Does psychological status influence clinical outcomes in patients with inflammatory bowel disease (IBD) and other chronic gastroenterological diseases: an observational cohort prospective study.

Antonina A Mikocka-Walus,Nicole T Moulding,Jane M Andrews,Ian G Wilson,Gerald J Holtmann,Deborah A Turnbull

doi:10.1186/1751-0759-2-11

Abstract

BackgroundWhether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched. Thus, our aims were 1) To observe and compare prospectively clinical outcomes in relation to psychological co-morbidity in patients with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and chronic hepatitis C (HCV) and, 2) To test the hypothesis that patients with psychological co-morbidities are less likely to have a satisfactory response to standard treatment at 12 months.MethodsOverall, 139 patients were enrolled in this observational cohort prospective study. Over the ensuing year, physical and psychological measures were made at baseline and after 12 months (HADS, SCL90, SF-12 and disease activity measures). A logistic regression was conducted to observe any relationship between baseline characteristics and patients' clinical outcomes after 12 months.ResultsOverall, there was no relationship between psychological status and quality of life at baseline and relapse at 12 months (p > 0.05). However, patients with inactive disease at baseline were at lower risk of relapse after 12 months (OR = 0.046, CI: 0.012–0.178). No significant relationship was found between psychological problems such as depression/anxiety and a total number of relapses in the IBD group. However, interestingly, patients with an active disease at baseline tended to have a greater number of relapses (OR = 3.07, CI: 1.650–5.738) and CD participants were found at lower risk of relapse than UC participants (OR = 0.382, CI: 0.198–0.736).ConclusionIn contrast to previous investigations, this study suggests that there is no temporal relationship between psychological problems at baseline and clinical outcomes over time. Longer and larger prospective studies are needed to better understand this result.

Highlights

Whether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched
The prevalence of Inflammatory bowel disease (IBD) ranges from 37 to 246 cases per 100,000 persons for ulcerative colitis (UC) and from 26 to 199 cases per 100,000 persons for Crohn's disease (CD) depending on the region of the world [4], with a peak incidence around 20 years of age
The editors of major texts in gastroenterology claim that psychological factors are a result, rather than a cause of IBD, and that they do not contribute to the aetiology [12,13]

Summary

Introduction

Whether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched. Diseases of the digestive tract frequently coexist with psychological disorders [1,2,3]. A temporal relationship between psychological problems and clinical outcomes in patients with gastroenterological disorders has not been widely researched. Some researchers have controversially proposed that IBD may be partly a psychosomatic disease [7,8,9,10,11]. The editors of major texts in gastroenterology claim that psychological factors are a result, rather than a cause of IBD, and that they do not contribute to the aetiology [12,13]. The possible psychosomatic origin of IBD is disputed, many studies report that stressful life events do exacerbate the disease [14,15,16,17]

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