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Bernabeu P, Belén-Galipienso O, van-der Hofstadt C, Gutiérrez A, Madero-Velázquez L, García del Castillo G, García-Sepulcre MF, Aguas M, Zapater P, Rodríguez-Marín J, Ruiz-Cantero MT, Cameo JI, Jover R, Sempere L. Psychological burden and quality of life in newly diagnosed inflammatory bowel disease patients. Front Psychol 2024; 15:1334308. [PMID: 38348263 PMCID: PMC10859525 DOI: 10.3389/fpsyg.2024.1334308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
Objective Psychological factors, such as stress, anxiety, and depression, are frequently related to inflammatory bowel disease (IBD). However, few studies have examined these factors in patients newly diagnosed with IBD. The aim of the present study was to test the psychological burden in patients with a recent diagnosis of IBD and the factors related to this psychological burden. Methods We performed a prospective, multi-center, observational study in patients with a new diagnosis of IBD (≤6 months). The patients were recruited from four different Spanish hospitals. Clinical and demographic characteristics were collected. Patients were evaluated using the Hospital Anxiety and Depression Scale and quality of life questionnaire for patients with inflammatory bowel disease (IBDQ-32). The Scale of Stress Perceived by the Disease was used to assess stressful life events. Results We included 156 patients newly diagnosed with IBD [69 women; 80 Crohn's disease (CD) and 76 ulcerative colitis (UC)], with a mean age of 42.3 (SD 16.21) years. A total of 37.2% of patients had symptoms of anxiety and 17.3% had symptoms of depression. Quality of life was affected in 30.1% of patients. Factors related to anxiety in early IBD were being a woman and having CD. The only factor related to depression was the presence of comorbidity. Being a woman and having suffered previous stressful life events were factors related to impaired quality of life. Conclusion Anxiety, depression, and impaired quality of life are frequent in patients with a recent diagnosis of IBD. This psychological burden is greater in women.
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Affiliation(s)
- Purificación Bernabeu
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Olivia Belén-Galipienso
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carlos van-der Hofstadt
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Health Psychology, Miguel Hernández University, Alicante, Spain
| | - Ana Gutiérrez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucía Madero-Velázquez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | | | - Mariam Aguas
- Gastroenterology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Pedro Zapater
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Pharmacology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, University Miguel Hernández de Elche, Alicante, Spain
| | - Jesús Rodríguez-Marín
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María-Teresa Ruiz-Cantero
- Public Health Department, University of Alicante, Alicante, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José I. Cameo
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, University Miguel Hernández de Elche, Alicante, Spain
| | - Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol 2022; 19:717-726. [PMID: 35732730 DOI: 10.1038/s41575-022-00634-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, relapsing immune-mediated disease with a varying and sometimes severe disease course. IBD is often diagnosed in early adulthood and can lead to a substantial decline in quality of life. It has been suggested that patients with IBD are at increased risk of depression and anxiety, but it is still unclear to what extent these diseases co-occur and in what sequence they arise. This Review summarizes the literature on the degree of co-occurrence of IBD with depression and anxiety and the temporal relationship between these diseases. We also discuss the effect of psychological stress on the onset and course of IBD. In addition, we outline the possible mechanisms underlying the co-occurrence of IBD and depression and anxiety, which include changes in brain signalling and morphology, increases in peripheral and intracerebral pro-inflammatory cytokines, impairment of the nitric oxide pathway, changes in vagal nerve signalling, gut dysbiosis and genetics. Finally, we examine the possible effects of treatment of depression and anxiety on the risk and course of IBD, the influence of psychological interventions on IBD, and the effects of IBD treatment on psychiatric comorbidity.
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Affiliation(s)
- Tania H Bisgaard
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Kristine H Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.,Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark. .,Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
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Dawoodi S, Dawoodi I, Dixit P. Gastrointestinal problem among Indian adults: Evidence from longitudinal aging study in India 2017-18. Front Public Health 2022; 10:911354. [PMID: 36225774 PMCID: PMC9549910 DOI: 10.3389/fpubh.2022.911354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/17/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Diseases and illnesses of the gastrointestinal system (GIS) have grown in the last decade due to considerable lifestyle changes. People with gastrointestinal (GI) diseases have a high prevalence of depression, stress, anxiety, and impaired central nervous system functioning. Therefore, this study aims to explore the factors associated with the self-reported gastrointestinal problems among the Indian elderly and to explore the relationship between non-communicable diseases (NCDs), such as hypertension, heart diseases, diabetes, and neurological or psychiatric and gastrointestinal disorder. Methods This study uses data from the Longitudinal Aging Study in India (LASI), a population-based national survey, conducted during 2017-2018 with a representative sample of 72,250 individuals. Descriptive statistics were used to provide the frequency distribution of sociodemographic and economic profiles of adults. Bivariate analysis was used to understand the percentage distribution of adults suffering from gastrointestinal problems by their background characteristics. Binary logistic regression was used to determine the factors associated with gastrointestinal problems. In the binary logistic regression analysis, a systematic model building procedure was adopted. Results The overall prevalence of self-reported gastrointestinal problems was 18%, with significant variations among regions, and it substantially increased with the increasing age of men. Hypertension and neurological problems have significant individual effects on gastrointestinal problems. Prevalence was higher in those who suffered from neurological or psychiatric problems (27%) than in those who suffered from hypertension (22%) and heart disease (23%). Adults from the age group 45-54 (1.11, p < 0.01) and 55-64 (1.09, p < 0.01) years were significantly more likely to have gastrointestinal problems compared with the <44 years age group. Former and current smokers and adults with the habits of chewing tobacco were significantly more likely to report gastrointestinal problems than their counterparts. Moreover, the increasing economic status significantly and positively increased the likelihood of having self-reported gastrointestinal problems among adults. Conclusion Aging-related gastrointestinal problems are physiological or pathological and more prevalent in the elderly population aged 64 years and above. Hence, policies and interventions have to be made age-specific. Gastrointestinal problems among older adults are acquiring greater importance in clinical practices to plan effective treatment, administration of gastrointestinal drugs, the early screening of gastrointestinal diseases. Given the policy focus through Health and Wellness centers for accessible NCD care, it is important that gastro-intestinal illnesses receive more focus and systemic support.
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Affiliation(s)
- Sameer Dawoodi
- Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT, United States
| | | | - Priyanka Dixit
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, India,*Correspondence: Priyanka Dixit
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Zhao E, Yu Q, Ali AI, Mu Y, Shi Y, Zhu L. Effects of standard treatments on depressive/anxiety symptoms in patients with inflammatory bowel disease: A systematic review and meta-analysis. Gen Hosp Psychiatry 2022; 74:118-125. [PMID: 32563588 DOI: 10.1016/j.genhosppsych.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A combination of inflammatory bowel disease (IBD) and psychological comorbidities can influence the natural course of IBD. A systematic review and meta-analysis was performed to examine whether a standard IBD medical therapy without any antipsychotic intervention has beneficial effects on depression/anxiety in IBD patients. METHODS PubMed and Web of Science databases were systematically searched for related literature from their inception to March 2020. The random-effects model was used to calculate the standardized mean difference (SMD). A total of 16 eligible studies were included in the present meta-analysis. RESULTS Compared with baseline assessments, IBD patients with standard IBD medication had significantly reduced depression assessment scores (pooled SMD = 0.500; 95% confidence interval: 0.207, 0.793; P = 0.001). These results were obtained without any psychological interventions. Additionally, no significant differences in anxiety-related scores were detected between the baseline assessments and the end of therapy assessments (pooled SMD = 0.083; 95% confidence interval: -0.120, 0.285; P = 0.425). The meta-regression and subgroup analyses revealed that differences in assessment tools and medications might be the main source of heterogeneity. CONCLUSION Standard IBD treatments can significantly alleviate the depressive symptoms in IBD patients. However, more studies are needed to analyze this association.
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Affiliation(s)
- En Zhao
- Department of Gastroenterology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Qian Yu
- Department of Gastroenterology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Abdoulaye Idriss Ali
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Yulu Mu
- Department of Vasculocardiology, Tanghe County People's Hospital, Nanyang, Henan 473400, China
| | - Yachen Shi
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
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5
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Badarnee M, Weiss B, Shouval D, Kreitler S. Motivational disposition towards psychological characteristics of israeli children with inflammatory bowel diseases: A case-control study. J Pediatr Nurs 2022; 62:e131-e138. [PMID: 34465507 DOI: 10.1016/j.pedn.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychological stress is a general and non-specific factor associated with many health conditions, including Inflammatory Bowel Diseases (IBD). It is related not only to external stressors but also to internal characteristics which enhance patients' vulnerability to stress. PURPOSE To identify specific psychological characteristics of pediatric IBD related to stress. DESIGN AND METHODS A case-control-cohort study that compared the psychological characteristics of 49 patients and 56 comparisons. The psychological characteristics were defined by four belief types - beliefs about self, general beliefs, beliefs about norms, and goals - which refer to a set of specific themes. RESULTS The belief types differentiated between the two groups, and the patients were characterized by six themes: like routines, strive to get others' love, caring about the body and the health, doing things only at their own pace, expressing negative emotion without regulations, and feeling over-identification with others. Patients' likelihood of being characterized by the themes is 2.18 to 2.90 times higher than the comparisons. CONCLUSION Children with IBD are characterized by a set of specific psychological characteristics. These characteristics were discussed mainly concerning generating chronic stress (e.g., over-identification with others) and interpersonal conflicts (e.g., doing things only at their own pace) among the patients. IMPLICATIONS FOR PRACTICE It is suggested to healthcare workers to be aware of the specific psychological characteristics of children with IBD, and sensitive to these characteristics during interactions with them. Besides, the characteristics may pave the way for developing a targeted psychological intervention that corresponds specifically to the patients' needs.
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Affiliation(s)
- Muhammad Badarnee
- School of Psychological Sciences, Tel-Aviv University, Israel; The Psycho-Oncology Research Center, The Chaim Sheba Medical Center, Israel; The Latif Mental Health Clinics in Umm Al-Fahim and Shefa-Amr, Israel.
| | - Batia Weiss
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Israel.
| | - Dror Shouval
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Israel.
| | - Shulamith Kreitler
- School of Psychological Sciences, Tel-Aviv University, Israel; The Psycho-Oncology Research Center, The Chaim Sheba Medical Center, Israel.
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6
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Qi Y, Wu HM, Yang Z, Zhou YF, Jin L, Yang MF, Wang FY. New Insights into the Role of Oral Microbiota Dysbiosis in the Pathogenesis of Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:42-55. [PMID: 33527328 DOI: 10.1007/s10620-021-06837-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 01/09/2021] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease (IBD) is a group of chronic intestinal inflammatory disorders with a prolonged duration characterized by recurrent relapse and remission. The exact etiology of IBD remains poorly understood despite the identification of relevant risk factors, including individual genetic susceptibility, environmental triggers, and disruption of immune homeostasis. Dysbiosis of the gut microbiota is believed to exacerbate the progression of IBD. Recently, increasing evidence has also linked oral microbiota dysbiosis with the development of IBD. On the one hand, IBD patients show significantly unbalanced composition and function of the oral microbiota known as dysbiosis. On the other, overabundances of oral commensal bacteria with opportunistic pathogenicity have been found in the gut microbiota of IBD patients. Herein, we review the current information on the causative factors of IBD, especially recent evidence of IBD-associated oral microbiota dysbiosis, which has seldom been covered in the previous literature review, highlighting the pathogenic mechanisms of specific oral bacteria in the development of IBD. Ectopic colonization of several oral bacteria, including a subset of Porphyromonas gingivalis, Streptococcus mutans, Fusobacterium nucleatum, Campylobacter concisus, and Klebsiella pneumoniae, may lead to destruction of the intestinal epithelial barrier, excessive secretion of inflammatory cytokines, disruption of the host immune system, and dysbiosis of gut microbiota, consequently aggravating chronic intestinal inflammation. Studying oral microbiota dysbiosis may open future horizons for understanding IBD pathogenesis and provide novel biomarkers for IBD. This review also presents the current treatment and new perspectives for IBD treatment.
