Patient preferences for inflammatory bowel disease treatment objectives. Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial Psychological Factors Are Associated with Changes in the Health-related Quality of Life in Inflammatory Bowel Disease Influence of inflammatory bowel disease on different dimensions of quality of life A prospective study of the relationship between disease activity and psychologic distress in patients with inflammatory bowel disease. Predictors of health care seeking for irritable bowel syndrome: a population based study Presence of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease Is Associated with High Rate of Anxiety and Depression Self-reported Disability in Patients with Inflammatory Bowel Disease Largely Determined by Disease Activity and Illness Perceptions Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Evaluation of a psychological treatment for inflammatory bowel disease. Psychometric scores and persistence of irritable bowel after infectious diarrhoea A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Familial association in adults with functional gastrointestinal disorders. Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome Characterization of Symptoms in Children with Recurrent Abdominal Pain: Resemblance to Irritable Bowel Syndrome Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease. Patient education in inflammatory bowel disease does not influence patients knowledge and long-term psychosocial well-being.
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 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 : 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 establish the impairment of different dimensions of quality of life in inflammatory bowel disease ( IBD ) . Design Prospect i ve observational study . Participants 289 patients [ 160 with ulcerative colitis ( UC ) and 129 with Crohn 's disease ( CD ) ] . Measures Health-related quality of life was assessed by means of the  Inflammatory Bowel Disease Question naire ( IBDQ ) and the Psychological General Well Being Index ( PGWBI ) . Results In active IBD , all dimensions of the quality of life scored significantly lower than in inactive IBD , indicating a poor quality of life . Social impairment was the least impaired dimension of the IBDQ in active UC and CD , compared with digestive and systemic symptoms . In inactive IBD , the systemic symptoms domain received the lowest score ( P < 0.01 ) . In a subgroup of 22 patients studied before and after remission , emotional function was the most impaired dimension after achieving remission . The Psychological General Well Being Index was significantly impaired in active UC [ 78.5 ( range 64–89 ) ] and CD [ 76.5 ( range 69–97 ) ] relative inactive IBD [ 104 ( range 93–111 ) ] vs 106 ( 95–113 ) , respectively;P < 0.05 ] . Conclusions Quality of life is impaired in IBD . During relapse , clinicians should pay attention to digestive symptoms and psychological distress . In remission , they should be sensitive to systemic symptoms BACKGROUND The evaluation of  psychologic states  is very useful in the management of inflammatory bowel disease ( IBD ) patients , particularly when related to disease activity ( DA ) . Our aim was to prospect ively evaluate the relationship between psychologic distress and DA . METHODS DA and psychologic distress were evaluated in 104 IBD out patients by means of clinical criteria and the  Hospital Anxiety and Depression Scale ( HADS ) at base line and after 6 months . Patients were grouped in unchanged , improved , and worsened DA from base line to follow-up . RESULTS Repeated- measures ANOVA showed a significant group-by-time interaction for HADS anxiety ( F = 89.6 , P = 0.0001 ) and depression ( F = 3.67 , P = 0.03 ) subscales . CONCLUSIONS Over time changes in DA significantly affect psychologic distress and are closely related to corresponding increases and decreases in anxiety and depression in IBD patients . Our findings therefore suggest that the assessment of psychologic distress , particularly anxiety , should be included in the clinical management of IBD patients Background —It has been suggested that psychological factors rather than symptoms drive subjects with irritable bowel syndrome ( IBS ) to seek medical care , but this issue has not been tackled in a population based study . Aim —To identify whether psychological factors or abuse explain health care seeking for IBS . Methods —A sample of residents of Penrith ( a Sydney suburb representative of the Australian population ) selected r and omly from the electoral rolls ( that by law include the entire population ⩾18 years ) was mailed a vali date d self-report question naire . Measured were gastrointestinal symptoms including the Manning ( and Rome ) criteria for IBS , health care seeking , neuroticism ( Eysenck Personality Question naire ) , psychological morbidity ( General Health Question naire : GHQ ) and sexual , physical and emotional abuse ( including the st and ardised Drossman questions ) . Results —Among 730 subjects , 96 ( 13 % , 95 % confidence interval ( CI ) 11–16 % ) had IBS by the Manning criteria . Of those with IBS , 73 % ( 95 % CI 63–81 % ) had sought medical care for abdominal pain or discomfort . Only increasing pain severity ( odds ratio ( OR ) = 2.10 , 95 % CI 1.11–3.95 ) and duration of pain ( OR=1.53 , 95 % CI 1.10–2.13 ) were independently associated with seeking health care for IBS . Pain severity was also