Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
Gastroenterology. 2018 May;154(6):1635-1646.e3. doi: 10.1053/j.gastro.2018.01.027. Epub 2018 Jan 31.
BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are associated with mood disorders, such as anxiety or depression, but it is not clear whether one contributes to development of the other, or if the interaction is bi-directional (anxiety or depression contributes to the progression of IBD, and IBD affects psychological health). We performed a 2-year longitudinal prospective study of patients in secondary to care investigate the bi-directionality of IBD and mood disorders.
We collected data from 405 adult patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) from November 2012 through June 2017. Demographic features, subtypes of IBD, treatments, symptoms, somatization, and fecal level of calprotectin were recorded at baseline. IBD activity was determined at baseline and after the follow-up period (2 years or more) using the Harvey-Bradshaw Index for CD and the Simple Clinical Colitis Activity Index for UC (scores ≥5 used to define disease activity). Anxiety and depression data were collected using the Hospital Anxiety and Depression Scale (HADS), at baseline and after the follow-up period. Objective markers of disease activity, including glucocorticosteroid prescription or flare of disease activity, escalation of therapy, hospitalization secondary to IBD activity, and intestinal resection during follow-up were assessed via case note review. A brain-gut direction of disease activity was defined as development of new IBD activity in patients with quiescent IBD and abnormal HADS scores at baseline. A gut-brain direction of disease activity was defined by subsequent development of abnormal HADS scores in patients with active IBD and normal HADS scores at baseline. We performed multivariate Cox regression controlling for patient characteristics and follow-up duration.
Baseline CD or UC disease activity were associated with an almost 6-fold increase in risk for a later abnormal anxiety score (hazard ratio [HR], 5.77; 95% CI, 1.89-17.7). In patients with quiescent IBD at baseline, baseline abnormal anxiety scores were associated with later need for glucocorticosteroid prescription or flare of IBD activity (HR, 2.08; 95% CI, 1.31-3.30) and escalation of therapy (HR, 1.82; 95% CI, 1.19-2.80). These associations persisted when normal IBD activity index scores and fecal level of calprotectin <250 μg/g were used to define quiescent disease at baseline.
In a 2-year study of patients with CD or UC, we found evidence for bi-directional effects of IBD activity and psychological disorders. Patients with IBD should be monitored for psychological well-being.
炎症性肠病（IBD）与焦虑或抑郁等情绪障碍有关，但尚不清楚是其中一种导致另一种的发生，还是相互作用是双向的（焦虑或抑郁会导致 IBD 的进展，而 IBD 会影响心理健康）。我们对二级护理中的患者进行了为期 2 年的纵向前瞻性研究，以调查 IBD 和情绪障碍的双向关系。
我们从 2012 年 11 月至 2017 年 6 月收集了 405 例成人克罗恩病（CD）或溃疡性结肠炎（UC）患者的数据。在基线时记录人口统计学特征、IBD 亚型、治疗、症状、躯体化和粪便钙卫蛋白水平。使用 CD 的 Harvey-Bradshaw 指数和 UC 的简单临床结肠炎活动指数（分数≥5 用于定义疾病活动）在基线和随访期（2 年或以上）确定 IBD 活动。在基线和随访期间使用医院焦虑和抑郁量表（HADS）收集焦虑和抑郁数据。通过病历回顾评估疾病活动的客观标志物，包括皮质类固醇处方或疾病活动的发作、治疗升级、因 IBD 活动导致的住院治疗以及随访期间的肠道切除术。通过评估基线时患有静止性 IBD 和异常 HADS 评分的患者中出现新的 IBD 活动来定义疾病活动的脑-肠方向。通过评估基线时患有活动性 IBD 和正常 HADS 评分的患者中随后出现异常 HADS 评分来定义疾病活动的肠-脑方向。我们进行了多变量 Cox 回归，控制了患者特征和随访时间。
基线 CD 或 UC 疾病活动与以后出现异常焦虑评分的风险增加近 6 倍相关（风险比 [HR]，5.77；95%CI，1.89-17.7）。在基线时患有静止性 IBD 的患者中，基线时异常的焦虑评分与以后需要皮质类固醇处方或 IBD 活动的发作（HR，2.08；95%CI，1.31-3.30）和治疗升级（HR，1.82；95%CI，1.19-2.80）相关。当使用正常的 IBD 活动指数评分和粪便钙卫蛋白<250 μg/g 来定义基线时的静止性疾病时，这些关联仍然存在。
在对 CD 或 UC 患者进行的为期 2 年的研究中，我们发现 IBD 活动和心理障碍存在双向影响的证据。患有 IBD 的患者应监测其心理健康状况。
