Depression and anxiety are comorbidities of inflammatory bowel disease (IBD). Though previous studies have proposed a relationship between anxiety, depression, and IBD, causality and directionality are largely unknown. Current and future research in these areas is aimed at exploring the biological underpinnings of this relationship, specifically pertaining to small molecule metabolism, such as tryptophan. Tryptophan is acquired through the diet and is the precursor to several vital bioactive metabolites including the hormone melatonin, the neurotransmitter serotonin, and vitamin B3. In this review, we discuss previous findings relating mental health comorbidities with IBD and underline ongoing research of tryptophan catabolite analysis.
BACKGROUND This study aimed to analyze the association of coexisting sinusitis and IBD, establish significant factors involved in their development, and enable further biological correlation between these two diseases. METHODS The IBD and Sinusitis Study at __________ (TISSUe) is a retrospective, single-center study. We reviewed patients to confirm IBD and chronic sinusitis diagnoses. Case-control propensity score matching was performed using matched controls with IBD only or sinusitis only. Statistical methods included Chi-squared test and Wilcoxon rank sum test. Logistic regression analysis was performed, and factors were considered significant if p<0.05. RESULTS Stratifying 214 patients with coexisting IBD and sinusitis, 176 patients had IBD first and 38 patients had sinusitis first. Multivariable analysis of factors associated with subsequent disease with matched controls determined that duration of disease, UC, steroid exposure ever, and younger age of IBD diagnosis were associated with subsequent sinusitis in patients with IBD; steroid exposure ever and duration of sinusitis were significantly associated with subsequent IBD in patients with sinusitis. CONCLUSIONS This study suggests that IBD maintenance therapies are not associated with increased risk of sinusitis, as proposed by adverse events in clinical trial data; rather, UC diagnosis and duration of disease may be more influential in sinusitis development. While further studies are necessary, this study also demonstrates that sinusitis precedes IBD in some patients, probing its biological association with IBD and possible classification as an extraintestinal manifestation.
Background Depression and anxiety are comorbidities of inflammatory bowel disease (IBD). Though previous studies have proposed a relationship between anxiety, depression and IBD, causality and directionality are unknown. We used a novel computerised adaptive testing technology to screen IBD patients for depression and anxiety and compared the screening results to recent measures of C-reactive protein (CRP). Methods Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH™ survey from Adaptive Testing Technologies (Chicago, IL); we then reviewed disease and patient characteristics. CRP measures from within 6 months of survey administration were used and levels ≥5 mg/l were considered positive. Patients who are CRP non-reactive were excluded. Pearson Chi-Square test was used to assess correlation. Results 134 patients (75 women, 112 Caucasian, 84 Crohn’s disease) participated in the study, 85 of whom had no prior history of psychiatric disorders. We identified 51 patients with depression (46 mild, 3 moderate, 2 severe) and 36 subjects with anxiety (24 mild, 10 moderate, 2 severe). Of the 134 patients recruited for this study, 57 had CRP reported. Median time between CRP measurement and CAT-MH™ administration was 2 days (IQR = 70). Categorical analysis stratified patients with positive and negative CRP who are also positive for depression and/or anxiety. Compared with patients with negative CRP values, patients with positive CRP were more likely to also test positive for depression and anxiety. These results were statistically significant for depression (p = 0.008) and nearly significant for anxiety (p = 0.058) (Figure 1). Quartile analysis of the 21 patients with elevated CRP levels revealed an increasing trend of average depression and anxiety severity scores. However, this correlation was lost when CRP >21 mg/l (Figure 2). Conclusion We illustrate the significant association between CRP and depression and anxiety severity scores on the CAT-MH™ survey. These findings suggest a positive relationship between inflammation and depression and anxiety in IBD patients. Physicians should consider patients with elevated CRP levels at risk for these mental health conditions.
BACKGROUND: Updated goals of management of IBD patients include monitoring disease activity, yet compliance with such strategies is poorly studied. We are performing a multi-year study of patients with active and quiescent IBD to assess the utility of a wearable, continuously active biosensor and validating disease activity with scheduled stool (calprotectin) and serum (CRP) testing. This study assessed compliance with these passive and active monitoring strategies. METHODS: Patients with diagnosed IBD were recruited for a prospective study using a biosensor (Fitbit Alta HR, San Francisco, CA) and mobile application (Litmus Health, Austin, TX). Each patient was instructed to wear a biosensor for a one-year period with stool sample drop-offs and blood draws for the first 6 months. The biosensor collected step count, sleep time, and heart rate during the study. Compliance was calculated as the number of days of heart rate, step count, and sleep data received over the duration of the study measured in days. Compliance was defined as ≥80% data collection in the time studied. A t-test was performed to determine the significant difference (P < 0.05) in compliance based on age, sex, disease activity, and body mass index (BMI); and between day time and night time wear. RESULTS: A total of 40 patients were analyzed; 23 men (57.5%), 24 with ulcerative colitis (60%), and 20 in remission (50%). 28 patients were <50 years of age (70%). The average BMI was 26.5 kg/m2. Overall, there was a 78% biosensor compliance rate among IBD patients. 45% of patients in clinical remission were compliant in stool drop-offs, while 60% of patients with clinically active disease were compliant in stool drop-offs (P > 0.05; 95% CI: -14.8 to 41.39). There were significant differences between biosensor compliance at night (57%) and day (98%) (P < 0.01; 95% CI: 0.31 to 0.5) and active disease (P < 0.01; 95% CI: -1.13 to -0.80). There was no significant difference in compliance and sex (P > 0.05; 95% CI: -0.53 to 0.11), age (P > 0.05; 95% CI: -11.14 to 7.84), and BMI (P > 0.05; 95% CI: -3.62 to 5.57). There were insufficient data to analyze compliance in answering questionnaires. CONCLUSION(S): In this study, patients were more compliant wearing the biosensor during the day than during the night and were more compliant if they had clinically active disease. In future studies, it will be important to provide an incentive and intervention to promote compliance in both active and passive monitoring strategies.
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