitive interviews, we recruited 13 IBD patients (UC=6, CD=7, mean age=23y, age range 14-44y, 61.5%F). Most patients understood the VSI questions and felt that it was applicable to their experience with IBD. Eight (61.5%) patients felt that VSI item 11 needed to be reworded. There were 4 themes patients felt were not addressed by the VSI: 1) worry that symptoms are a sign of loss of response to medications; 2) worry that symptoms mean they will need surgery; 3) worry that they will be judged by peers due to symptoms; and 4) avoidance of social situations because of symptoms. Accordingly, 1 item was revised and 4 questions were added.

Conclusion
The VSI appears to be a useful and novel tool to assess GSA in patients with IBD, however revisions were needed to better address fears related to consequences of having IBD and social interactions, especially in younger patients. Future studies will assess the added validity and utility of the revised version of the VSI as an important clinical assessment in IBD.