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International Journal of Colorectal Disease

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01-11-2018 | Original Article

Anxiety, depression, and inflammation after restorative proctocolectomy

Authors: Venkata Subhash Gorrepati, Sanjay Yadav, August Stuart, Walter Koltun, Evangelos Messaris, Emmanuelle D. Williams, Matthew D. Coates

Published in: International Journal of Colorectal Disease | Issue 11/2018

Abstract

Purpose

Anxiety and depression (A&D) are more common in inflammatory bowel disease (IBD) and in IBD patients who undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Our aim was to test the hypothesis that chronic inflammatory conditions in IPAA are associated with increased incidence of A&D.

Methods

Retrospective cohort study at a single tertiary care referral center using a consented IBD and colon cancer natural history registry. Demographic and clinical factors, including surgical and psychiatric history, were abstracted.

Results

We compared A&D rate in three cohorts: (1) ulcerative proctocolitis with IPAA (UC) (n = 353), (2) Crohn’s disease/indeterminate proctocolitis with IPAA (CDIC) (n = 49), and (3) familial adenomatous polyposis with IPAA (FAP) (n = 33). Forty-six CDIC patients (93.9%) demonstrated pouch-related inflammation, while 126 UC patients (35.7%) and 2 FAP patients (6.1%) developed pouchitis. CDIC had a higher rate of A&D co-diagnosis compared to UC and FAP (20.4 vs.12.7 vs.12.1% respectively; p < 0.05). UC patients with pouchitis also exhibited a higher rate of A&D than UC without pouchitis (19.8 vs.8.8%; p < 0.05). Multivariable analysis demonstrated that pre-operative corticosteroid use (OR = 4.46, CI = 1.34–14.87, p < 0.05), female gender (OR = 2.19, CI = 1.22–3.95, p < 0.01), tobacco use (OR = 2.92, CI = 1.57 = 5.41, p < 0.001), and pouch inflammation (OR = 2.37, CI = 1.28–4.39, p < 0.05) were each independently associated with A&D in these patients.

Conclusions

Anxiety and depression were more common in patients experiencing inflammatory conditions of the pouch. UC without pouchitis and FAP patients demonstrated lower rates of A&D (that were comparable to the general population), implying that having an IPAA alone was not enough to increase risk for A&D. Factors independently associated with A&D in IPAA included an inflamed pouch, corticosteroid use, smoking, and female gender.

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Title: Anxiety, depression, and inflammation after restorative proctocolectomy
Authors: Venkata Subhash Gorrepati
Sanjay Yadav
August Stuart
Walter Koltun
Evangelos Messaris
Emmanuelle D. Williams
Matthew D. Coates
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 11/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3110-y

At a glance: The STEP trials

Springer Medicine

Anxiety, depression, and inflammation after restorative proctocolectomy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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