predictive of recent care seeking ( OR=1.74 , 95 % CI 1.12–1.96 ) . Neuroticism , psychological morbidity and abuse history were not significant predictors . Conclusion —Psychological factors do not seem to explain health care seeking among community subjects with IBS 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 : 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 Although previous studies have shown that psychological disturbances are frequently associated with the irritable bowel syndrome ( IBS ) , the relation was not necessarily cause and effect . The development of chronic bowel symptoms after an episode of acute gastroenteritis has allowed us to examine prospect ively the role of psychological factors . METHODS Seventy-five patients with acute gastroenteritis completed a series of psychometric tests  soon after admission to hospital . Of these , 22 had persistent symptoms compatible with IBS after the acute illness , and in 20 of these the symptoms were still present at six months . FINDINGS At the time of their initial illness , patients who subsequently developed IBS had higher scores for anxiety , depression , somatization and neurotic trait than those who returned to normal bowel function . The psychometric scores had not changed when remeasured after the acute illness . Lactose malabsorption was not an important factor . INTERPRETATION These results support the hypothesis that psychological factors are important in IBS Inflammatory bowel disease ( IBD ) encompasses two related gastrointestinal-tract diseases , ulcerative colitis ( UC ) and Crohn 's Disease ( CD ) . This study , a r and omized controlled trial , compared the effectiveness of a multi-component behavioral treatment package ( n = 11 ) , which included IBD education , progressive muscle relaxation , thermal biofeedback , and training in use of cognitive coping strategies , to the effectiveness of symptom-monitoring ( n = 10 ) as a control condition ; 8 controls subsequently completed treatment . At posttreatment , the treatment group showed mean reductions on 5 symptoms , while the symptom monitoring controls showed mean reductions on all 8 symptoms . On a measure of Total Symptomatic change , the controls showed more improvement than the treated group ; the treated controls at posttreatment , showed increases on all 8 symptoms . However , treated subjects perceived themselves as coping better with IBD , as feeling less IBD-related stress , and as experiencing less depression and anxiety . It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses BACKGROUND Although previous studies have shown that psychological disturbances are frequently associated with the irritable bowel syndrome ( IBS ) , the relation was not necessarily cause and effect . The development of chronic bowel symptoms resembling IBS after an episode of acute gastroenteritis has allowed us to examine prospect ively the role of psychological factors . METHODS 75 patients with acute gastroenteritis completed a series of psychometric tests  soon after admission to hospital . Of these , 22 had persistent symptoms compatible with IBS after the acute illness , and in 20 of these the symptoms were still present at six months . FINDINGS At the time of their initial illness , patients who subsequently developed IBS symptoms had higher scores for anxiety , depression , somatisation , and neurotic trait than those who returned to normal bowel function . The psychometric scores had not changed when remeasured three months after the acute illness . Lactose malabsorption was not an important factor . INTERPRETATION These results support the hypothesis that psychological factors are important in IBS We r and omized , at two sites , 210 patients with Rome II diagnosed irritable bowel syndrome ( IBS ) , of at least moderate severity , to one of three conditions :  group-based cognitive therapy ( CT ; n=120 ) , psychoeducational support groups ( n=46 ) as an active control , or intensive symptom and daily stress monitoring ( n=44 ) . One hundred eighty-eight participants completed the initial treatment . Those in symptom monitoring were then crossed over to CT . For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries , both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition , but the CT and psychoeducational support group did not differ . Among treatment completers on the same composite measure of GI symptoms , again , both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite , or on any other measure . On individual IBS symptoms , both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence . Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity , with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being . Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms , including the McGill Pain Question naire . Group CT and psychoeducational support groups continued not to differ on any measure . We thus conclude that group CT is not superior to an attention placebo control condition OBJECTIVE To evaluate the association between functional gastrointestinal ( GI ) symptoms and a family history of abdominal pain or bowel problems . SUBJECTS AND METHODS A valid self-report question naire that records GI symptoms and spouse 's and first-degree relatives ' history of abdominal pain or bowel troubles and includes the psychosomatic symptom checklist ( a measure of somatization ) was mailed to an age- and sex-stratified r and om sample of Olmsted County , Minnesota , residents aged 30 to 64 years . A logistic regression model that adjusted for age , sex , and somatic symptom score was used to estimate the odds ratio ( OR ) and 95 % confidence interval ( CI ) of a positive family history for each functional GI disorder . RESULTS Six hundred forty-three ( 72 % ) of 892 eligible subjects returned the survey . Reporting a first-degree relative with abdominal pain or bowel problems was significantly associated with reporting of irritable bowel syndrome ( OR , 2.3 ; 95 % CI , 1.3 - 3.9 ) and dyspepsia ( OR , 1.8 ; 95 % CI , 1.05 - 3.0 ) but not constipation , diarrhea , or gastroesophageal reflux . The reporting of a spouse with abdominal pain or bowel problems was not associated with any of these disorders . CONCLUSIONS A history of abdominal pain or bowel troubles in first-degree relatives was significantly associated with irritable bowel syndrome and dyspepsia . Whether the familial associations represent similar exposures in a shared environment , heightened familial awareness of GI symptoms ( reporting bias ) , or genetic factors remains to be determined ABSTRACT The aim of the present study was to assess the relationship between change in interpersonal difficulties with change in chronic pain , health status and psychological state in 257 irritable bowel syndrome ( IBS ) patients in a r and omized control trial comparing  psychotherapy , antidepressant and usual care . We assessed at three time points  interpersonal problems ( IIP‐32 ) , abdominal pain and bowel symptoms , psychological distress ( SCL‐90 ) , and health status ( SF‐36 ) . Analysis included repeated measures ( ANOVA ) to assess change over time and multiple regressions to identify whether change in IIP was associated with outcome after controlling for psychological status . The main findings were : ( 1 ) difficulties with social inhibition and dependency were associated with longer disease duration ; ( 2 ) change in mean IIP‐32 over 15 months was significantly correlated with changes in pain , but these relationships were mediated by change in psychological distress ; ( 3 ) change in IIP‐32 was an independent predictor of improved health status at 15 months only in the psychotherapy group . These results indicate that improvement in interpersonal problems in IBS patients appear to be primarily associated with reduced psychological distress but , in addition , the association with improved health status  following psychotherapy suggests that specific help with interpersonal problems may play a role in improving health status of patients with chronic painful IBS We sought to prospect ively characterize and compare the symptoms of children ≥ 5 years of age with recurrent abdominal pain to previously established criteria for irritable bowel syndrome ( IBS ) in adults . For all eligible subjects , a detailed question naire concerning characteristics of abdominal pain and defecatory pattern was completed at presentation . In addition , a battery of screening tests was performed and additional evaluation was done at the discretion of their physician . In all , 227 subjects fulfilled the entrance criteria , but 56 were sub-sequently excluded because of diagnoses of inflammatory bowel disease ( nine cases ) , lactose malabsorption ( 46 cases ) , or celiac disease ( one case ) . Of the remaining 171 patients , 117 had IBS symptoms . In the IBS subjects , lower abdominal discomfort ( p < 0.001 ) , cramping pain ( p < 0.0009 ) , and increased flatus ( p < 0.0003 ) were more common , whereas dyspeptic symptoms such as epigastric discomfort ( p < 0.003 ) , pain radiating to the chest ( p < 0.009 ) , and regurgitation ( p < 0.02 ) were more common in the non-IBS subjects . Our study not only confirms the clinical heterogeneity of children with recurrent abdominal pain  but also concomitantly demonstrates that most children with this disorder have symptoms that fulfill the st and ardized criteria for IBS in adults . The identification of subgroups of children with recurrent abdominal pain can provide a framework for the diagnosis of functional bowel disease as well as establish the need for invasive and expensive tests 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 AND AIMS Patient education is accepted in many disciplines as a valid component of disease management in chronic diseases . The aim of this prospect i ve study was to analyze the effects of an education program in patients with inflammatory bowel disease . METHODS 145 patients with inflammatory bowel disease were prospect ively included : 73 were  educated in four sessions  , 72 were  educated after the one year evaluation period ( control group ) . The following topics were presented : pathogenesis , diagnostic procedures , course of disease , medical and surgical treatment , nutrition , social problems and support , stress management , and coping with the disease . RESULTS The repeated measurement two-way analysis of variances showed no effects of the patient education program on disease-related knowledge , depression and quality of life . CONCLUSION This patient education program was not able to increase disease-related knowledge or psychosocial variables in patients with IBD . However , most of the patients were very satisfied with the education program , since as judged by their own assessment it helped them to act responsibly for themselves and their disease
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 .