MONTREAL — When rating the impact of ulcerative colitis, patients and physicians are not always on the same page, according to a study presented in two posters at the Canadian Digestive Diseases Week.
Adult patients with ulcerative colitis (UC) report a heavier psychological burden than do adult patients with rheumatoid arthritis (RA), migraine, or asthma, but gastroenterologists often underestimate the impact of this disease, reported Dr. David T. Rubin of the University of Chicago Medical Center, and his colleagues.
The UC: New Observations on Remission Management and Lifestyle (NORMAL) study, sponsored by Shire Pharmaceuticals, included 451 adult UC patients and 300 gastroenterologists. The participants completed an online survey in February and March 2007. The survey also included 309 RA patients, 305 migraine patients, and 305 asthma patients, all of whom were adults.
The UC patients were not necessarily being treated by the physicians in the study, as both groups were recruited separately.
Based on discussions with their physicians, 20% of the UC patients reported mild disease, 63% reported moderate disease, and 13% reported severe disease. Gastroenterologists tended to underestimate the frequency of disease flares in these patient groups, with 58% estimating only one flare per year in the mild UC group (patients self-reported a mean of five).
For the moderate UC group, 70% of the physicians estimated two or three flares, whereas patients self-reported a mean of eight. For the severe UC group, 22% of the physicians estimated 6 or more flares, whereas patients self-reported a mean of 11.
Furthermore, gastroenterologists underestimated how many patients thought that feeling unwell was a part of normal life, predicting this would be true for 37% of patients, when actually 73% of patients reported this, the authors wrote.
Compared with patients who had other illnesses, a significantly higher proportion (53%) of UC patients felt that their disease was controlling their lives, compared with RA patients (44%), migraine patients (37%), or asthma patients (19%). Stress, depression, and embarrassment were reported by 82%, 62%, and 70% of UC patients, respectively, compared with significantly lower proportions among all the other patients.
Physicians and patients had more similar views regarding the challenges of treatment with 5-aminosalicylic acid (5-ASA) medications. Whereas 41% of physicians believed patients were not adherent, 46% of patients reported that they had missed taking some of their medication in the previous week. Almost all (90%) of the gastroenterologists and 42% of the patients reported that it was difficult to take the medication at the prescribed intervals. Most patients (89%) reported that they would be interested in trying a once-daily 5-ASA medication.
“Patients with UC may benefit from improved disease management strategies (including simplified therapeutic regimens), disease education, and enhanced communication with gastroenterologists,” the authors concluded.
The meeting was sponsored by the Canadian Association of Gastroenterology.