Background: Disease activity may be a risk factor for psychological illness in patients with inflammatory bowel disease (IBD). Aim:To correlate objective measures of disease activity with psychological symptoms.Methods: Adult patients with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, psychological symptoms (depression, anxiety, stress), disease activity (symptoms, biomarkers, endoscopy), and quality of life (QoL) data were collected. One-way ANOVA and multivariable analyses examined the associations between disease activity and symptoms of psychological illness, and identified other predictors of mental illness and reduced QoL.Results: A total of 172 patients were included, 107 with Crohn's disease (CD) and 65 with ulcerative colitis (UC). There was no significant association between objec-

The Health Reach Sri Lanka project (1993-96) is described. It was a school-based assessment of children's exposure to war-related events and the presence of psychological distress, undertaken in six communities in parts of Sri Lanka variously affected by armed conflict. Its objectives, methods and results are presented. The research project aimed to raise national awareness of the psychosocial effects of armed conflict on children, using a community-development approach to local capacity building, based on the 'health initiative as peace initiative' model. As a follow-up to the study, a locally run programme, based on creative play and trauma-healing, was established, initially for the children involved in the study. This was later extended to other children in the district affected by armed conflict.

Summary Background The Disease Severity Index (DSI) is a novel tool to predict disease severity in inflammatory bowel disease (IBD). However, its ability to predict disease complications and the presence of psychosocial comorbidity is unclear. Aims: To assess prospectively associations between the DSI and psychological symptoms, quality‐of‐life (QoL) and disease outcomes in an IBD cohort. Methods Patients with IBD undergoing ileocolonoscopy were followed prospectively for 12 months. DSI, psychological symptoms (perceived stress (PSS‐10), depression (PHQ‐9), anxiety (GAD‐7)) and QoL (IBDQ‐32) scores were assessed at baseline. Logistic regression identified variables predicting a complicated IBD course at 12 months (composite outcome of need for escalation of biological/immunomodulator for disease relapse, recurrent corticosteroid use, IBD‐related hospitalisation and surgery). Receiver operating characteristics (ROC) analysis identified optimal DSI thresholds predicting a complicated disease course and multivariable logistic regression assessed the risk of reaching this outcome. Results One hundred and seventy‐two patients were recruited (100 Crohn's disease, 91 female). Median DSI was 21 (IQR 11–32) and 97 patients had endoscopically active disease at baseline. The DSI was significantly higher in patients with symptoms of moderate–severe stress (PSS‐10 > 14, p < 0.01), depression (PHQ‐9 ≥ 10, p < 0.01), anxiety (GAD‐7 ≥ 10, p < 0.05) and impaired quality‐of‐life (IBDQ‐32 < 168, p < 0.01). Only the baseline DSI (OR 1.05, p < 0.01) and endoscopically active disease (OR 6.12, p < 0.01) were associated with a complicated IBD course. A DSI > 23 was strongly predictive of a complicated IBD course (OR 8.31, p < 0.001). Conclusions The DSI is associated with psychological distress, impaired QoL and predicts a more complicated disease course in patients with IBD.

In healthy volunteers, both glucose meters showed a systematic positive bias one hour after breakfast. The significance of this finding in diabetes remains to be determined.

Background and aims Inflammatory bowel disease (IBD), consisting of Crohn’s disease (CD) and ulcerative colitis (UC), is a relapsing-remitting illness. Treat-to-target IBD management strategies require monitoring of gastrointestinal inflammation. This study aimed to investigate faecal myeloperoxidase (fMPO), a neutrophil granule enzyme, as a biomarker of IBD activity. Methods Prospectively recruited participants with IBD undergoing ileocolonoscopy for disease assessment provided biological samples and completed symptom questionnaires prior to endoscopy. fMPO, C-reactive protein (CRP) and faecal calprotectin (fCal) were compared with validated endoscopic indices (simple endoscopic score for CD and UC endoscopic index of severity). Receiver operating characteristics (ROC) curves assessed the performance of fMPO, CRP, and fCal in predicting endoscopic disease activity. Baseline biomarkers were used to predict a composite endpoint of complicated disease at 12 months (need for escalation of biological/immunomodulator due to relapse, steroid use, IBD-related hospitalisation and surgery). Results One hundred and seventy-two participants were recruited (91 female, 100 with CD). fMPO was significantly correlated with endoscopic activity in both CD (r=0.53, p&lt;0.01) and UC (r=0.63, p&lt;0.01), and with fCal in all patients with IBD (r=0.82, p&lt;0.01). fMPO was effective in predicting moderate-to-severely active CD (AUROC 0.86, p&lt;0.01) and UC (AUROC 0.92, p&lt;0.01). Individuals with a baseline fMPO &gt;26 µg/g were significantly more likely to reach the composite outcome at 12 months (HR 3.71, 95% CI 2.07-6.64, p&lt;0.01). Conclusions Faecal myeloperoxidase is an accurate biomarker of endoscopic activity in IBD and predicted a more complicated IBD course during follow-up.

The IBD-Cope is a concise IBD-specific coping strategy questionnaire with demonstrated reliability and validity. The IBD-Cope subscales are moderately correlated with adaptive and maladaptive subscales of the Brief COPE. Prospective studies are required to determine whether the 6 questions represented in the IBD-Cope accurately identify IBD patients who may benefit from interventions to improve coping strategies.

Background Increased disease activity may be a risk factor for sexual dysfunction (SD) in patients with inflammatory bowel disease (IBD). This study investigated associations between objective measures of disease activity and sexual function. Methods Adults with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, sexual function (Female Sexual Function Index and International Index of Erectile Function), disease activity (endoscopic, biomarker, and symptoms), psychological symptoms, and quality-of-life data were collected. Rates of SD and erectile dysfunction (ED) were compared between patients with active and inactive inflammation and symptoms using the Fisher’s exact test. Logistic regression examined associations between SD and ED, and disease characteristics and psychological symptoms. Results A total of 159 participants were included, 97 had Crohn’s disease and 85 were women. SD was reported in 36 of 59 and 13 of 59 sexually active women and men, respectively and ED in 22 of 59 sexually active men. Rates of SD and ED were similar between individuals with active and inactive IBD based on endoscopic indices (P &gt; .05) and biomarkers (P &gt; .05). Women with active IBD symptoms experienced significantly higher rates of SD (P &lt; .05), but men did not (P &gt; .05). Multivariable logistic regression identified that symptoms of severe depression (odds ratio, 5.77; 95% confidence interval, 1.59-20.94) were associated with SD in women, and severe anxiety (odds ratio, 15.62; 95% confidence interval, 1.74-140.23) was associated with ED in men. Conclusions Objective measures of disease activity are not associated with SD or ED in patients with IBD. Clinicians should consider concomitant psychological symptoms contributing to the sexual health of patients with IBD.

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