Su1334 Metronidazole Treatment of Clostridium difficile Infection in Inflammatory Bowel Disease Is Associated With a High Risk of Treatment Failure and Recurrence

Abstract

Background and aim: Coping strategies are used to manage conflicts and illness and can have adaptative or maladaptative effects on health status. Coping strategies have not been well studied in Inflammatory Bowel Disease (IBD) and their influence on the clinical course of these diseases is unknown. The aim of the study was to evaluate the influence of the use of different coping strategies on the number of emergency or unscheduled visits and hospitalisations in IBD patients. Methods:A prospective observational cohort study was designed. The cohort consisted of consecutive patients with IBD (Crohn's disease (CD) and ulcerative colitis (UC)) who attended our monographic IBD Unit. A basal demographic and clinical questionnaire was completed by all patients. Coping strategies were assessed with the Spanish version of the COPE scale. It consists of 60 items that participants rated themselves using the dispositional response format. Patients indicated how frequently they engaged in each coping behaviour on a 4-point Likert scale. The scale had 3 different global strategies: Problem-focused coping, Avoidance coping and Emotion-focused coping. In order to assess the clinical course of IBD, all emergency or unscheduled visits and hospitalisations related with IBD over a follow-up period of 18 months were recorded. The influence of coping on clinical course was analysed by multiple regression analysis. Results: 776 patients were consecutively included [364 male (46.9%), mean age 45 years, age range 18-86 years)]. 317 (40.9%) patients suffered from CD and 459 (59.1%) from UC. At baseline evaluation, the most frequently used coping strategies by IBD patients were problem-focused coping (mean: 2.72 standard deviation (SD): 0.45) and avoidance coping (mean: 2.60 SD: 0.37), and the least frequently used was emotion-focused coping (mean: 2.36, SD: 0.57). The mean number of unscheduled or emergency visits was 1.05 (SD: 1.68, range 0-14) and the mean number of hospitalizations was 0.35 (SD: 0.94, range 0-9). The use of avoidance coping strategies was a risk factor for more emergency or unscheduled visits in themultivariate analysis (B=0.027, CI95%: 0.009-0.045; p<0.005). However, none of the coping strategies were related to more hospitalizations in the multivariate model including sociodemographic and clinical variables. Conclusions: The coping strategies most used in IBD patients were problem-focused and avoidance coping. A higher use of avoidance coping strategies appears to be a risk factor for more emergency visits in the following months. Therefore, these patients would probably benefit from psychological support.