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Background-Adjustment to chronic disease is a multidimensional construct described as successful adaptation to disease-specific demands, preservation of psychological well-being, functional status, and quality of life. Inflammatory bowel disease (IBD) can be particularly challenging due to the unpredictable, relapsing and remitting course of the disease.

Background Psychotherapy for CD has focused on patients w/psychological distress. Another approach to optimize management of CD is to target patients who do not exhibit psychological distress but engage in behaviors that undermine treatment efficacy/increase risk for flare. We sought to determine the feasibility/acceptability and estimate the effects of a program framed around Project Management (PM) principles on CD outcomes. Methods Twenty-eightadults w/quiescent CD w/o history of psychiatric disorder were randomized to Project Management(N = 16) or treatment as usual (TAU;N=12). Baseline and follow-up measures were IBDQ, Medication Adherence Scale (MAS), Perceived Stress Questionnaire (PSQ) and IBD Self-Efficacy Scale (IBD-SES). Results There were significant group X time effects favoring PM on IBDQ-Total Score [F(1) = 15.2, p = .001], IBDQ-Bowel [F(1) = 6.5, p = .02] and IBDQ-Systemic [F(1) = 9.3, p = .007] but not IBDQ-Emotional [F(1) = 1.9, p = ns] or IBDQ-Social [F(1) = 2.4, p = ns]. There was a significant interaction effect favoring PM w/ respect to PSQ [F(1) = 8.4, p = .01] and IBD SES [F(1) = 12.2, p = .003]. There was no immediate change in MAS [F(1) = 4.3, p = ns]. Moderate effect sizes (d > .30) were observed for IBDQ total score (d =.45), IBDQ bowel health (d =.45) and systemic health (d = .37). Effect sizes for PSQ (d = .13) and IBDSES (d = .17) were smaller. Conclusions Behavioral programs that appeal to patients who may not seek psychotherapy for negative health behaviors may improve quality of life and potentially disease course and outcomes.

Background Esophageal dysphagia is common in gastroenterology practice and has multiple etiologies. A complication for some patients with dysphagia is food impaction. A valid and reliable questionnaire to rapidly evaluate esophageal dysphagia and impaction symptoms can aid the gastroenterologist in gathering information to inform treatment approach and further evaluation, including endoscopy. Methods 1,638 patients participated over two study phases. 744 participants completed the Brief Esophageal Dysphagia Questionnaire (BEDQ) for phase 1; 869 completed the BEDQ, Visceral Sensitivity Index, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for phase 2. Demographic and clinical data were obtained via the electronic medical record. The BEDQ was evaluated for internal consistency, split-half reliability, ceiling and floor effects, and construct validity. Key Results The BEDQ demonstrated excellent internal consistency, reliability, and construct validity. The symptom frequency and severity scales scored above the standard acceptable cutoffs for reliability while the impaction subscale yielded poor internal consistency and split-half reliability; thus the impaction items were deemed qualifiers only and removed from the total score. No significant ceiling or floor effects were found with the exception of 1 item, and inter-item correlations fell within accepted ranges. Construct validity was supported by moderate yet significant correlations with other measures. The predictive ability of the BEDQ was small but significant. Conclusions & Inferences The BEDQ represents a rapid, reliable and valid assessment tool for esophageal dysphagia with food impaction for clinical practice that differentiates between patients with major motor dysfunction and mechanical obstruction.

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