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Affiliation(s)
- Ying Qi
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China
| | - Hui-Min Wu
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China
| | - Zhao Yang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China
| | - Yi-Fei Zhou
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China
| | - Lei Jin
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Miao-Fang Yang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China
| | - Fang-Yu Wang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Zhongshan East Road 305, Nanjing, 210002, China.
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7
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Tavakoli P, Vollmer-Conna U, Hadzi-Pavlovic D, Grimm MC. A Review of Inflammatory Bowel Disease: A Model of Microbial, Immune and Neuropsychological Integration. Public Health Rev 2021; 42:1603990. [PMID: 34692176 PMCID: PMC8386758 DOI: 10.3389/phrs.2021.1603990] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/01/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: Inflammatory bowel diseases (IBDs) are complex chronic inflammatory disorders of the gastro-intestinal (GI) tract with uncertain etiology. IBDs comprise two idiopathic disorders: Crohn’s disease (CD) and ulcerative colitis (UC). The aetiology, severity and progression of such disorders are still poorly understood but thought to be influenced by multiple factors (including genetic, environmental, immunological, physiological, psychological factors and gut microbiome) and their interactions. The overarching aim of this review is to evaluate the extent and nature of the interrelationship between these factors with the disease course. A broader conceptual and longitudinal framework of possible neuro-visceral integration, core microbiome analysis and immune modulation assessment may be useful in accurately documenting and characterizing the nature and temporal continuity of crosstalk between these factors and the role of their interaction (s) in IBD disease activity. Characterization of these interactions holds the promise of identifying novel diagnostic, interventions, and therapeutic strategies. Material and Methods: A search of published literature was conducted by exploring PubMed, EMBASE, MEDLINE, Medline Plus, CDSR library databases. Following search terms relating to key question were set for the search included: “Inflammatory bowel diseases,” “gut microbiota,” “psychological distress and IBD,” “autonomic reactivity and IBD,” “immune modulation,” “chronic inflammation,” “gut inflammation,” “enteric nervous system,” “gut nervous system,” “Crohn’s disease,” “Ulcerative colitis”, “depression and IBD”, “anxiety and IBD”, “quality of life in IBD patients,” “relapse in IBDs,” “remission in IBDs,” “IBD disease activity,” “brain-gut-axis,” “microbial signature in IBD,” “validated questionnaires in IBD,” “IBD activity indices,” “IBD aetiology,” “IBDs and stress,” “epidemiology of IBDs”, “autonomic nervous system and gut inflammation”, “IBD and environment,” “genetics of IBDs,” “pathways of immune response in IBDs,” “sleep disturbances in IBD,” “hypothalamic-pituitary-adrenal axis (HPA),” “sympatho-adrenal axis,” “CNS and its control of gut function” “mucosal immune response,” “commensal and pathogenic bacteria in the gut,” “innate and adaptive immunity.” Studies evaluating any possible associations between gut microbiome, psychological state, immune modulation, and autonomic function with IBDs were identified. Commonly cited published literatures with high quality research methodology/results and additional articles from bibliographies of recovered papers were examined and included where relevant. Results: Although there is a substantial literature identifying major contributing factors with IBD, there has been little attempt to integrate some factors over time and assess their interplay and relationship with IBD disease activity. Such contributing factors include genetic and environmental factors, gut microbiota composition and function, physiological factors, psychological state and gut immune response. Interdependences are evident across psychological and biological factors and IBD disease activity. Although from the available evidence, it is implausible that a single explanatory model could elucidate the interplay between such factors and the disease course as well as the sequence of the effect during the pathophysiology of IBD. Conclusion: Longitudinal monitoring of IBD patients and integrating data related to the contributing/risk factors including psychological state, physiological conditions, inflammatory/immune modulations, and microbiome composition/function, could help to explain how major factors associate and interrelate leading to exacerbation of symptoms and disease activity. Identifying the temporal trajectory of biological and psychosocial disturbances may also help to assess their effects and interdependence on individuals’ disease status. Moreover, this allows greater insight into understanding the temporal progressions of subclinical events as potential ground for disease severity in IBD. Furthermore, understanding the interaction between these risk factors may help better interventions in controlling the disease, reducing the costs related to disease management, further implications for clinical practice and research approaches in addition to improving patients’ mental health and quality of life.
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Affiliation(s)
- P Tavakoli
- St George and Sutherland Clinical School, Sydney, NSW, Australia
| | - U Vollmer-Conna
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - M C Grimm
- St George and Sutherland Clinical School, Sydney, NSW, Australia
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8
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Chen LM, Bao CH, Wu Y, Liang SH, Wang D, Wu LY, Huang Y, Liu HR, Wu HG. Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease. J Neuroinflammation 2021; 18:135. [PMID: 34127024 PMCID: PMC8204445 DOI: 10.1186/s12974-021-02175-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/13/2021] [Indexed: 02/08/2023] Open
Abstract
Inflammatory bowel disease (IBD), which mainly includes ulcerative colitis (UC) and Crohn's disease (CD), is a group of chronic bowel diseases that are characterized by abdominal pain, diarrhea, and bloody stools. IBD is strongly associated with depression, and its patients have a higher incidence of depression than the general population. Depression also adversely affects the quality of life and disease prognosis of patients with IBD. The tryptophan-kynurenine metabolic pathway degrades more than 90% of tryptophan (TRP) throughout the body, with indoleamine 2,3-dioxygenase (IDO), the key metabolic enzyme, being activated in the inflammatory environment. A series of metabolites of the pathway are neurologically active, among which kynerunic acid (KYNA) and quinolinic acid (QUIN) are molecules of great interest in recent studies on the mechanisms of inflammation-induced depression. In this review, the relationship between depression in IBD and the tryptophan-kynurenine metabolic pathway is overviewed in the light of recent publications.
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Affiliation(s)
- Li-Ming Chen
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Chun-Hui Bao
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China.
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China.
| | - Yu Wu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
| | - Shi-Hua Liang
- Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, The Netherlands
| | - Di Wang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
| | - Lu-Yi Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Yan Huang
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Hui-Rong Liu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China
| | - Huan-Gan Wu
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437, China.
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030, China.
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9
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Vecchiarelli HA, Morena M, Keenan CM, Chiang V, Tan K, Qiao M, Leitl K, Santori A, Pittman QJ, Sharkey KA, Hill MN. Comorbid anxiety-like behavior in a rat model of colitis is mediated by an upregulation of corticolimbic fatty acid amide hydrolase. Neuropsychopharmacology 2021; 46:992-1003. [PMID: 33452437 PMCID: PMC8115350 DOI: 10.1038/s41386-020-00939-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 01/29/2023]
Abstract
Peripheral inflammatory conditions, including those localized to the gastrointestinal tract, are highly comorbid with psychiatric disorders such as anxiety and depression. These behavioral symptoms are poorly managed by conventional treatments for inflammatory diseases and contribute to quality of life impairments. Peripheral inflammation is associated with sustained elevations in circulating glucocorticoid hormones, which can modulate central processes, including those involved in the regulation of emotional behavior. The endocannabinoid (eCB) system is exquisitely sensitive to these hormonal changes and is a significant regulator of emotional behavior. The impact of peripheral inflammation on central eCB function, and whether this is related to the development of these behavioral comorbidities remains to be determined. To examine this, we employed the trinitrobenzene sulfonic acid-induced model of colonic inflammation (colitis) in adult, male, Sprague Dawley rats to produce sustained peripheral inflammation. Colitis produced increases in behavioral measures of anxiety and elevations in circulating corticosterone. These alterations were accompanied by elevated hydrolytic activity of the enzyme fatty acid amide hydrolase (FAAH), which hydrolyzes the eCB anandamide (AEA), throughout multiple corticolimbic brain regions. This elevation of FAAH activity was associated with broad reductions in the content of AEA, whose decline was driven by central corticotropin releasing factor type 1 receptor signaling. Colitis-induced anxiety was reversed following acute central inhibition of FAAH, suggesting that the reductions in AEA produced by colitis contributed to the generation of anxiety. These data provide a novel perspective for the pharmacological management of psychiatric comorbidities of chronic inflammatory conditions through modulation of eCB signaling.
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Affiliation(s)
- Haley A. Vecchiarelli
- grid.22072.350000 0004 1936 7697Neuroscience Graduate Program, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Maria Morena
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Catherine M. Keenan
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Vincent Chiang
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Kaitlyn Tan
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Min Qiao
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Kira Leitl
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Alessia Santori
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Quentin J. Pittman
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Keith A. Sharkey
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1 Canada
| | - Matthew N. Hill
- grid.22072.350000 0004 1936 7697Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB T2N4N1 Canada ,grid.22072.350000 0004 1936 7697Department of Psychiatry, University of Calgary, Calgary, AB T2N4N1 Canada
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10
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Bednarikova H, Kascakova N, Furstova J, Zelinkova Z, Falt P, Hasto J, Tavel P. Life Stressors in Patients with Inflammatory Bowel Disease: Comparison with a Population-Based Healthy Control Group in the Czech Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063237. [PMID: 33800985 PMCID: PMC8003904 DOI: 10.3390/ijerph18063237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
Background: Stress has been suggested to play a potential role in inflammatory bowel disease (IBD) pathogenesis, but studies focussing on the occurrence of specific life stress events among IBD patients are scarce. Therefore, the aim of the present study was to explore the association between various life stress events and IBD. Methods: Patients with IBD (N = 98, mean age: 38.45, 54.1% men) were compared to a group of healthy controls (N = 405, mean age: 36.45, 58.0% men) originating from a health survey conducted on a representative population sample of Czech adults. The Life Stressor Checklist-Revised (LSC-R) was used to assess the stressors. Results: IBD patients had higher odds of reporting life stressors overall (p < 0.001), life stressors before the age of 16 (p < 0.004) and a higher score in traumatic stress (p < 0.005) and interpersonal violence (p < 0.001) when compared to the control group. Gender- and diagnosis-related differences are discussed. Conclusion: Reporting life stressors experienced during childhood or adulthood is strongly associated with IBD. This should be considered in illness management, especially in a severe course of IBD.
