Predictors of Depressive Severity in Adolescents With Inflammatory Bowel Disease

Abstract

Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion:There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.

Psychosocial functioning in pediatric inflammatory bowel disease

“…Two studies investigating the effects of steroids on mood and memory in children with IBD found that subjects on steroids had significantly more problems with verbal memory, working memory, and depression compared with youths not on steroids 23,24. Mixed results have been found for the relationship between age at diagnosis and more behavioral/emotional symptoms,11,18 although increasing age during adolescence was associated with increased depressive severity, independent of IBD severity 11,25…”

“…23,24 Mixed results have been found for the relationship between age at diagnosis and more behavioral/emotional symptoms, 11,18 although increasing age during adolescence was associated with increased depressive severity, independent of IBD severity. 11,25 To summarize, rates of psychiatric disorders in children with IBD vary a great deal, and many studies are limited by small sample sizes. The studies with larger samples reported lower rates (4% to 28%) than studies with small samples (59% to 73%).…”