Wileman Vari, Chilcot Joseph, Norton Christine, Hart Ailsa, Miller Laura, Stagg Imogen, Seaton Natasha, Pollok Richard, Aziz Qasim, Moss-Morris Rona
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
J Crohns Colitis. 2025 May 8;19(5). doi: 10.1093/ecco-jcc/jjae183.
Inflammatory bowel disease (IBD) causes fatigue, pain, and fecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.
This study was nested within a randomized controlled trial of a digital symptom intervention for people with IBD (n = 780). Latent profile analysis was conducted on pre-randomization baseline measures of fatigue, pain, and fecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.
Latent profile analysis determined a three-profile model: Moderate (50%), High (40%), and Severe symptoms (10%). Diagnosis and fecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis, and irritable bowel syndrome (IBS)-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviors significantly increased the relative risk of High and Severe symptoms profile membership.
Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioral factors. These factors were also associated with IBS-type symptoms. Recognizing the potential impact of cognitive behavioral factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioral interventions to enhance patient care and improve outcomes.
炎症性肠病（IBD）会引发疲劳、疼痛以及排便急迫/失禁症状。识别症状特征亚组及其相关的心理关联因素或许能够实现更早的干预以及更有效的个性化治疗方案。
本研究嵌套于一项针对IBD患者（n = 780）的数字症状干预随机对照试验中。对随机分组前疲劳、疼痛和大便失禁的基线测量数据进行潜在特征分析。多项逻辑回归分析检验了特征类别与临床、人口统计学和心理因素之间的关联。
潜在特征分析确定了一个三特征模型：中度症状（50%）、重度症状（40%）和极重度症状（10%）。诊断和粪便钙卫蛋白与特征类别无关，但女性、合并症、确诊后的时间以及肠易激综合征（IBS）型症状与重度和极重度症状特征相关。抑郁、焦虑、负面症状认知、全或无及回避行为显著增加了属于重度和极重度症状特征的相对风险。
许多参与者即便被认为处于临床缓解期仍有症状。在控制了临床、炎症和人口统计学因素后，属于重度或极重度症状特征的相对风险与潜在可改变的认知行为因素相关。这些因素也与IBS型症状相关。认识到认知行为因素在加重症状方面的潜在影响，可促使更早识别需要支持的患者，并使治疗计划制定得更精准。本研究结果推动了一种更综合的IBD管理方法，将药物治疗与认知行为干预相结合，以加强患者护理并改善治疗效果。