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Affiliation(s)
- Hana Bednarikova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- Department of Gastroenterology and Digestive Endoscopy, University Hospital—St. Michael’s Hospital, Satinskeho 1, 811 08 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-903956665
| | - Natalia Kascakova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- 2nd Department of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic;
| | - Jana Furstova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
| | - Zuzana Zelinkova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- Department of Gastroenterology and Digestive Endoscopy, University Hospital—St. Michael’s Hospital, Satinskeho 1, 811 08 Bratislava, Slovakia
| | - Premysl Falt
- 2nd Department of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic;
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Jozef Hasto
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- Psychiatric-Psychotherapeutic Outpatient Clinic, Pro Mente Sana, Heydukova 27, 811 06 Bratislava, Slovakia
- Department of Social Work, St. Elizabeth College of Health and Social Work, Namestie 1. maja 1, 810 00 Bratislava, Slovakia
- Faculty of Medicine, Department of Psychiatry, Slovak Medical University in Bratislava, Limbova 12, 833 03 Bratislava, Slovakia
| | - Peter Tavel
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
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11
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Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:359-370. [PMID: 33721557 DOI: 10.1016/s2468-1253(21)00014-5] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a lifelong condition with no cure. Patients with IBD might experience symptoms of common mental disorders such as anxiety and depression because of bidirectional communication via the gut-brain axis and chronicity of symptoms, and because of impaired quality of life and reduced social functioning. However, uncertainties remain about the magnitude of this problem. We aimed to assess prevalence of symptoms of anxiety or depression in adult patients with IBD. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Embase Classic, and PsycINFO for papers published from inception to Sept 30, 2020, reporting observational studies that recruited at least 100 adult patients with IBD and that reported prevalence of symptoms of anxiety or depression according to validated screening instruments. We excluded studies that only used a structured interview to assess for these symptoms and studies that did not provide extractable data. We extracted data from published study reports and calculated pooled prevalences of symptoms of anxiety and depression, odds ratios (OR), and 95% CIs. FINDINGS Of 5544 studies identified, 77 fulfilled the eligibility criteria, including 30 118 patients in total. Overall, pooled prevalence of anxiety symptoms was 32·1% (95% CI 28·3-36·0) in 58 studies (I2=96·9%) and pooled prevalence of depression symptoms was 25·2% (22·0-28·5) in 75 studies (I2=97·6%). In studies that reported prevalence of anxiety or depression in patients with Crohn's disease and ulcerative colitis within the same study population, patients with Crohn's disease had higher odds of anxiety symptoms (OR 1·2, 95% CI 1·1-1·4) and depression symptoms (1·2, 1·1-1·4) than patients with ulcerative colitis. Overall, women with IBD were more likely to have symptoms of anxiety than were men with IBD (pooled prevalence 33·8% [95% CI 26·5-41·5] for women vs 22·8% [18·7-27·2] for men; OR 1·7 [95% CI 1·2-2·3]). They were also more likely to have symptoms of depression than men were (pooled prevalence 21·2% [95% CI 15·4-27·6] for women vs 16·2% [12·6-20·3] for men; OR 1·3 [95% CI 1·0-1·8]). The prevalence of symptoms of anxiety (57·6% [95% CI 38·6-75·4]) or depression (38·9% [26·2-52·3]) was higher in patients with active IBD than in patients with inactive disease (38·1% [30·9-45·7] for anxiety symptoms and 24·2% [14·7-35·3] for depression symptoms; ORs 2·5 [95% CI 1·5-4·1] for anxiety and 3·1 [1·9-4·9] for depression). INTERPRETATION There is a high prevalence of symptoms of anxiety and depression in patients with IBD, with up to a third of patients affected by anxiety symptoms and a quarter affected by depression symptoms. Prevalence was also increased in patients with active disease: half of these patients met criteria for anxiety symptoms and a third met criteria for depression symptoms. Encouraging gastroenterologists to screen for and treat these disorders might improve outcomes for patients with IBD. FUNDING None.
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Affiliation(s)
- Brigida Barberio
- Department of Surgery, Oncology, and Gastroenterology, Gastroenterology Unit, Padova University Hospital, University of Padova, Padova, Italy
| | - Mohammad Zamani
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Christopher J Black
- Leeds Gastroenterology Institute, St James' University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James', University of Leeds, Leeds, UK
| | - Edoardo V Savarino
- Department of Surgery, Oncology, and Gastroenterology, Gastroenterology Unit, Padova University Hospital, University of Padova, Padova, Italy
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James' University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James', University of Leeds, Leeds, UK.
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12
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Peppas S, Pansieri C, Piovani D, Danese S, Peyrin-Biroulet L, Tsantes AG, Brunetta E, Tsantes AE, Bonovas S. The Brain-Gut Axis: Psychological Functioning and Inflammatory Bowel Diseases. J Clin Med 2021; 10:377. [PMID: 33498197 PMCID: PMC7863941 DOI: 10.3390/jcm10030377] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
The brain-gut axis represents a complex bi-directional system comprising multiple interconnections between the neuroendocrine pathways, the autonomous nervous system and the gastrointestinal tract. Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, is a chronic, relapsing-remitting inflammatory disorder of the gastrointestinal tract with a multifactorial etiology. Depression and anxiety are prevalent among patients with chronic disorders characterized by a strong immune component, such as diabetes mellitus, cancer, multiple sclerosis, rheumatoid arthritis and IBD. Although psychological problems are an important aspect of morbidity and of impaired quality of life in patients with IBD, depression and anxiety continue to be under-diagnosed. There is lack of evidence regarding the exact mechanisms by which depression, anxiety and cognitive dysfunction may occur in these patients, and whether psychological disorders are the result of disease activity or determinants of the IBD occurrence. In this comprehensive review, we summarize the role of the brain-gut axis in the psychological functioning of patients with IBD, and discuss current preclinical and clinical data on the topic and therapeutic strategies potentially useful for the clinical management of these patients. Personalized pathways of psychological supports are needed to improve the quality of life in patients with IBD.
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Affiliation(s)
- Spyros Peppas
- Department of Gastroenterology, Athens Naval Hospital, 11521 Athens, Greece;
| | - Claudia Pansieri
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U1256 NGERE, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-les-Nancy, France;
| | - Andreas G. Tsantes
- Attiko Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.G.T.); (A.E.T.)
| | - Enrico Brunetta
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Argirios E. Tsantes
- Attiko Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.G.T.); (A.E.T.)
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
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13
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van der Sloot KWJ, Weersma RK, Alizadeh BZ, Dijkstra G. Identification of Environmental Risk Factors Associated With the Development of Inflammatory Bowel Disease. J Crohns Colitis 2020; 14:1662-1671. [PMID: 32572465 DOI: 10.1093/ecco-jcc/jjaa114] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Multiple genetic and environmental factors are involved in the aetiology of inflammatory bowel disease [IBD] including Crohn's disease [CD] and ulcerative colitis [UC], but data on these exposome factors are difficult to identify. Several exposome factors such as smoking have been shown to be involved; as for other environmental factors, eg stress, results have been conflicting. METHODS We performed a case-control study including 674 IBD patients of the 1000IBD cohort, frequency-matched based on sex and age with 1348 controls from the population-based Lifelines Cohort Study. Exposome data were obtained using the validated Groningen IBD Environmental Questionnaire [GIEQ], capturing exposome factors through different stages of life using 844 items, of which 454 were applicable to study the role of 93 exposome factors in disease aetiology. Logistic regression [LR] modelling with Bonferroni correction for multiple testing was applied to estimate the multivariable-adjusted effect of each exposome factor. RESULTS For IBD, we identified four novel factors: stressful life events (CD odds ratio [OR] 2.61/UC OR 2.92), high perceived stress [2.29/2.67], alcohol use [0.40/0.43], and bronchial hyper-reactivity [3.04/2.36]. Four novel factors were associated with only CD: prenatal smoke exposure [1.89], having a bed partner [0.53], allergies [2.66], and cow's milk hypersensitivity [5.87]; and two solely with UC: carpet flooring [0.57] and neuroticism [1.32]. Nine factors were replicated. CONCLUSIONS In this study we identified 10 novel, and replicated nine previously reported, exposome factors associated with IBD. Identifying these factors is important for both understanding disease aetiology and future prevention strategies to decrease the development of IBD in genetically susceptible persons.
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Affiliation(s)
- Kimberley W J van der Sloot
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.,Department of Epidemiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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14
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Abstract
Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life.
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15
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Yeshi K, Ruscher R, Hunter L, Daly NL, Loukas A, Wangchuk P. Revisiting Inflammatory Bowel Disease: Pathology, Treatments, Challenges and Emerging Therapeutics Including Drug Leads from Natural Products. J Clin Med 2020; 9:E1273. [PMID: 32354192 PMCID: PMC7288008 DOI: 10.3390/jcm9051273] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and life-long disease characterized by gastrointestinal tract inflammation. It is caused by the interplay of the host's genetic predisposition and immune responses, and various environmental factors. Despite many treatment options, there is no cure for IBD. The increasing incidence and prevalence of IBD and lack of effective long-term treatment options have resulted in a substantial economic burden to the healthcare system worldwide. Biologics targeting inflammatory cytokines initiated a shift from symptomatic control towards objective treatment goals such as mucosal healing. There are seven monoclonal antibody therapies excluding their biosimilars approved by the US Food and Drug Administration for induction and maintenance of clinical remission in IBD. Adverse side effects associated with almost all currently available drugs, especially biologics, is the main challenge in IBD management. Natural products have significant potential as therapeutic agents with an increasing role in health care. Given that natural products display great structural diversity and are relatively easy to modify chemically, they represent ideal scaffolds upon which to generate novel therapeutics. This review focuses on the pathology, currently available treatment options for IBD and associated challenges, and the roles played by natural products in health care. It discusses these natural products within the current biodiscovery research agenda, including the applications of drug discovery techniques and the search for next-generation drugs to treat a plethora of inflammatory diseases, with a major focus on IBD.
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Affiliation(s)
- Karma Yeshi
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns QLD 4878, Australia
| | - Roland Ruscher
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns QLD 4878, Australia
| | - Luke Hunter
- School of Chemistry, University of New South Wales (UNSW), Sydney NSW 2052, Australia
| | - Norelle L. Daly
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns QLD 4878, Australia
| | - Alex Loukas
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns QLD 4878, Australia
| | - Phurpa Wangchuk
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns QLD 4878, Australia
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16
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Kornelsen J, Wilson A, Labus JS, Witges K, Mayer EA, Bernstein CN. Brain Resting-State Network Alterations Associated With Crohn's Disease. Front Neurol 2020; 11:48. [PMID: 32132964 PMCID: PMC7040490 DOI: 10.3389/fneur.2020.00048] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease that is associated with aspects of brain anatomy and activity. In this preliminary MRI study, we investigated differences in brain structure and in functional connectivity (FC) of brain regions in 35 participants with Crohn's disease (CD) and 21 healthy controls (HC). Voxel-based morphometry (VBM) analysis was performed to contrast CD and HC structural images. Region of interest (ROI) analyses were run to assess FC for resting-state network nodes. Independent component analysis (ICA) identified whole brain differences in FC associated with resting-state networks. Though no structural differences were found, ROI analyses showed increased FC between the frontoparietal (FP) network and salience network (SN), and decreased FC between nodes of the default mode network (DMN). ICA results revealed changes involving cerebellar (CER), visual (VIS), and SN components. Differences in FC associated with sex were observed for both ROI analysis and ICA. Taken together, these changes are consistent with an influence of CD on the brain and serve to direct future research hypotheses.
