Optimizing Treatment Strategies to Manage Inflammatory Bowel Disease - Episode 3
Expert opinions on the effect of the progressive, relapsing nature of inflammatory bowel disease on a patients’ quality of life.
Remo Panaccione, MD, FRCPC: We know that our patients have significant symptoms. Those symptoms may vary, and there’s an impact on quality of life. Ed, can you summarize what we know about the impact of quality of life and how broad that is, both in Crohn disease and ulcerative colitis?
Edward Loftus Jr., MD: It’s bidirectional; disease activity impairs quality of life. Think about it: If you’re having abdominal pain all the time, or if you’re having urgency and frequency all the time, you’re not going to feel well. You’re going to be fatigued. You’re going to be anxious. You’re going to be depressed. There are clinical trials that have measured some of these instruments for quality of life, and they get worse when the disease gets worse. Then, when you successfully treat the disease, they often get better. On the flip side, we’re also accumulating evidence that depression can be a risk factor for IBD [irritable bowel disease]. Ashwin Ananthakrishnan MBBS, MPH has shown that in the Nurses’ Health Study, so it’s all intertwined. It’s just important to let patients know about this and recognize it and tell them, “You’re not alone. This is normal. Let’s get your disease under control. A lot of this is hopefully going to sort itself out, but if it doesn’t, we have additional resources to involve.”
William Sandborn, MD: We talked about early treatment to prevent irreversible bile damage or tissue damage with the idea that there’s a window of time that you can prevent damage and irreversible physical and physiological disability. Do you think the same thing applies to the psychological aspect, so that when you first get sick, if you recover, you can probably fully recover? Inversely, if you have a tough course, you almost see post-traumatic stress disorder [PTSD] in patients after a lot of hospitalizations and surgery. If you finally get the magic bullet and you stabilize their disease course and get them into a clinical—an endoscopic—remission, it’s too late psychologically. Do you guys see that?
Edward Loftus Jr., MD: Absolutely. I agree, and maybe certain people are more genetically susceptible to that because we’ve all seen patients who’ve gone through that same experience and haven’t had that reaction. But you can prevent all those bad things from happening up front, and you can think about the patients for whom you did happen to catch them when they had a little ileal disease, and you got them on appropriate biologic and they’ve never had a resection, and those people are well adjusted and normal. I agree with you, Bill. That area hasn’t been adequately studied, but you’re on to something.
Remo Panaccione, MD, FRCPC: We all know that there are so many components outside the typical symptoms that affect quality of life. Bill, when you’re mentioning this, you get people into what we’d consider an even deeper mission, and they still have the fatigue, depression, and anxiety disorders associated with this—which, in general, we aren’t very good at looking after. We’re becoming better at being multidisciplinary, but we need to take care of those components. To Bill’s point, we just finished a study looking at individual patients who are diagnosed early on—while they were still children or adolescents vs adults, looking at resiliency scales. An individual patient’s resiliency may be related to what Bill is saying. We’re working with a psychiatrist who has an interest in PTSD and hypnosis, and there are early signals; you could identify these patients who need that support. The way we understand the impact of quality of life may be evolving, and we just need to get better as a whole.
Remo Panaccione, MD, FRCPC: Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box. I’m sure you’ll see the folks in front of you on future programs. With that, thank you very much.
Transcript edited for clarity.