Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, 60-572 Poznan, Poland.
Department of Clinical Psychology, Poznan University of Medical Sciences, 60-812 Poznan, Poland.
Int J Environ Res Public Health. 2021 Jan 18;18(2):784. doi: 10.3390/ijerph18020784.
No gold standard is available to evaluate subjective psychophysical experiences in pediatric inflammatory bowel disease (IBD). We aimed to assess pain, anxiety, and limitations in social activities at diagnosis and the worst flare of the disease in relation to clinical expression, treatment and IBD severity. A total of 376 children completed the survey (Crohn's disease (CD) n = 196; ulcerative colitis (UC) n = 180). The questionnaire included 12 questions regarding pain, anxiety, and social activity, all assessed at recruitment and retrospectively at diagnosis and worst flare using a numeric rating scale. Patients that had ever been treated with systemic glucocorticosteroids scored higher in pain ( < 0.001), anxiety ( = 0.015), and social activity domains ( < 0.016) at worst flare, and the answers correlated with the number of steroid courses ( < 0.0392). The perception of social activity limitations also correlated independently with the number of immunosuppressants ( < 0.0433) and biological agents ( < 0.0494). There was no difference in retrospective perception of pain, anxiety and social activity limitations between CD and UC patients at diagnosis and the worst flare. The level of limitations in social activity correlated with hospitalisations due to relapse, days spent in the hospital, number of relapses, and severe relapses with the strongest association of rho = 0.39 ( = 0.0004). Subjective and retrospective perception of pain, anxiety, and limitations in social activity differs depending on therapy, correlates with treatment modalities, and severity measures such as hospitalisations.
目前尚无金标准可用于评估儿科炎症性肠病(IBD)患者的主观心理体验。我们旨在评估疾病诊断时和疾病最严重发作时的疼痛、焦虑和社会活动受限情况,并将其与临床表现、治疗和 IBD 严重程度相关联。共有 376 名儿童完成了问卷调查(克罗恩病(CD)n=196;溃疡性结肠炎(UC)n=180)。问卷包括 12 个关于疼痛、焦虑和社会活动的问题,所有问题均在入组时进行评估,并在诊断和疾病最严重发作时通过数字评分量表进行回顾性评估。曾接受全身糖皮质激素治疗的患者在疾病最严重发作时的疼痛(<0.001)、焦虑(=0.015)和社会活动领域(<0.016)评分更高,且评分与类固醇疗程数相关(<0.0392)。社会活动受限的感知也与免疫抑制剂(<0.0433)和生物制剂(<0.0494)的使用数量独立相关。在疾病诊断和最严重发作时,CD 和 UC 患者对疼痛、焦虑和社会活动受限的回顾性感知无差异。社会活动受限程度与因复发而住院、住院天数、复发次数以及严重复发相关,相关系数 rho 为 0.39(=0.0004)。疼痛、焦虑和社会活动受限的主观和回顾性感知取决于治疗方法,与治疗方式和严重程度指标(如住院)相关。