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Affiliation(s)
- Jennifer Kornelsen
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Alyssia Wilson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer S Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kelcie Witges
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Charles N Bernstein
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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17
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Emotion regulation processes as mediators of the impact of past life events on older adults' psychological distress. Int Psychogeriatr 2020; 32:199-209. [PMID: 31969208 DOI: 10.1017/s1041610219002084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Although it is known that certain emotion regulation processes produce a buffering effect on the relationship between life events and well-being, this issue has been poorly studied in the elderly population. Thus, the aim of the present study is to test and confirm a comprehensive model of the impact that past life events have on older adults' psychological distress, exploring the possible mediating roles of emotion regulation processes. These include rumination, experiential avoidance, and personal growth. METHODS In this cross-sectional study, 387 people over 60 years old residing in the community were assessed on life events, physical functioning, emotion regulation variables, psychological well-being, as well as symptoms of anxiety and depression. RESULTS The structural model tested achieved a satisfactory fit to the data, explaining 73% of the variance of older adults' psychological distress. In addition, the main results suggest possible mediation effects of both the physical functioning and the emotional variables: rumination, experiential avoidance, and personal growth in the face of hardship. CONCLUSIONS These findings confirm the importance of emotion regulation processes in the final stages of life. They reveal the various adaptive and maladaptive mechanisms that underlie the relationship between life events and psychological distress. The findings suggest - both in the explanatory models of psychological well-being and in psychotherapeutic interventions - the importance of emotion regulation in the elderly population's health.
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18
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Labanski A, Langhorst J, Engler H, Elsenbruch S. Stress and the brain-gut axis in functional and chronic-inflammatory gastrointestinal diseases: A transdisciplinary challenge. Psychoneuroendocrinology 2020; 111:104501. [PMID: 31715444 DOI: 10.1016/j.psyneuen.2019.104501] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022]
Abstract
The broad role of stress in the brain-gut axis is widely acknowledged, with implications for multiple prevalent health conditions that are characterized by chronic gastrointestinal symptoms. These include the functional gastrointestinal disorders (FGID), such as irritable bowel syndrome and functional dyspepsia, as well as inflammatory bowel diseases (IBD) like ulcerative colitis and Crohn's disease. Although the afferent and efferent pathways linking the gut and the brain are modulated by stress, the fields of neurogastroenterology and psychoneuroendocrinology (PNE)/ psychoneuroimmunology (PNI) remain only loosely connected. We aim to contribute to bringing these fields closer together by drawing attention to a fascinating, evolving research area, targeting an audience with a strong interest in the role of stress in health and disease. To this end, this review introduces the concept of the brain-gut axis and its major pathways, and provides a brief introduction to epidemiological and clinical aspects of FGIDs and IBD. From an interdisciplinary PNE/PNI perspective, we then detail current knowledge regarding the role of chronic and acute stress in the pathophysiology of FGID and IBD. We provide an overview of evidence regarding non-pharmacological treatment approaches that target central or peripheral stress mechanisms, and conclude with future directions, particularly those arising from recent advances in the neurosciences and discoveries surrounding the gut microbiota.
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Affiliation(s)
- Alexandra Labanski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jost Langhorst
- Chair for Integrative Medicine, University of Duisburg-Essen, Essen, Germany; Clinic for Internal and Integrative Medicine, Klinikum Bamberg, Bamberg, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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19
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The inflammatory event of birth: How oxytocin signaling may guide the development of the brain and gastrointestinal system. Front Neuroendocrinol 2019; 55:100794. [PMID: 31560883 DOI: 10.1016/j.yfrne.2019.100794] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023]
Abstract
The role of oxytocin (OT) as a neuropeptide that modulates social behavior has been extensively studied and reviewed, but beyond these functions, OT's adaptive functions at birth are quite numerous, as OT coordinates many physiological processes in the mother and fetus to ensure a successful delivery. In this review we explore in detail the potential adaptive roles of oxytocin as an anti-inflammatory, protective molecule at birth for the developing fetal brain and gastrointestinal system based on evidence that birth is a potent inflammatory/immune event. We discuss data with relevance for a number of neurodevelopmental disorders, as well as the emerging role of the gut-brain axis for health and disease. Finally, we discuss the potential relevance of sex differences in OT signaling present at birth in the increased male vulnerability to neurodevelopmental disabilities.
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20
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Yvon S, Schwebel L, Belahcen L, Tormo H, Peter M, Haimoud-Lekhal DA, Eutamene H, Jard G. Effects of thermized donkey milk with lysozyme activity on altered gut barrier in mice exposed to water-avoidance stress. J Dairy Sci 2019; 102:7697-7706. [PMID: 31326167 DOI: 10.3168/jds.2019-16642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/16/2019] [Indexed: 01/26/2023]
Abstract
Nutrition plays a crucial role in human gut health through the improvement of gut barrier functionality. Donkey milk represents an interesting source of natural antimicrobial factors such as lysozyme. Recently, anti-inflammatory properties of donkey milk lysozyme activity were described in a mouse model of ileitis. The current increase of donkey milk consumption highlights the necessity to propose a healthy milk compliant with microbiological standards. This study aims to define a heat treatment of donkey milk, retaining its high lysozyme activity, and to evaluate its beneficial effects on a gut barrier impairment model due to chronic stress in mice. To perform this experiment, samples of raw donkey milk were collected in 15 distinct French farms. Microbiological analysis and lysozyme content and activity were evaluated for each sample. Then, several heat treatments were carried out to define a time and temperature combination that allowed for both a reduction in the number of total micro-organisms, increasing the shelf-life of the product, and preservation of lysozyme activity. The beneficial effect of heated donkey milk on the gut barrier of mice was evaluated and compared with raw donkey milk. We found that samples of raw donkey milk showed low total mesophilic microbial counts, and no pathogens were detected. Among the different heat-treatment procedures tested, a 2-min, 72°C combination was determined to be the most optimal time and temperature combination to preserve lysozyme activity and increase the shelf-life of donkey milk. Oral administration of this heat-treated donkey milk in mice counteracted chronic stress-induced intestinal damage, illustrated by gut hyper-permeability and low-grade inflammation, similar to raw donkey milk. We have demonstrated for the first time that oral intervention with donkey milk, optimally heat-treated to retain enzymatic lysozyme activity, improves intestinal barrier damage linked to psychological stress in mice.
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Affiliation(s)
- Sophie Yvon
- Unité Mixte de Recherche 1331 Toxalim, Institut National de la Recherche Agronomique, Institut National Polytechnique-Ecole Nationale Vétérinaire de Toulouse, Institut National Polytechnique-Purpan, Université de Toulouse, Neuro-Gastroenterology and Nutrition Group, Toulouse, France
| | - Lauriane Schwebel
- Unité Mixte de Recherche 1331 Toxalim, Institut National de la Recherche Agronomique, Institut National Polytechnique-Ecole Nationale Vétérinaire de Toulouse, Institut National Polytechnique-Purpan, Université de Toulouse, Neuro-Gastroenterology and Nutrition Group, Toulouse, France
| | - Loubnah Belahcen
- Equipe Agromolécules et Agroalimentaire, Université de Toulouse, Institut National Polytechnique-Purpan, Toulouse, France
| | - Helene Tormo
- Equipe Agromolécules et Agroalimentaire, Université de Toulouse, Institut National Polytechnique-Purpan, Toulouse, France
| | - Magali Peter
- Equipe Agromolécules et Agroalimentaire, Université de Toulouse, Institut National Polytechnique-Purpan, Toulouse, France
| | - Djamila Ali Haimoud-Lekhal
- Unité Mixte de Recherche 1388 Génétique, Physiologie et Systèmes d'Elevage, Institut National de la Recherche Agronomique, Institut National Polytechnique-Purpan, Toulouse, France
| | - Hélène Eutamene
- Unité Mixte de Recherche 1331 Toxalim, Institut National de la Recherche Agronomique, Institut National Polytechnique-Ecole Nationale Vétérinaire de Toulouse, Institut National Polytechnique-Purpan, Université de Toulouse, Neuro-Gastroenterology and Nutrition Group, Toulouse, France.
| | - Gwenaelle Jard
- Equipe Agromolécules et Agroalimentaire, Université de Toulouse, Institut National Polytechnique-Purpan, Toulouse, France
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21
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M'Koma AE. The Multifactorial Etiopathogeneses Interplay of Inflammatory Bowel Disease: An Overview. GASTROINTESTINAL DISORDERS 2019; 1:75-105. [PMID: 37577036 PMCID: PMC10416806 DOI: 10.3390/gidisord1010007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The gastrointestinal system where inflammatory bowel disease occurs is central to the immune system where the innate and the adaptive/acquired immune systems are balanced in interactions with gut microbes under homeostasis conditions. This article overviews the high-throughput research screening on multifactorial interplay between genetic risk factors, the intestinal microbiota, urbanization, modernization, Westernization, the environmental influences and immune responses in the etiopathogenesis of inflammatory bowel disease in humans. Inflammatory bowel disease is an expensive multifactorial debilitating disease that affects thousands new people annually worldwide with no known etiology or cure. The conservative therapeutics focus on the established pathology where the immune dysfunction and gut injury have already happened but do not preclude or delay the progression. Inflammatory bowel disease is evolving globally and has become a global emergence disease. It is largely known to be a disease in industrial-urbanized societies attributed to modernization and Westernized lifestyle associated with environmental factors to genetically susceptible individuals with determined failure to process certain commensal antigens. In the developing nations, increasing incidence and prevalence of inflammatory bowel disease (IBD) has been associated with rapid urbanization, modernization and Westernization of the population. In summary, there are identified multiple associations to host exposures potentiating the landscape risk hazards of inflammatory bowel disease trigger, that include: Western life-style and diet, host genetics, altered innate and/or acquired/adaptive host immune responses, early-life microbiota exposure, change in microbiome symbiotic relationship (dysbiosis/dysbacteriosis), pollution, changing hygiene status, socioeconomic status and several other environmental factors have long-standing effects/influence tolerance. The ongoing multipronged robotic studies on gut microbiota composition disparate patterns between the rural vs. urban locations may help elucidate and better understand the contribution of microbiome disciplines/ecology and evolutionary biology in potentially protecting against the development of inflammatory bowel disease.
