Korean J Gastroenterol.  2015 Feb;65(2):99-104. 10.4166/kjg.2015.65.2.99.

Discordance between Patients and Parents Regarding the Perceived Causes of Clinical Relapse in Young Inflammatory Bowel Disease Patients

Affiliations
  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. cello7727@naver.com

Abstract

BACKGROUND/AIMS
Relapse in inflammatory bowel disease (IBD) is not predictable, although several factors have been suggested. The aims of the current study were to assess and compare the possible causes of clinical relapse as perceived by patients and parents.
METHODS
Of 107 young (<35 years old) IBD patients, 26 patients who experienced recent (<3 month) relapse and their parents completed a questionnaire at the same time. Baseline characteristics and clinical manifestations were reviewed and the most common causes of relapse as perceived by patients and parents were compared.
RESULTS
Median patient age was 22.5 years and the male to female ratio was 17:9. Crohn's disease was diagnosed in 23 patients and ulcerative colitis in the other three patients. Mean disease duration was 39.8+/-30.3 months. Eighteen (69.2%) patients experienced stress before relapse. Fifteen (57.7%) parents thought that their children experienced stress before relapse. Agreement between patients and parents for non-adherence to medication and stress was 100% and 73.1%, respectively. Stress was considered the most likely cause of relapse in both groups. Discordance rate between parents and patients with respect to main causes of relapse was 40.4%.
CONCLUSIONS
Stress was perceived to be the most common condition noted before clinical relapse in young IBD patients and their parents. However, the discordance rate between patients and parents with respect to the main causes of relapse was 40.4%. This result suggests a considerable difference in terms of disease understanding between young IBD patients and parents.

Keyword

Inflammatory bowel diseases; Recurrence; Cause; Parents

MeSH Terms

Adolescent
Adult
Colitis, Ulcerative/diagnosis/psychology
Crohn Disease/diagnosis/psychology
Female
Humans
Inflammatory Bowel Diseases/*diagnosis/psychology
Male
Medication Adherence
Parents/*psychology
Recurrence
Stress, Psychological
Surveys and Questionnaires
Young Adult

Reference

References

1. Solberg IC, Vatn MH, H⊘ie O, et al. IBSEN Study Group. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007; 5:1430–1438.
Article
2. Solberg IC, Lygren I, Jahnsen J, et al. IBSEN Study Group. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol. 2009; 44:431–440.
Article
3. Cosnes J, Bourrier A, Nion-Larmurier I, Sokol H, Beaugerie L, Seksik P. Factors affecting outcomes in Crohn's disease over 15 years. Gut. 2012; 61:1140–1145.
4. Ha CY, Newberry RD, Stone CD, Ciorba MA. