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Introduction Medical trauma related to IBD (IBD-PTS) affects approximately 25% of patients and is associated with poor outcomes. Prior studies identify common hospitalization experiences as potentially traumatic but have not measured risk relationships for the development of IBD-PTS. We aim to investigate what aspects of hospitalizations may increase the chance of medical trauma and IBD-PTS development. Methods Adult patients with IBD enrolled in the IBD Partners database were recruited. Study specific questionnaires included PTSD checklist, 5th edition (PCL-5), patient experience questionnaire, and items about the patient’s most stressful hospitalization and nonhospital sources of medical trauma. Established criteria for the PCL-5 identified significant IBD-PTS symptoms (re-experiencing, avoidance, mood change, hyperarousal, global diagnosis). Select disease and treatment information was obtained from the main IBD Partners dataset. Univariate and multivariate statistics evaluated the relationships between hospitalization data and IBD-PTS. Results There were 639 participants with at least 1 hospitalization for IBD included. Approximately two-thirds had Crohn’s disease; most were White, non-Hispanic, female, middle-aged, and reported their IBD as being in remission. Forty percent of patients stated a hospitalization was a source of IBD-PTS. Frequent anxiety while hospitalized increased the odds of IBD-PTS 2 to 4 times; similar relationships existed for pain/pain control. Higher quality communication, information, and listening skills reduced the odds of IBD-PTS, albeit marginally. Conclusions Patients with IBD consistently cite hospitalizations as potential sources of medical trauma. Poorly managed anxiety and pain demonstrate the greatest chance for IBD-PTS development. Gender and racial/ethnic differences emerged for these risks. Positive interactions with the medical team may help mitigate in-hospital IBD-PTS development.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal illness with symptoms of heartburn, chest pain, and regurgitation. Management of GERD can involve medication use, lifestyle modification (eg, dietary modification), and surgical intervention depending on the individual patient and disease severity. Poor adherence to medication and recommended lifestyle changes may result in increased symptom severity and decreased quality of life. This paper aimed to systematically review the literature on lifestyle modification for the management of GERD. Fourteen articles were included based on search criteria. Following review and analysis, three types of lifestyle modifications were present in the literature and include medication use, dietary recommendations, and sleep recommendations. Despite being a pharmacological treatment, medication adherence was included in the review, as health behavior change can be used to improve adherence. Overall, the factors associated with adherence to modifications varied in terms of impact and directionality, depending on the type of lifestyle modification. Symptom severity emerged as important across all lifestyle modifications, and is associated with increased adherence to medication use, but decreased adherence to dietary guidelines. While patient–provider communication appeared to improve patient knowledge, it is unclear if increased knowledge translates to improved adherence. The review also demonstrated a lack of clear and standardized guidelines across lifestyle modifications, which may have an influence on adherence and adherence reporting. Future research in GERD treatment adherence would benefit from the use of validated measures to assess adherence. Specific recommendations to improving patient adherence are discussed.

INTRODUCTION Heart Rate Variability (HRV), the variation in time between each heartbeat, is a proxy for vagus nerve function and validated indicator of cardiovascular health. Lower HRV is associated with increased risk of cardiac events and greater vulnerability to psychological stress. Fatigue is a common, frustrating and persistent symptom for IBD patients, with multifaceted mechanisms including nutrient deficiencies, inflammation, and poor sleep. Lower HRV is associated with higher fatigue in patients with cancer and myalgic encephalomyelitis. We postulate lower HRV could be associated with fatigue in IBD patients. METHODS Adults recruited from an outpatient IBD clinic wore a FitBit Inspire 2.0 for 14 days to monitor nighttime total time asleep, restlessness (# of ~30 second awakenings), and HRV (RMSSD in milliseconds (ms)). At baseline, weeks 1 and 2, participants completed the IBD Fatigue Scale and Harvey Bradshaw Index (HBI) or Simple Colitis Clinical Activity Index (SCCAI). Baseline laboratory testing for c-reactive protein (CRP), vitamins B12 and D, and ferritin was done. Averages for HRV and sleep metrics were computed for the 14-day period. Pearson’s correlations assessed relationships between all study variables (any p < .10). Then, partial correlations calculated the relationship between HRV and fatigue scores while controlling for identified confounding variables. We report an interim analysis. RESULTS 41 participants (63% female, 72.5% White, 92.7% non-Hispanic, 61% Crohn’s, 40.02 (SD=14.18) yrs old). Most (>75%) were in remission (HBI/SCCAI< 4). 34% had B12< 400 pg/mL, 20% vitamin D< 30 ng/mL, 54% ferritin< 50 ng/mL. Participants slept an average of 6.6 hours with 24.1(5.48) awakenings per night. All reported fatigue, with 43.9% having severe levels. Fatigue severity and impact remained consistent over the study (p=.106). Average HRV was 31.79(19.0) ms (Range: 11 - 92). Older patients had lower HRV (r= -0.34, p=.025) with no gender differences. Patients who reported more fatigue had higher CRP (r= 0.29), more active IBD symptoms (r= 0.62), and spent more time asleep (r= 0.20). When controlling for these variables and age, IBD patients with lower HRV reported significantly more global fatigue (r= -0.38, p=.041). The relationship between HRV and fatigue was larger for lower HRV and fatigue impact (r= -0.37, p=.047) than fatigue severity (r= -0.30, p=.11). No relationships existed for restlessness, vitamins B12 or D, or ferritin and fatigue. CONCLUSIONS When controlling for other contributors, patients with IBD and lower HRV reported more significant global fatigue and impact of fatigue on daily functioning. Findings may suggest lower HRV increases physical feelings of fatigue and reduces ability to manage fatigue impacts. Increasing HRV, e.g., with biofeedback training, may be a way to improve fatigue symptoms and management in IBD.

Background: Achalasia is a debilitating major motor disorder of the oesophagus.Hypervigilance and symptom-specific anxiety substantially impact dysphagia symptom reporting, and quality of life is a critical patient outcome. Earlier achalasia symptom scales did not consider these constructs in their psychometric development. Aim: To develop a new symptom measure, the Achalasia Patient-Reported Outcomes (APRO) Questionnaire Methods: Four gastroenterologists with achalasia expertise generated preliminary items. Patients reviewed items via cognitive interviews. Patients undergoing highresolution manometry completed the APRO with Oesophageal Hypervigilance and Anxiety Scale, Northwestern Oesophageal Quality of Life Scale, and three measures of reflux and dysphagia. Full APRO psychometric assessment (reliability, validity, factor structure) was done. Cluster analysis evaluated APRO + symptom-anxiety/hypervigilance patient phenotypes. Results:We included 961 patients with normal motility and 296 with achalasia. The APRO yielded three subscales: dysphagia, reflux, chest pain with two items for weight change and diet modifications. Reliability and validity were excellent. Twenty-five percent of achalasia patients may have high levels of anxiety/hypervigilance despite low symptoms, while 8% may report severe symptoms with low anxiety/hypervigilance. The APRO significantly predicted quality of life, but less cognitive-affective processes. Conclusions:The APRO is a reliable and valid measure of achalasia symptoms that addresses the limitations of existing questionnaires. Symptom anxiety and hypervigilance moderate the relationship between APRO and quality of life; 33% of patients with achalasia exhibit concerning patterns in symptom severity, anxiety and hypervigilance that may contribute to poorer outcomes.