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Affiliation(s)
- Amosy E M'Koma
- Meharry Medical College School of Medicine, Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Nashville, TN 37208, USA
- Vanderbilt University School of Medicine, Department of Surgery, Colon and Rectal Surgery, Nashville, TN 37232, USA
- The American Society of Colon and Rectal Surgeons (ASCRS), Arlington Heights, IL 60005, USA
- The American Gastroenterological Association (AGA), Bethesda, MD 20814, USA
- Vanderbilt-Ingram Cancer Center (VICC), Vanderbilt University Medical Center, Nashville, TN 37232, USA
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22
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Miyazawa T, Shiga H, Kinouchi Y, Takahashi S, Tominaga G, Takahashi H, Takagi S, Obana N, Kikuchi T, Omori S, Sato Y, Takahashi S, Umemura K, Endo K, Kakuta Y, Matsuura M, Kimura T, Kuroha M, Shimosegawa T. Long-term course of inflammatory bowel disease after the Great East Japan Earthquake. J Gastroenterol Hepatol 2018; 33:1956-1960. [PMID: 29791048 DOI: 10.1111/jgh.14286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM This study analyzed inflammatory bowel disease activity for 2 years after the Great East Japan Earthquake. METHODS We compared the relapse rates of patients with ulcerative colitis or Crohn's disease 1 and 2 years after the earthquake with rates immediately after the earthquake. To evaluate continuous disease courses, we also performed multivariate time-to-event analyses from the time of the earthquake to the onset of additional treatments. RESULTS Of 903 patients with ulcerative colitis or Crohn's disease in our previous study, we could evaluate 2-year courses in 677 patients (394 ulcerative colitis and 283 Crohn's disease). Compared with the relapse rates of ulcerative colitis and Crohn's disease immediately after the earthquake (15.8% and 7.0%, respectively), those in the corresponding periods in 2012 (2.5% and 1.1%, respectively) and 2013 (2.3% and 2.5%, respectively) significantly decreased. There were 226 patients who required additional treatments after the earthquake. Multivariate time-to-event analyses revealed that only patients who had experienced the death of family members or friends were likely to need additional treatments (hazard ratio = 1.77, 95% confidence interval = 1.25-2.47). No other factors had a significant influence. CONCLUSIONS The relapse rates 1 and 2 years after the earthquake significantly decreased. The factors that influenced long-term relapse were different from those that influenced short-term relapse.
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Affiliation(s)
- Teruko Miyazawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Kinouchi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seiichi Takahashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Gen Tominaga
- Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | | | | | | | | | - Shinya Omori
- Japanese Red Cross Sendai Hospital, Sendai, Japan
| | | | | | | | - Katsuya Endo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Geng Q, Zhang QE, Wang F, Zheng W, Ng CH, Ungvari GS, Wang G, Xiang YT. Comparison of comorbid depression between irritable bowel syndrome and inflammatory bowel disease: A meta-analysis of comparative studies. J Affect Disord 2018; 237:37-46. [PMID: 29758449 DOI: 10.1016/j.jad.2018.04.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/19/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of comorbid depression is high in chronic gastrointestinal disorders, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). For these two disorders in particular, the findings have not been consistent. This meta-analysis systematically compares the rates and severity of comorbid depression between IBS and IBD patients. METHODS A systematic literature search was conducted using PubMed, PsycINFO, Embase, Cochrane Library, Wan Fang, SinoMed, Chinese National Knowledge Infrastructure from their inception date to September 12, 2017 for comparative studies on IBS and IBD patients. Standardized mean differences (SMDs) and odds ratios (OR) of comorbid depression were calculated using random effect models. Data on comorbid anxiety in the included studies were also extracted and analyzed. RESULTS Altogether, 22 studies with 1,244 IBS and 1,048 IBD patients were included. While there was no significant group difference in the prevalence of depression (10 studies, OR = 1.18, 95%CI: 0.87-1.60, P = 0.29), the IBS group had more severe depression (pooled SMD = 0.18, 95%CI: 0.04-0.33, P = 0.01) and anxiety than the IBD group (pooled SMD = 0.31, 95%CI: 0.14-0.49, P = 0.0006). Sixteen (72.7%) studies were assessed as 'high quality' using the Newcastle-Ottawa Scale (NOS). CONCLUSIONS Although the prevalence of comorbid depression was similar between groups, IBS patients had more severe comorbid depressive and anxiety symptoms compared to IBD patients. Appropriate assessment and treatment of depressive and anxiety symptoms in these patient groups should be implemented.
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Affiliation(s)
- Qin Geng
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Qing-E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Fei Wang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia & Graylands Hospital, Perth, Australia
| | - Gang Wang
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China.
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China.
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24
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Kelley KD, Peavy G, Edland S, Rogers W, Riley DE, Bordelon Y, Standaert D, Reich SG, Litvan I. The Role of Stress as a Risk Factor for Progressive Supranuclear Palsy. JOURNAL OF PARKINSONS DISEASE 2018; 7:377-383. [PMID: 28409749 DOI: 10.3233/jpd-160945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND PSP, like Alzheimer's disease (AD), is a tauopathy. The etiopathogenesis of PSP is not well known and the role of stress has not yet been examined. Recent studies have shown that stress increases the risk for developing AD. This study investigates the role of stress as a risk factor for PSP. OBJECTIVE B To examine the association between the development of progressive supranuclear palsy (PSP) and self-reported life stressors. METHODS 76 patients diagnosed with PSP according to the NINDS-SPSP criteria and 68 age-matched unrelated controls were administered a life stressor questionnaire. Stress was quantified as total number of events, number of life changing events, and number of events characterized by self-rated severity. Conditional odds ratio (OR) was calculated for each measure, with participants in the highest quartile of each measure being defined as high-exposure in relation to all other participants. RESULTS There were no significant differences between the reported number of total events or life-changing events in cases and controls. However, we found 24.4% of cases (N = 11) and 9.1% of controls (N = 5) had a higher exposure to high severity events, yielding an OR of 3.2 (p = 0.04). CONCLUSIONS We found that cases have over a three times greater odds of high exposure to high-severity events than controls prior to the clinical development of PSP, while there were no differences in overall number of reported events. Our findings suggest that high exposure to highly stressful events may be associated with the development of PSP.
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Affiliation(s)
| | - Guerry Peavy
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
| | - Steven Edland
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
| | - Whitney Rogers
- Department of Neuroscience Training, University of Louisville, Louisville, KY, USA
| | - David E Riley
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - David Standaert
- Department of Neurology, University of Alabama in Birmingham, Birmingham, AL, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - Irene Litvan
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
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26
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Abstract
BACKGROUND The relative contribution of psychological factors to the onset and course of inflammatory bowel diseases (IBD) is a matter of constant debate since its beginning, as is the clinical need and the efficacy of psychotherapeutic interventions. However, the perspective of patients with IBD has largely been ignored in this debate. METHODS Psychometric tests including the Short-Form IBD Questionnaire (SIBDQ), the ADAP test measuring demand for psychotherapy, and the Fear-of-Progression Questionnaire Short Form as well as disease-related questions were positioned on the internet between December 2014 and January 2016. The study was advertised through DCCV (German branch of the European Federation of Crohn's and Ulcerative Colitis Associations). RESULTS n = 631 patients responded, and complete data from n = 578 (356 Crohn's disease, 219 ulcerative colitis, 3 unclear) were available for analysis. n = 296 had previous experiences with psychotherapy, whereas n = 282 had not. This distribution clearly determined the factor "demand for psychotherapy" (chi-square = 23.7, P < 0.001). When all available data were entered into a (stepwise-forward) regression model, psychotherapy demand was dependent on previous experience (P < 0.001), fear of progression (P < 0.001), quality of life (P = 0.001), smoking (P = 0.003), and previous surgery (P = 0.005) with the total model explaining 29.7% of the variance. The total explained variance of this model was higher in ulcerative colitis (37.6%) than in Crohn's disease alone (25.4%). CONCLUSIONS The demand for psychotherapy as additional therapy in IBD depends on previous experience with psychotherapy, fear for disease progression but also other disease or social characteristics and quality of life.
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27
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Abstract
Inflammatory bowel diseases consisting of Crohn's disease and ulcerative colitis are chronic inflammatory diseases of the gastrointestinal tract. In addition to genetic susceptibility and disturbances of the microbiome, environmental exposures forming the exposome play an important role. Starting at birth, the cumulative effect of different environmental exposures combined with a predetermined genetic susceptibility is thought to cause inflammatory bowel disease. All these environmental factors are part of a Western lifestyle, suiting the high incidence rates in Europe and the United States. Whereas receiving breastfeeding, evidence of a Helicobacter pylori infection and vitamin D are important protective factors in Crohn's disease as well as ulcerative colitis, increased hygiene, experiencing a bacterial gastroenteritis in the past, urban living surroundings, air pollution, the use of antibiotics, nonsteroidal anti-inflammatory drugs, and oral contraceptives are likely to be the most important risk factors for both diseases. Current cigarette smoking yields a divergent effect by protecting against ulcerative colitis but increasing risk of Crohn's disease, whereas former smoking increases chances of both diseases. This review gives a clear overview of the current state of knowledge concerning the exposome. Future studies should focus on measuring this exposome yielding the possibility of combining all involved factors to one exposome risk score and our knowledge on genetic susceptibility.
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28
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Burke KE, Boumitri C, Ananthakrishnan AN. Modifiable Environmental Factors in Inflammatory Bowel Disease. Curr Gastroenterol Rep 2017; 19:21. [PMID: 28397132 PMCID: PMC5651146 DOI: 10.1007/s11894-017-0562-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
PURPOSE OF REVIEW Environmental factors may influence predisposition to develop inflammatory bowel diseases (Crohn's disease, ulcerative colitis) or alter its natural history by modification of both the host immune response and intestinal microbial composition. The purpose of this review is to translate such evidence into clinical practice by a focus on interventional studies that have modified such environmental influences to improve disease outcomes. RECENT FINDINGS Several environmental influences have been identified in the recent literature including tobacco use, diet, antibiotics, vitamin D deficiency, stress, appendectomy, and oral contraceptive use. Some risk factors have similar influences on both Crohn's disease and ulcerative colitis while others are disease-specific or have divergent effects. Emerging epidemiologic evidence has confirmed the association of many of these factors with incident disease using prospective data. In addition, laboratory data has supported their mechanistic plausibility and relevance to intestinal inflammation.
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Affiliation(s)
- Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital, Boston, USA
| | - Christine Boumitri
- Division of Gastroenterology, University of Missouri-Columbia, Columbia, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, USA.
- Massachusetts General Hospital Crohn's and Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA.
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29
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Porter CK, Welsh M, Riddle MS, Nieh C, Boyko EJ, Gackstetter G, Hooper TI. Epidemiology of inflammatory bowel disease among participants of the Millennium Cohort: incidence, deployment-related risk factors, and antecedent episodes of infectious gastroenteritis. Aliment Pharmacol Ther 2017; 45:1115-1127. [PMID: 28230274 DOI: 10.1111/apt.13991] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/05/2016] [Accepted: 01/26/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC) are two pathotypes of inflammatory bowel disease (IBD) with unique pathology, risk factors and significant morbidity. AIM To estimate incidence and identify IBD risk factors in a US military population, a healthy subset of the US population, using information from the Millennium Cohort Study. METHODS Incident IBD was identified from medical encounters from 2001 to 2009 or by self-report. Our primary risk factor of interest, infectious gastroenteritis, was identified from medical encounters and self-reported post-deployment health assessments. Other potential risk factors were assessed using self-reported survey responses and military personnel files. Hazard ratios were estimated using Cox proportional hazards analysis. RESULTS We estimated 23.2 and 21.9 diagnoses per 100 000 person-years, respectively, for CD and UC. For CD, significant risk factors included [adjusted hazard ratio (aHR), 95% confidence interval]: current smoking (aHR: 2.7, 1.4-5.1), two life stressors (aHR: 2.8, 1.4-5.6) and prior irritable bowel syndrome (aHR: 4.7, 1.5-15.2). There was no significant association with prior infectious gastroenteritis. There was an apparent dose-response relationship between UC risk and an increasing number of life stressors. In addition, antecedent infectious gastroenteritis was associated with almost a three-fold increase in UC risk (aHR: 2.9, 1.4-6.0). Moderate alcohol consumption (aHR: 0.4, 0.2-0.6) was associated with lower UC risk. CONCLUSIONS Stressful conditions and the high risk of infectious gastroenteritis in deployment operations may play a role in the development of IBD in military populations. However, observed differences in risk factors for UC and CD warrant further investigation.
