Psychological comorbidities & IBD

July 17, 2021

Issue 13

Clinical Question

Do psychological comorbidities correlate with worse IBD?

Editor’s Bottom Line

Multiple psychological comorbidities predict a worse course for patients with inflammatory bowel disease.

Reference

Fairbrass KM, Gracie DJ, Ford AC. Longitudinal follow-up study: effect of psychological co-morbidity on the prognosis of inflammatory bowel disease. Aliment Pharmacol Therapeut. Epub ahead of print June 11, 2021; https://onlinelibrary.wiley.com/doi/10.1111/apt.16454

Synopsis

To examine whether a higher number of psychological comorbidities correlate with worse IBD, researchers analyzed 218 adult IBD patients in biochemical remission at baseline with fecal calprotectin (FC) <250 mcg/g.

Anxiety and depression were documented using the hospital anxiety and depression scale (HADS) and the patient health questionnaire-12 (PHQ-12). Disease activity was reassessed after a mean 2.35 years of follow-up using FC and Harvey-Bradshaw Index (for patients with Crohn’s disease) or the Simple Clinical Colitis Activity Index (for those with ulcerative colitis). The authors also examined medical records for IBD outcomes, including hospitalization, changes in IBD-related medications, and IBD surgery.

Overall, 22% of patients had one psychological comorbidity at baseline, while 6% had two comorbidities and 4% had three. While having a single psychological comorbidity did not correlate with IBD outcomes, those with two comorbidities were over three times more likely to receive a glucocorticosteroid prescription or experience a flare during follow-up (Hazard Ratio [HR] 3.18; 95% Confidence Interval [CI], 1.44–7.02) or require escalation of medical therapy (HR 2.48; 95% CI, 1.03–5.93). Those with three comorbidities were even more likely to experience these outcomes (HR 3.53; 95% CI, 1.26–9.92 for steroids/flare and HR 8.19; 95% CI, 2.88–23.23 for therapy escalation).

A composite outcome of corticosteroid prescription or flare, drug therapy escalation, hospitalization or intestinal resection was correlated with psychological comorbidities (HR 1.74; 95% CI, 1.07–2.82 for one comorbidity; HR 2.47; 95% CI, 1.12–5.46 for two comorbidities and HR 4.93; 95% CI, 1.84–13.17 for three comorbidities). Patient sex, IBD type or IBD-related medications had no impact on these associations.

Details

Study Design: Cross-sectional cohort with longitudinal follow-up

Funding: Leeds Teaching Hospitals Charitable Foundation and Tillotts Pharma UK Ltd.

Allocation: None

Setting: Single center

Level of Evidence: 1b