Only a minority of patients with longstanding inflammatory bowel disease – 19% of those with Crohn’s disease and 11% of those with ulcerative colitis – report having moderate to severe disability, Dr. Eran Israeli and his colleagues reported in the August issue of Clinical Gastroenterology and Hepatology (doi:10.1016/j.cgh.2013.12.009).
These rates compare favorably with those for patients with other chronic inflammatory diseases of long duration such as multiple sclerosis and ankylosing spondylitis, they noted.
Until now, most studies of IBD-related disability "have focused narrowly on work and employment," while data have been limited regarding home, social, and psychological domains. Dr. Israeli and his associates assessed IBD-related disability across all of these domains by analyzing information from the ongoing Manitoba IBD Cohort Study. This longitudinal cohort included patients aged 16 years and older who had had their disease for at least a decade when they enrolled in 2002.The MICS-enrolled patients from a population-based research registry who were representative of the general population of IBD patients in Canada, and tracked disease-related factors through semiannual questionnaires and annual in-person interviews.
For their study, Dr. Israeli and his colleagues assessed disability in 125 of these study patients with Crohn’s disease and 119 with ulcerative colitis 8 years after they had enrolled in the MCIS. Approximately 60% were women, and most of the participants were younger than 50 years, married, and working full- or part-time jobs. The median duration of IBD at the time of the disability assessment was 13 years, said Dr. Israeli of Hadassah-Hebrew University Medical Center, Jerusalem, and his associates.
Overall, 19% of the patients with Crohn’s disease and 11% of those with ulcerative colitis reported having significant disability across all spheres of life, as measured using the World Health Organization Disability Schedule and the Work and Social Adjustment Scale.
These rates were remarkably consistent across all domains studied, including patients’ perception of their stress level, as measured by the Cohen Perceived Stress Scale; current emotional distress, as measured by the Brief Symptom Inventory; and quality of life, as measured by the Inflammatory Bowel Disease Questionnaire.
Not only was the prevalence of disability higher in Crohn’s disease than in ulcerative colitis, but the severity of disability also was significantly greater in the realms of home management and social relationships. Patients with Crohn’s disease also reported greater emotional distress (depression and anxiety), higher stress levels, and poorer quality of life than those with ulcerative colitis.
Overall, 27% of the participants had a history of major depression, which often predated the development of IBD. This rate was much higher than that in the general population, and it was higher still in the subgroup of patients with the most significant disability: Depression was reported in 57% of the significantly disabled patients with Crohn’s disease and 37% among the significantly disabled patients with ulcerative colitis.
Both a history of depression and a higher degree of disease activity over time were significant predictors of disability. "The strong predictive effect of lifetime history of depression on disability in IBD suggests that when depression is identified, clinicians should be as aggressive in its treatment as they are in treating the luminal manifestations of the disease," the investigators said.
Somewhat surprisingly, a history of multiple IBD-related surgeries did not predict disability. This may be because surgical resection leads to long-term remission of symptoms, at least among patients with ulcerative colitis, they added.