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Affiliation(s)
- C K Porter
- Naval Medical Research Center, Silver Spring, MD, USA
| | - M Welsh
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - M S Riddle
- Naval Medical Research Center, Silver Spring, MD, USA
| | - C Nieh
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - E J Boyko
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - G Gackstetter
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - T I Hooper
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Wells JM, Brummer RJ, Derrien M, MacDonald TT, Troost F, Cani PD, Theodorou V, Dekker J, Méheust A, de Vos WM, Mercenier A, Nauta A, Garcia-Rodenas CL. Homeostasis of the gut barrier and potential biomarkers. Am J Physiol Gastrointest Liver Physiol 2017; 312:G171-G193. [PMID: 27908847 PMCID: PMC5440615 DOI: 10.1152/ajpgi.00048.2015] [Citation(s) in RCA: 350] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/09/2016] [Accepted: 11/19/2016] [Indexed: 02/07/2023]
Abstract
The gut barrier plays a crucial role by spatially compartmentalizing bacteria to the lumen through the production of secreted mucus and is fortified by the production of secretory IgA (sIgA) and antimicrobial peptides and proteins. With the exception of sIgA, expression of these protective barrier factors is largely controlled by innate immune recognition of microbial molecular ligands. Several specialized adaptations and checkpoints are operating in the mucosa to scale the immune response according to the threat and prevent overreaction to the trillions of symbionts inhabiting the human intestine. A healthy microbiota plays a key role influencing epithelial barrier functions through the production of short-chain fatty acids (SCFAs) and interactions with innate pattern recognition receptors in the mucosa, driving the steady-state expression of mucus and antimicrobial factors. However, perturbation of gut barrier homeostasis can lead to increased inflammatory signaling, increased epithelial permeability, and dysbiosis of the microbiota, which are recognized to play a role in the pathophysiology of a variety of gastrointestinal disorders. Additionally, gut-brain signaling may be affected by prolonged mucosal immune activation, leading to increased afferent sensory signaling and abdominal symptoms. In turn, neuronal mechanisms can affect the intestinal barrier partly by activation of the hypothalamus-pituitary-adrenal axis and both mast cell-dependent and mast cell-independent mechanisms. The modulation of gut barrier function through nutritional interventions, including strategies to manipulate the microbiota, is considered a relevant target for novel therapeutic and preventive treatments against a range of diseases. Several biomarkers have been used to measure gut permeability and loss of barrier integrity in intestinal diseases, but there remains a need to explore their use in assessing the effect of nutritional factors on gut barrier function. Future studies should aim to establish normal ranges of available biomarkers and their predictive value for gut health in human cohorts.
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Affiliation(s)
- Jerry M. Wells
- 1Host-Microbe Interactomics, Animal Sciences, Wageningen University, Wageningen, The Netherlands;
| | - Robert J. Brummer
- 2Nutrition-Gut-Brain Interactions Research Centre, School of Medicine and Health, Örebro University, Örebro, Sweden;
| | - Muriel Derrien
- 3Centre Daniel Carasso, Danone Research, Palaiseau, France;
| | - Thomas T. MacDonald
- 4Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, United Kingdom;
| | - Freddy Troost
- 5Division of Gastroenterology-Hepatology, Department of Internal Medicine, University Hospital Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands;
| | - Patrice D. Cani
- 6Louvain Drug Research Institute, WELBIO (Walloon Excellence in Life Sciences and BIOtechnology), Metabolism and Nutrition Research Group, Université Catholique de Louvain, Brussels, Belgium;
| | - Vassilia Theodorou
- 7Neuro-Gastroenterology and Nutrition Group, Institut National de la Recherche Agronomique, Toulouse, France;
| | - Jan Dekker
- 1Host-Microbe Interactomics, Animal Sciences, Wageningen University, Wageningen, The Netherlands;
| | | | - Willem M. de Vos
- 9Laboratory of Microbiology, Wageningen UR, Wageningen, The Netherlands;
| | - Annick Mercenier
- 10Institute of Nutritional Science, Nestlé Research Center, Lausanne, Switzerland; and
| | - Arjen Nauta
- 11FrieslandCampina, Amersfoort, The Netherlands
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Melinder C, Hiyoshi A, Fall K, Halfvarson J, Montgomery S. Stress resilience and the risk of inflammatory bowel disease: a cohort study of men living in Sweden. BMJ Open 2017; 7:e014315. [PMID: 28130207 PMCID: PMC5278277 DOI: 10.1136/bmjopen-2016-014315] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine if low psychosocial stress resilience in adolescence (increasing chronic stress arousal throughout life) is associated with an increased inflammatory bowel disease (IBD) risk in adulthood. Subclinical Crohn's disease (CD) and ulcerative colitis (UC) can exist over many years and we hypothesise that psychosocial stress may result in conversion to symptomatic disease through its proinflammatory or barrier function effects. DESIGN National register-based cohort study of men followed from late adolescence to middle age. SETTING A general population cohort of men in Sweden. PARTICIPANTS Swedish population-based registers provided information on all men born between 1952 and 1956 who underwent mandatory Swedish military conscription assessment (n=239 591). Men with any gastrointestinal diagnoses (except appendicitis) prior to follow-up were excluded. PRIMARY OUTCOME MEASURES An inpatient or outpatient diagnosis of CD or UC recorded in the Swedish Patient Register (1970-2009). RESULTS A total of 938 men received a diagnosis of CD and 1799 UC. Lower stress resilience in adolescence was associated with increased IBD risk, with unadjusted HRs (95% CIs) of 1.54 (1.26 to 1.88) and 1.24 (1.08 to 1.42), for CD and UC, respectively. After adjustment for potential confounding factors, including markers of subclinical disease activity in adolescence, they are 1.39 (1.13 to 1.71) and 1.19 (1.03 to 1.37). CONCLUSIONS Lower stress resilience may increase the risk of diagnosis of IBD in adulthood, possibly through an influence on inflammation or barrier function.
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Affiliation(s)
- Carren Melinder
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ayako Hiyoshi
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Katja Fall
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
- Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2:189-199. [PMID: 28404134 DOI: 10.1016/s2468-1253(16)30206-0] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease is associated with psychological comorbidity and impaired quality of life. Psychological comorbidity could affect the natural history of inflammatory bowel disease. Psychological therapies might therefore have beneficial effects on disease activity, mood, and quality of life in patients with inflammatory bowel disease. We did a systematic review and meta-analysis examining these issues. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Embase Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials for articles published between 1947 and Sept 22, 2016. Randomised controlled trials (RCTs) recruiting patients with inflammatory bowel disease aged at least 16 years that compared psychological therapy with a control intervention or usual treatment were eligible. We pooled dichotomous data to obtain relative risks of induction of remission in active disease or prevention of relapse of quiescent disease, with 95% CIs. We pooled continuous data to estimate standardised mean differences in disease activity indices, anxiety, depression, perceived stress, and quality-of-life scores in patients dichotomised into those with clinically active or quiescent disease, with 95% CIs. We extracted data from published reports and contacted the original investigators of studies for which the required data were not available. We pooled all data using a random-effects model. FINDINGS The search identified 1824 studies, with 14 RCTs of 1196 patients eligible for inclusion. The relative risk of relapse of quiescent inflammatory bowel disease with psychological therapy versus control was 0·98 (95% CI 0·77-1·24; p=0·87; I2=50%; six trials; 518 patients). We observed a significant difference in depression scores (standardised mean difference -0·17 [-0·33 to -0·01]; p=0·04; I2=0%; seven trials; 605 patients) and quality of life (0·30 [0·07-0·52]; p=0·01; I2=42%; nine trials; 578 patients) with psychological therapy versus control at the end of therapy for patients with quiescent disease. However, these beneficial effects were lost at final point of follow-up (depression scores -0·11 [-0·27 to 0·05], p=0·17, I2=0%, eight trials, 593 patients; quality of life 0·15 [-0·05 to 0·34], p=0·14, I2=22%, ten trials, 577 patients). When we assessed the effect of individual physiological therapies on quality of life, only cognitive behavioural therapy had any significant beneficial effect (0·37 [0·02-0·72]). We noted no effect on disease activity indices or other psychological wellbeing scores when compared with control in patients with quiescent disease. Dichotomous data for induction of remission and continuous data for change in clinical disease activity indices, depression, anxiety, and perceived stress scores were only reported in one RCT of patients with active disease. Quality of life was assessed in two RCTs of patients with active disease, but was not significantly different between intervention and control groups (0·27 [-0·05 to 0·59]). INTERPRETATION Psychological therapies, and cognitive behavioural therapy in particular, might have small short-term beneficial effects on depression scores and quality of life in patients with inflammatory bowel disease. Further RCTs of these interventions in patients with coexistent psychological distress are required. FUNDING None.
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Vedolizumab Therapy Is Associated with an Improvement in Sleep Quality and Mood in Inflammatory Bowel Diseases. Dig Dis Sci 2017; 62:197-206. [PMID: 27796768 PMCID: PMC5218976 DOI: 10.1007/s10620-016-4356-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/17/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Poor sleep, depression, and anxiety are common in patients with inflammatory bowel diseases (IBD) and associated with increased risk of relapse and poor outcomes. The effectiveness of therapies in improving such psychosocial outcomes is unclear but is an important question to examine with increasing selectivity of therapeutic agents. METHODS This prospective cohort enrolled patients with moderate-to-severe CD or UC starting biologic therapy with vedolizumab or anti-tumor necrosis factor α agents (anti-TNF). Sleep quality, depression, and anxiety were measured using validated short-form NIH PROMIS questionnaires assessing sleep and mood quality over the past 7 days. Disease activity was assessed using validated indices. Improvement in sleep and mood scores from baseline was assessed, and regression models were used to identify determinants of sleep quality. RESULTS Our study included 160 patients with IBD (49 anti-TNF, 111 Vedolizumab) among whom half were women and the mean age was 40.2 years. In the combined cohort, we observed a statistically significant and meaningful decrease in mean scores from baseline (52.8) by week 6 (49.8, p = 0.002). Among vedolizumab users, sleep T-score improved from baseline (53.6) by week 6 (50.7) and persisted through week 54 (46.5, p = 0.009). Parallel reductions in depression and anxiety were also noted (p < 0.05 by week 6). We observed no difference in improvement in sleep, depression, and anxiety between vedolizumab and anti-TNF use at week 6. CONCLUSIONS Both vedolizumab and anti-TNF biologic therapies were associated with improvement in sleep and mood quality in IBD.
