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Wileman V, Chilcot J, Norton C, Hart A, Miller L, Stagg I, Seaton N, Pollok R, Aziz Q, Moss-Morris R. Modifiable Psychological Factors are Associated With Clusters of Pain, Fatigue, Fecal Incontinence, and Irritable Bowel Syndrome-Type Symptoms in Inflammatory Bowel Disease: A Latent Profile Analysis. J Crohns Colitis 2025; 19:jjae183. [PMID: 39656929 PMCID: PMC12087568 DOI: 10.1093/ecco-jcc/jjae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 10/22/2024] [Accepted: 12/03/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) causes fatigue, pain, and fecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways. METHODS This study was nested within a randomized controlled trial of a digital symptom intervention for people with IBD (n = 780). Latent profile analysis was conducted on pre-randomization baseline measures of fatigue, pain, and fecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors. RESULTS Latent profile analysis determined a three-profile model: Moderate (50%), High (40%), and Severe symptoms (10%). Diagnosis and fecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis, and irritable bowel syndrome (IBS)-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviors significantly increased the relative risk of High and Severe symptoms profile membership. CONCLUSIONS Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioral factors. These factors were also associated with IBS-type symptoms. Recognizing the potential impact of cognitive behavioral factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioral interventions to enhance patient care and improve outcomes.
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Affiliation(s)
- Vari Wileman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Ailsa Hart
- IBD Unit, St Mark’s Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - Laura Miller
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Natasha Seaton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George’s University Hospitals NHS Foundation Trust, London, UK
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Qasim Aziz
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | - Rona Moss-Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Riggott C, Fairbrass KM, Gracie DJ, Ford AC. Editorial: Cumulative Impact of Clinical Disease Activity, Biochemical Activity and Psychological Health on the Natural History of Inflammatory Bowel Disease During 8 Years of Longitudinal Follow-Up. Authors' Reply. Aliment Pharmacol Ther 2025; 61:1707-1708. [PMID: 40119562 DOI: 10.1111/apt.70100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 03/13/2025] [Accepted: 03/13/2025] [Indexed: 03/24/2025]
Affiliation(s)
- Christy Riggott
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Keeley M Fairbrass
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Koppelman LJM, Oyugi AA, Maljaars PWJ, van der Meulen-de Jong AE. Modifiable Factors Influencing Disease Flares in Inflammatory Bowel Disease: A Literature Overview of Lifestyle, Psychological, and Environmental Risk Factors. J Clin Med 2025; 14:2296. [PMID: 40217745 PMCID: PMC11989426 DOI: 10.3390/jcm14072296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 03/21/2025] [Accepted: 03/24/2025] [Indexed: 04/14/2025] Open
Abstract
Background: A significant concern for patients with Inflammatory Bowel Disease (IBD) is predicting and managing disease flares. While healthcare providers rely on biomarkers, providing conclusive patient advice remains challenging. This review explores the role of lifestyle, psychological health, and environmental exposures in the prediction and management of IBD flares. Methods: This review followed PRISMA guidelines (2020). A structured search was conducted in PubMed for articles published between 2012 and 2024, using free and Medical Subject Heading (MeSH) terms for predicting factors in IBD. Inclusion criteria included studies reporting primary data on modifiable clinical or environmental predictors of IBD relapse, excluding studies on post-operative investigations, treatment cessation, and pediatric or pregnant populations. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies. Results: Out of 2287 identified citations, 58 articles were included. Several modifiable factors influencing disease flares were identified, including psychological stress, sleep disturbances, smoking, and nutrition. Poor sleep quality and mental health were linked to increased flare risks, while smoking was associated with higher relapse rates in Crohn's disease. Environmental exposures, such as heat waves and high-altitude regions, also contributed. Predictive models integrating clinical, lifestyle, and psychological factors showed promising accuracy but require further refinement. Limitations of this review include the potential for publication bias, variability in flare definitions, and limited sample sizes Conclusions: Key predictors of IBD flares include dietary factors, psychological stress, poor sleep quality, and pharmacological influences. Personalized approaches integrating these predictors can optimize disease control and improve patient outcomes.
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Affiliation(s)
- Lola J. M. Koppelman
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Kamp K, Yang PL, Tsai CS, Zhang X, Yoo L, Altman MR, Heitkemper M, Conley S, Kane S, Winders S. Gender and Sex Differences in Abdominal Pain, Fatigue, And Psychological Symptoms Among Adults with Inflammatory Bowel Disease: A Network Analysis. Inflamm Bowel Dis 2025; 31:442-449. [PMID: 39671570 PMCID: PMC11808578 DOI: 10.1093/ibd/izae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND AND AIMS Individuals with inflammatory bowel disease (IBD) experience a high symptom burden, including abdominal pain, fatigue, anxiety, depression, and sleep disturbances; yet, little is known regarding the relationship between sex and gender on symptoms. We sought to report symptom severity for cisgender men, cisgender women, and transgender and gender-diverse (TGD) individuals. In addition, we used network analysis to identify core symptoms and explore if symptoms and their relationships differ between cisgender men and cisgender women. METHODS This was a cross-sectional study. We recruited adults with IBD online through ResearchMatch. Individuals responded to Patient-Reported Outcomes Measurement Information symptom questionnaires, as well as demographic and clinical questionnaires. Network analysis was used to identify the core symptoms driving the symptom structure. RESULTS One-hundred and fifty-seven (63.3%) participants identified as cisgender women, 84 (33.9%) as cisgender men, and 7 (2.8%) as TGD. Cisgender men (M = 61.8) and TGD (M = 61.3) groups reported higher abdominal pain levels compared with cisgender women (M = 57.8; P = .02). Transgender and gender-diverse individuals reported higher depression levels (M = 64.8) compared with cisgender men (M = 56.7) and cisgender women (M = 54.4; P = .01). Using a network analysis approach, anxiety and fatigue emerged as core symptoms for the entire sample (clinically active and inactive disease), and among only those with active clinical disease. Fatigue was a top core symptom for cisgender women; anxiety emerged as a top core symptom for cisgender men. CONCLUSIONS This study highlights that fatigue and anxiety are core symptoms among individuals with IBD and demonstrates a potential sex and/or gender difference in core symptoms. Replication of this study is needed with further consideration of inclusion of TGD patients.
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Affiliation(s)
- Kendra Kamp
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | | | - Chi-Shan Tsai
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Xiaoyu Zhang
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Linda Yoo
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Molly R Altman
- Child Family, and Population Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Margaret Heitkemper
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Samantha Conley
- Division of Nursing Research, Mayo Clinic, Rochester, MN, USA
| | - Sunanda Kane
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Samantha Winders
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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Pittet V, Restellini S. Editorial: Gastroenterologists should definitely draw closer attention to psychosocial comorbidities. Aliment Pharmacol Ther 2024; 59:278-279. [PMID: 38153278 DOI: 10.1111/apt.17769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
LINKED CONTENTThis article is linked to Riggott et al paper. To view this article, visit https://doi.org/10.1111/apt.17735
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Affiliation(s)
- Valerie Pittet
- Center for Primary Care and Public Health, University of Lausanne, Epidemiology and Health Systems, Lausanne, Switzerland
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