Relative Contribution of Disease Activity and Psychological Health to Prognosis of Inflammatory Bowel Disease During 6.5 Years of Longitudinal Follow-Up

Chicken or Egg, Mental Health Disorders in Inflammatory Bowel Disease: Does It Matter?

“…Additionally, 34%-40% of patients had an elevated fecal calprotectin at baseline. 4 Does this finding suggest that the population was undertreated for their IBD? Unpublished data from 4369 participants in the Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) cohort (65% Crohn's disease and 33% ulcerative colitis) reported that baseline biologic use was present in 68% of participants with over 50% of participants on anti-tumor necrosis factor therapy.…”

“…Health psychologists and medical social workers working with people living with IBD will not be surprised by the results of the Fairbass study-patients with clinical depression and anxiety, albeit not formally diagnosed, had poorer IBD outcomes. 4 We know that most patients develop mental health disorders after a diagnosis of IBD, which can even lead to suicide, especially if the disease is untreated or undertreated and clinical symptoms persist. 11 Undertreated inflammation, to Dr Cross' earlier point, can worsen IBD symptoms and impact patient quality of life, lead to disability and work absenteeism or low presenteeism, 12 and, most relevant to the chicken-egg question, increases depression, also an inflammatory state.…”

“…The ability to achieve our immediate effectiveness goal of CE-IM has been demonstrated in randomized controlled trials and several large observational studies. 1,4,5 Although limited data have addressed the long-term goal of reduction in mortality related to EAC, 6,7 there is a growing body of evidence describing the durability of EET and variable risk of neoplastic recurrence after achieving CE-IM. [8][9][10][11][12][13] To address the potential risk of recurrent BE and BE-related neoplasia, endoscopic surveillance is recommended after CE-IM.…”

“…In the study by Fairbrass et al 4 in this issue of Gastroenterology, investigators from the IBD Clinic at St. James University Hospital in the UK assessed whether depression or anxiety increased the risk of relapse (including steroid use and escalation of medical therapy), IBD-related hospitalization, intestinal resection, and death in 760 well-characterized patients with IBD, followed prospectively for 6.5 years. Participants 16 years of age were evaluated at baseline for a common mental disorder (anxiety or depression) using the Hospital Anxiety and Depression Scale.…”

Editorial: natural history of irritable bowel syndrome in inflammatory bowel disease—authors' reply

“…2 The overlap between IBS and IBD, and the role of the brain-gut axis in IBD, have been areas of interest of our group for over 10 years. [3][4][5][6][7][8][9][10] Studies have become more sophisticated in terms of their ability to distinguish between active disease and ongoing symptoms in the absence of inflammation, akin to IBS, in patients with IBD due to the advent of markers of biochemical remission, such as faecal calprotectin. As a result, the prevalence of IBStype symptoms in patients with IBD 'in remission' is likely lower than the reported 39% in our first meta-analysis examining this issue.…”