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General Self-Efficacy and Mortality in the USA; Racial Differences. J Racial Ethn Health Disparities 2016; 4:746-757. [PMID: 27734342 DOI: 10.1007/s40615-016-0278-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE General self-efficacy has been historically assumed to have universal health implications. However, less is known about population differences in long-term health effects of general self-efficacy across diverse populations. This study compared black and white American adults for (1) the association between psychosocial and health factors and general self-efficacy at baseline, and (2) the association between baseline self-efficacy and long-term risk of all-cause mortality over 25 years. METHODS The Americans' Changing Lives (ACL) study, 1986-2011, is a nationally representative longitudinal cohort of US adults. The study followed 3361 black (n = 1156) and white (n = 2205) adults for up to 25 years. General self-efficacy as well as demographics, socioeconomics, stressful life events, health behaviors, obesity, depressive symptoms, and self-rated health were measured at baseline in 1986. The outcome was time to all-cause mortality since 1986. Race was the focal moderator. Logistic regression and proportional hazards models were used for data analysis. RESULTS Although blacks had lower general self-efficacy, this association was fully explained by socioeconomic factors (education and income). Our logistic regression suggested interactions between race and education, self-rated health, and stress on general self-efficacy at baseline. Baseline general self-efficacy was associated with risk of mortality in the pooled sample. Race interacted with baseline general self-efficacy on mortality risk, suggesting stronger association for whites than blacks. CONCLUSION Black-white differences exist in psychosocial and health factors associated with self-efficacy in the USA. Low general self-efficacy does not increase mortality risk for blacks. Future research should test whether socioeconomic status, race-related attitudes, world views, attributions, and locus of control can potentially explain why low self-efficacy is not associated with higher risk of mortality among American blacks.
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Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID. Psoriasis and inflammatory bowel disease: links and risks. PSORIASIS-TARGETS AND THERAPY 2016; 6:73-92. [PMID: 29387596 PMCID: PMC5683131 DOI: 10.2147/ptt.s85194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Psoriasis and the spectrum of inflammatory bowel diseases (IBD) are chronic, inflammatory, organotropic conditions. The epidemiologic coexistence of these diseases is corroborated by findings at the level of disease, biogeography, and intrafamilial and intrapatient coincidence. The identification of shared susceptibility loci and DNA polymorphisms has confirmed this correlation at a genetic level. The pathogenesis of both diseases implicates the innate and adaptive segments of the immune system. Increased permeability of the epidermal barrier in skin and intestine underlies the augmented interaction of allergens and pathogens with inflammatory receptors of immune cells. The immune response between psoriasis and IBD is similar and comprises phagocytic, dendritic, and natural killer cell, along with a milieu of cytokines and antimicrobial peptides that stimulate T-cells. The interplay between dendritic cells and Th17 cells appears to be the core dysregulated immune pathway in all these conditions. The distinct similarities in the pathogenesis are also reflected in the wide overlapping of their therapeutic approaches. Small-molecule pharmacologic immunomodulators have been applied, and more recently, biologic treatments that target proinflammatory interleukins have been introduced or are currently being evaluated. However, the fact that some treatments are quite selective for either skin or gut conditions also highlights their crucial pathophysiologic differences. In the present review, a comprehensive comparison of risk factors, pathogenesis links, and therapeutic strategies for psoriasis and IBD is presented. Specific emphasis is placed on the role of the immune cell species and inflammatory mediators participating in the pathogenesis of these diseases.
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Affiliation(s)
| | | | - Konstantinos H Katsanos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Tsianos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Niu J, Miao J, Tang Y, Nan Q, Liu Y, Yang G, Dong X, Huang Q, Xia S, Wang K, Miao Y. Identification of Environmental Factors Associated with Inflammatory Bowel Disease in a Southwestern Highland Region of China: A Nested Case-Control Study. PLoS One 2016; 11:e0153524. [PMID: 27070313 PMCID: PMC4829194 DOI: 10.1371/journal.pone.0153524] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/30/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to examine environmental factors associated with inflammatory bowel disease (IBD) in Yunnan Province, a southwestern highland region of China. METHODS In this nested case-control study, newly diagnosed ulcerative colitis (UC) cases in 2 cities in Yunnan Province and Crohn's disease (CD) cases in 16 cities in Yunnan Province were recruited between 2008 and 2013. Controls were matched by geography, sex and age at a ratio of 1:4. Data were collected using the designed questionnaire. Conditional logistic regression models were used to estimate adjusted odds ratios (ORs). RESULTS A total of 678 UC and 102 CD cases were recruited. For UC, various factors were associated with an increased risk of developing UC: dietary habits, including frequent irregular meal times; consumption of fried foods, salty foods and frozen dinners; childhood factors, including intestinal infectious diseases and frequent use of antibiotics; and other factors, such as mental labor, high work stress, use of non-aspirin non-steroidal anti-inflammatory drugs and allergies (OR > 1, p < 0.05). Other factors showed a protective effect: such as consumption of fruits, current smoking, physical activity, and drinking tea (OR < 1, p < 0.05). For CD, appendectomy and irregular meal times increased the disease risk (OR >1, p < 0.05), whereas physical activity may have reduced this risk (OR < 1, p < 0.05). CONCLUSIONS This study is the first nested case-control study to analyze the association between environmental factors and IBD onset in a southwestern highland region of China. Certain dietary habits, lifestyles, allergies and childhood factors may play important roles in IBD, particularly UC.
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Affiliation(s)
- Junkun Niu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Jiarong Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Yuan Tang
- Department of Gastroenterology, The First People's Hospital of Qujing, Qujing, Yunnan Province, P. R. China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Yan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Gang Yang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Xiangqian Dong
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Qi Huang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Shuxian Xia
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Kunhua Wang
- Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
| | - Yinglei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming, Yunnan Province, P. R. China
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Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2016; 22:752-62. [PMID: 26841224 DOI: 10.1097/mib.0000000000000620] [Citation(s) in RCA: 354] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies. METHODS Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research. RESULTS (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn's disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset. CONCLUSIONS The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.
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Dutta AK, Chacko A. Influence of environmental factors on the onset and course of inflammatory bowel disease. World J Gastroenterol 2016; 22:1088-1100. [PMID: 26811649 PMCID: PMC4716022 DOI: 10.3748/wjg.v22.i3.1088] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 09/24/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
Numerous environmental factors have been linked with inflammatory bowel disease. These include smoking, diet, hygiene, drugs, geographical and psychosocial factors. These factors may either increase the risk of or protect against developing this condition and can also affect the course of illness in a positive or negative manner. A number of studies have examined the influence of environmental factors on inflammatory bowel diseases as a whole as well as on ulcerative colitis and Crohn’s disease separately. As there are differences in the pathogenesis of ulcerative colitis and Crohn’s disease, the effect of environmental factors on their onset and course is not always similar. Some factors have shown a consistent association, while reports on others have been conflicting. In this article we discuss the current evidence on the roles of these factors on inflammatory bowel disease, both as causative/protective agents and as modifiers of disease course.
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Zhang M, Hong L, Zhang T, Lin Y, Zheng S, Zhou X, Fan R, Wang Z, Zhang C, Zhong J. Illness perceptions and stress: mediators between disease severity and psychological well-being and quality of life among patients with Crohn's disease. Patient Prefer Adherence 2016; 10:2387-2396. [PMID: 27920505 PMCID: PMC5125764 DOI: 10.2147/ppa.s118413] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Disease severity, illness perceptions, coping strategies, stress, psychological well-being, and quality of life were reported to have close relationships. According to the Common Sense Model, illness perceptions and coping strategies could mediate the relationship between illness stimuli and illness outcomes such as psychological health and quality of life. Stress was also associated with the individual's disease severity, anxiety, depression, and quality of life. OBJECTIVES The study aimed to explore the influencing factors of illness outcomes, and to what extent illness perceptions, coping strategies, and stress mediate the relationship between disease severity and anxiety, and depression and quality of life. METHODS Our study included 159 patients with Crohn's disease who were attending a tertiary hospital outpatient clinic or who were hospitalized. Disease severity was measured with the Crohn's Disease Activity Index. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire. Coping strategies were measured with the Carver Brief Coping Questionnaire. Stress was measured with the Perceived Stress Questionnaire. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Quality of life was measured with the Inflammatory Bowel Disease Questionnaire. RESULTS Disease severity, illness perceptions, maladaptive coping, stress, anxiety, depression and quality of life were significantly correlated with each other among patients with Crohn's disease. Using structural equation modeling to describe the inner relationship of the aforementioned variables, an excellent-fitted model was drawn. (χ2[10]=13.83, P=0.18, χ2/N=1.38, standardized root mean square residual [SRMR] <0.05, root mean square error of approximation [RMSEA] <0.05, goodness of fit index [GFI] >0.97, comparative fit index [CFI] >0.99). Disease severity had a direct influence on illness perceptions. Illness perceptions had a direct influence on stress. Both illness perceptions and stress had direct influences on anxiety, depression, and quality of life, while maladaptive coping did not directly influence anxiety, depression, or quality of life. Stress had a direct influence on maladaptive coping. Quality of life was also directly influenced by disease severity and anxiety. CONCLUSION Interrelationships between disease stimuli, disease perceptions and management and disease outcomes could be found in patients with Crohn's disease. Illness perceptions and stress mediated an individual's disease severity and anxiety, depression and quality of life, while coping strategy was not an applicable mediator.
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Affiliation(s)
| | | | | | - Yun Lin
- Department of Gastroenterology
| | | | | | | | | | - Chenli Zhang
- Exclusive Medical Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Chenli Zhang, Exclusive Medical Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email
| | - Jie Zhong
- Department of Gastroenterology
- Correspondence: Jie Zhong, Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email
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Alarhayem A, Achebe E, Logue AJ. Psychosocial Support of the Inflammatory Bowel Disease Patient. Surg Clin North Am 2015; 95:1281-93, vii-viii. [PMID: 26596928 DOI: 10.1016/j.suc.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic, debilitating disease whose effects spread far beyond the gut. IBD does not generally result in excess mortality; health care providers should thus focus their efforts on improving health-related quality of life and minimizing associated morbidity. A bidirectional relationship exists between IBD and psychiatric conditions; chronic inflammation can produce neuromodulatory effects with resultant mood disorders, and the course of IBD is worse in patients with anxiety and depression. Screening for the early signs of depression or anxiety and initiating appropriate treatment can lead to improved functioning and positively impact disease course.
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Affiliation(s)
- Abdul Alarhayem
- Department of Surgery, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
| | - Ebele Achebe
- Department of Surgery, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Alicia J Logue
- Department of Surgery, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder: Findings from a Nationally Representative Canadian Study. Inflamm Bowel Dis 2015. [PMID: 26218145 DOI: 10.1097/mib.0000000000000518] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD. METHODS Data were derived from the nationally representative 2012 Canadian Community Health Survey-Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalized anxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis. RESULTS Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50-3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates of anxiety. Those with Crohn's and ulcerative colitis were equally vulnerable to generalized anxiety disorder. CONCLUSIONS Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.
