Blackwell Jonathan, Saxena Sonia, Jayasooriya Nishani, Petersen Irene, Hotopf Matthew, Creese Hanna, Bottle Alex, Pollok Richard C G
Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; St George's University of London (SGUL), Institute for Infection and Immunity, London, United Kingdom; School of Public Health, Imperial College London, London, United Kingdom.
School of Public Health, Imperial College London, London, United Kingdom.
Clin Gastroenterol Hepatol. 2022 Apr;20(4):e703-e710. doi: 10.1016/j.cgh.2020.12.026. Epub 2020 Dec 25.
BACKGROUND & AIMS: The impact of a temporary or permanent stoma on mental health in Crohn's Disease (CD) is unknown. The aim was to examine the association between intestinal surgery and stoma formation and subsequent antidepressant medication (ADM) use.
Using the Clinical Practice Research Datalink, we identified individuals with CD who underwent intestinal surgery between 1998-2018. We excluded individuals with a prescription for an ADM in the 6 months before surgery. Individuals were stratified into three groups: no stoma, temporary stoma, and permanent stoma. We used Kaplan-Meier curves to examine initiation of ADM after intestinal surgery and Cox regression to identify risk factors for ADM use after intestinal surgery.
We identified 1,272 cases of CD undergoing their first intestinal surgery. Of these, 871 (68.5%) had no stoma, 191 (15.0%) had a temporary stoma and 210 (16.5%) had a permanent stoma. The 10-year cumulative incidence of ADM use was 26.4%, 33.4% and 37.3% respectively. Individuals with a permanent stoma were 71% more likely to receive an ADM than those with no stoma (HR 1.71, 95% CI 1.20-2.44). Individuals with a temporary stoma reversed within 12 months had a similar likelihood of ADM use to those without stoma formation (HR 0.99, 95% CI 0.64-1.53) whereas temporary stoma formation with late reversal after 12 months was associated with significantly greater likelihood of ADM use (HR 1.85, 95% CI 1.15-2.96).
Permanent stomas and temporary stomas with late reversal surgery are associated with increased ADM use after intestinal surgery, likely associated with increased anxiety and depression.
临时性或永久性造口对克罗恩病（CD）患者心理健康的影响尚不清楚。本研究旨在探讨肠道手术及造口形成与后续抗抑郁药物（ADM）使用之间的关联。
利用临床实践研究数据链，我们确定了1998年至2018年间接受肠道手术的CD患者。我们排除了术前6个月内有ADM处方的患者。将患者分为三组：无造口组、临时性造口组和永久性造口组。我们使用Kaplan-Meier曲线来研究肠道手术后ADM的起始使用情况，并使用Cox回归分析来确定肠道手术后使用ADM的危险因素。
我们共确定了1272例首次接受肠道手术的CD患者。其中，871例（68.5%）无造口，191例（15.0%）有临时性造口，210例（16.5%）有永久性造口。ADM使用的10年累积发病率分别为26.4%、33.4%和37.3%。有永久性造口的患者接受ADM治疗的可能性比无造口患者高71%（风险比1.71，95%置信区间1.20-2.44）。12个月内回纳临时性造口的患者使用ADM的可能性与未形成造口的患者相似（风险比0.99，95%置信区间0.64-1.53），而12个月后延迟回纳临时性造口则与使用ADM的可能性显著增加相关（风险比1.85，95%置信区间1.15-2.96）。
永久性造口以及延迟回纳手术的临时性造口与肠道手术后ADM使用增加有关，可能与焦虑和抑郁增加有关。
