Remission on thiopurinic immunomodulators normalizes quality of life and psychological status in patients with Crohnʼs disease

Calvet, Xavier; Gallardo, Olga; Coronas, Ramón; Casellas, Francesc; Montserrat, A.; Torrejón, Antonio; Vergara, Mercedes; Campo, Rafel; Brullet, Enric

doi:10.1097/00054725-200608000-00004

Cited by 41 publications

(39 citation statements)

References 39 publications

(40 reference statements)

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“…In a case-control study of patients with active CD, anxiety and depression were measured in quiescent vs. active disease ( 106 ). Anxiety and depression scores were signifi cantly worse in those not being treated aggressively, and treatment with a thiopurine to achieve remission was associated with improved psychiatric survey scores.…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

View full text Add to dashboard Cite

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“…However, studies that were more adequately powered to detect differences have found that distress levels change in parallel with disease activity 11,16,60 , and those in relapse have poorer quality of life than those in remission 61,62 . The findings from this study, showing clear differences in distress between a matched community non-IBD sample and those with active IBD, add further support to the understanding that it is not having the disease per se that relates to psychological difficulties, but rather that disease activity is pivotal.…”

Section: Discussionmentioning

confidence: 99%

Stress Coping, Distress, and Health Perceptions in Inflammatory Bowel Disease and Community Controls

Graff

Walker

Clara

et al. 2009

American Journal of Gastroenterology

108

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Psychological health and IBD 2Background: This study compares a community IBD sample with a matched non-IBD community sample on psychological functioning and health perceptions. Methods:Participants in the population-based Manitoba IBD Cohort Study (n=388) were directly compared with sex, age, and region-matched controls from a national random-sample health survey on aspects of psychological health, coping, and perceived general health. Results:The IBD sample overall had lower psychological wellbeing and mastery, and higher distress than the non-IBD controls (p < 0.02). Those with IBD used avoidant coping significantly more often, and active coping modestly more often than the non-IBD sample; both had similar levels of 'self-soothing' behaviors. Crohn's disease and ulcerative colitis participants had similarly poor levels of functioning along these dimensions compared to the non-IBD sample, as did those with active disease (p < 0.01). However, those with inactive disease were similar to the non-IBD sample, and had modestly higher mastery levels. While nearly half of the non-IBD group reported chronic health conditions, those with IBD were threefold more likely to report poorer health (OR 3.07, 95% CI 2.10-4.47). Psychological factors explained a greater amount of variance in perceived health for the IBD than the non-IBD sample. Conclusions:Those with IBD have significantly poorer psychological health than those without IBD and view their general health status more negatively, although adaptive stress coping strategies were similar. However, when disease is quiescent there is little detriment to functioning. Active disease should be a flag to consider psychological needs in the care of the IBD patient.Psychological health and IBD 3

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“…The comparative studies have typically reported higher levels of anxiety or depression for those who had active disease or symptoms than those in remission or in comparison to a normative sample. [49][50][51][52] A recent study had contradictory results, concluding that anxiety and depression levels were similar regardless of disease activity status. 53 The authors noted that anxiety and depression scores were relatively low in this study, potentially restricting the ability to distinguish any differences relative to disease activity.…”

Section: Anxiety and Depression As Risk Factors For Disease Exacerbationmentioning

confidence: 99%

Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management

Graff

Walker

Bernstein

2009

Inflammatory Bowel Diseases

512

358

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Remission on thiopurinic immunomodulators normalizes quality of life and psychological status in patients with Crohnʼs disease

Abstract: Thiopurinic immunomodulator-induced remission restores normal levels of quality of life and psychological well-being in Crohn's disease patients.

Cited by 41 publications

References 39 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Stress Coping, Distress, and Health Perceptions in Inflammatory Bowel Disease and Community Controls

Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management

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