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Abstract
IBD, comprising Crohn's disease and ulcerative colitis, is a chronic immunologically mediated disease at the intersection of complex interactions between genetics, environment and gut microbiota. Established high-prevalence populations of IBD in North America and Europe experienced the steepest increase in incidence towards the second half of the twentieth century. Furthermore, populations previously considered 'low risk' (such as in Japan and India) are witnessing an increase in incidence. Potentially relevant environmental influences span the spectrum of life from mode of childbirth and early-life exposures (including breastfeeding and antibiotic exposure in infancy) to exposures later on in adulthood (including smoking, major life stressors, diet and lifestyle). Data support an association between smoking and Crohn's disease whereas smoking cessation, but not current smoking, is associated with an increased risk of ulcerative colitis. Dietary fibre (particularly fruits and vegetables), saturated fats, depression and impaired sleep, and low vitamin D levels have all been associated with incident IBD. Interventional studies assessing the effects of modifying these risk factors on natural history and patient outcomes are an important unmet need. In this Review, the changing epidemiology of IBD, mechanisms behind various environmental associations and interventional studies to modify risk factors and disease course are discussed.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Massachusetts General Hospital Crohn's and Colitis Centre, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA
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Ananthakrishnan AN, Greer JB, Schraut WH, Regueiro MD, Davis PL, Hartman DJ, Siegel CA, Herfarth HH, Williams ED, Schwartz MB. Environmental risk factors for inflammatory bowel diseases: a review. Dig Dis Sci 2015; 60:290-8. [PMID: 25204669 PMCID: PMC4304948 DOI: 10.1007/s10620-014-3350-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/01/2014] [Indexed: 12/23/2022]
Abstract
Inflammatory bowel diseases comprising Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunologically mediated diseases. The key mechanism underlying the pathogenesis of these diseases is a dysregulated immune response to commensal flora in a genetically susceptible host. Thus intestinal microbial dysbiosis, host genetics, and the external environment all play an important role in the development of incident disease and in determining subsequent disease behavior and outcomes. There are several well-defined or putative environmental risk factors including cigarette smoking, appendectomy, diet, stress and depression, vitamin D as well as hormonal influence. The effect of some of the risk factors appears to differ between CD and UC suggesting that despite shared genetic and immunologic mechanisms, distinct pathways of pathogenesis exist. There is a growing body of literature identifying risk factors for incident disease. There is less rigorous literature defining triggers of relapse, and few controlled clinical trials examining if modification of such risk factors results in an improvement in patient outcomes. This is an area of considerable patient, physician, and scientific interest, and there is an important unmet need for rigorous studies of the external environment in disease pathogenesis and subsequent course.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Horst S, Chao A, Rosen M, Nohl A, Duley C, Wagnon JH, Beaulieu DB, Taylor W, Gaines L, Schwartz DA. Treatment with immunosuppressive therapy may improve depressive symptoms in patients with inflammatory bowel disease. Dig Dis Sci 2015; 60:465-70. [PMID: 25274158 DOI: 10.1007/s10620-014-3375-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 09/24/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Recent research suggests a relationship of inflammatory bowel disease (IBD) and depression. Our objective was to evaluate for improvement of depressive symptoms with treatment of IBD using immunosuppressive medications. METHODS A retrospective study of consecutive patients with IBD started on immunosuppressive agents [anti-tumor necrosis factor (anti-TNF) or immunomodulator therapy] was conducted. Patients were evaluated if disease activity indices using Harvey Bradshaw Index for Crohn's disease (CD) and Simple Clinical Colitis Disease Activity Index for ulcerative colitis (UC) and depressive indices using Patient Health Questionnaire-9 (PHQ-9) scores were obtained before and at least 30 days after initiation of therapy. RESULTS Sixteen patients with UC and 53 patients with CD (all with active disease symptoms) were evaluated over a 60 day median follow-up evaluation (range 30, 140 days). Twenty-two patients started on immunomodulator therapy, and 47 patients started on anti-TNF therapy. Crohn's disease patients had significantly decreased PHQ-9 scores at follow-up [median 9 (range 3, 14) to 4 (1, 8)], with significant decreases only in those started on anti-TNF therapy. Changes in PHQ-9 and CRP were correlated (ρ = 0.38, p < 0.05). In patients with UC, PHQ-9 scores [5 (3, 9) to 2 (0, 5)] were significantly decreased. Percentage at risk of moderate to severe depression (PHQ-9 scores ≥10) was lower after treatment [Crohn's disease 51-18 % (p < 0.05), ulcerative colitis 18-0 %]. CONCLUSION Depressive scores decreased significantly in patients with IBD treated with immunosuppressive therapy and the number at risk for moderate to severe depression improved significantly.
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Affiliation(s)
- Sara Horst
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA,
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45
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Environment and the inflammatory bowel diseases. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2015; 27:e18-24. [PMID: 23516681 DOI: 10.1155/2013/102859] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gastrointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breastfeeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology.
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46
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Heikkilä K, Madsen IEH, Nyberg ST, Fransson EI, Ahola K, Alfredsson L, Bjorner JB, Borritz M, Burr H, Dragano N, Ferrie JE, Knutsson A, Koskenvuo M, Koskinen A, Nielsen ML, Nordin M, Pejtersen JH, Pentti J, Rugulies R, Oksanen T, Shipley MJ, Suominen SB, Theorell T, Väänänen A, Vahtera J, Virtanen M, Westerlund H, Westerholm PJM, Batty GD, Singh-Manoux A, Kivimäki M. Job strain and the risk of inflammatory bowel diseases: individual-participant meta-analysis of 95,000 men and women. PLoS One 2014; 9:e88711. [PMID: 24558416 PMCID: PMC3928274 DOI: 10.1371/journal.pone.0088711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 01/09/2014] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95 000 European adults. Methods We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD-Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations between job strain and inflammatory bowel disease outcomes were modelled using Cox proportional hazards regression. The study-specific results were combined in random effects meta-analyses. Results Of the 95 379 participants who were free of inflammatory bowel disease at baseline, 111 men and women developed Crohn's disease and 414 developed ulcerative colitis during follow-up. Job strain at baseline was not associated with incident Crohn's disease (multivariable-adjusted random effects hazard ratio: 0.83, 95% confidence interval: 0.48, 1.43) or ulcerative colitis (hazard ratio: 1.06, 95% CI: 0.76, 1.48). There was negligible heterogeneity among the study-specific associations. Conclusions Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis.
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Affiliation(s)
- Katriina Heikkilä
- Finnish Institute of Occupational Health, Helsinki, Finland
- * E-mail:
| | - Ida E. H. Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Eleonor I. Fransson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- School of Health Sciences, Jönköping University, Jönköping, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Kirsi Ahola
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jakob B. Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Marianne Borritz
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Hermann Burr
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Nico Dragano
- Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany,
| | - Jane E. Ferrie
- School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Markku Koskenvuo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Martin L. Nielsen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Jan H. Pejtersen
- The Danish National Centre for Social Research, Copenhagen, Denmark
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland
| | - Martin J. Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Sakari B. Suominen
- Folkhälsan Research Center, Helsinki, Finland
- Department of Public Health, University of Turku, Turku, Finland
- Nordic School of Public Health, Göteborg, Sweden
| | - Töres Theorell
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Vahtera
- Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | | | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | | | - G. David Batty
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edingurgh, United Kingdom
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Quick V, McWilliams R, Byrd-Bredbenner C. A case-control study of current psychological well-being and weight-teasing history in young adults with and without bowel conditions. J Hum Nutr Diet 2014; 28:28-36. [DOI: 10.1111/jhn.12202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- V. Quick
- Division of Intramural Population Health Research; Eunice Kennedy Shriver National Institute of Child Health and Human Development; NIH; DHHS; Bethesda MD USA
| | - R. McWilliams
- Department of Human Ecology; Rutgers University; New Brunswick NJ USA
| | - C. Byrd-Bredbenner
- Department of Nutritional Sciences; Rutgers University; New Brunswick NJ USA
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The role of the environment in the development of pediatric inflammatory bowel disease. Curr Gastroenterol Rep 2013; 15:326. [PMID: 23640032 DOI: 10.1007/s11894-013-0326-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The incidence of inflammatory bowel disease (IBD) is rising worldwide, with a particularly sharp increase in children. Rates are highest in North America and Europe, with rapid increases noted in developing nations adopting the Westernized environment. While many genetic risk loci have been identified that predispose people to IBD, incomplete penetrance and overlapping genotypes among patients with different phenotypes inadequately explain the etiology of these chronic diseases. Therefore, environmental risk factors have been the subject of much recent research. This article reviews the role of the environment in IBD, with particular focus on early-life exposures and pediatric-onset disease. The literature surrounding environmental risk factors is reviewed, including prenatal and perinatal exposures, the hygiene hypothesis, the urban environment, infection and antibiotic use, and secondhand tobacco smoke exposure. In addition, the possible role of the environment in altering the intestinal microbiome is addressed.
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49
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Ciacci C, Siniscalchi M, Bucci C, Zingone F, Morra I, Iovino P. Life events and the onset of celiac disease from a patient's perspective. Nutrients 2013; 5:3388-98. [PMID: 23989754 PMCID: PMC3798910 DOI: 10.3390/nu5093388] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023] Open
Abstract
Stressful events have been investigated in various immune-mediated diseases but not in celiac disease. Our aim was to examine the relationship of stressful events assessed by the standardized interview of Paykel with the diagnosis of celiac disease in comparison to patients, with a diagnosis of gastroesophageal reflux disease used as the control group. Adults with celiac disease (n = 186) reported more frequent and more severe life events in the years prior to the diagnosis than control patients (n = 96) (67.2% vs. 37.5%, p < 0.001, mean Paykel score 11.5 vs. 13.4, p = 0.001, respectively). Findings were not significantly different between celiac disease and control patients for the time lapse between the event and the diagnosis (mean 5.5 vs. 5.7 months). Pregnancy was defined as a negative event by 20.3% of celiac women, but never by control women. Findings were confirmed when analyses were repeated in the subgroup of patients of both groups with diagnosis made within one year of onset of symptoms. Data indicate that, before diagnosis, the number of stressful events in celiac disease was more frequent although less severe than in the control group suggesting that life events may favor the clinical appearance of celiac disease or accelerate its diagnosis.
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Affiliation(s)
- Carolina Ciacci
- Department of Medicine and Surgery, University of Salerno, via S.Allende 84081, Salerno 84081, Italy.
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50
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Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel disease. Clin Epidemiol 2013; 5:237-47. [PMID: 23922506 PMCID: PMC3728155 DOI: 10.2147/clep.s33961] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel diseases (IBD), including both Crohn's disease and ulcerative colitis, are disorders of chronic inflammation of the gastrointestinal tract marked by episodes of relapse and remission. Over the past several decades, advances have been made in understanding the epidemiology of IBD. The incidence and prevalence of both Crohn's disease and ulcerative colitis have been increasing worldwide across pediatric and adult populations. As IBD is thought to be related to a combination of individual genetic susceptibility, environmental triggers, and alterations in the gut microbiome that stimulate an inflammatory response, understanding the potentially modifiable environmental risk factors associated with the development or the course of IBD could impact disease rates or management in the future. Current hypotheses as to the development of IBD are reviewed, as are a host of environmental cofactors that have been investigated as both protective and inciting factors for IBD onset. Such environmental factors include breast feeding, gastrointestinal infections, urban versus rural lifestyle, medication exposures, stress, smoking, and diet. The role of these factors in disease course is also reviewed. Looking forward, there is still much to be learned about the etiology of IBD and how specific environmental exposures intimately impact the development of disease and also the potential for relapse.
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Affiliation(s)
- Alexis Ponder
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Millie D Long
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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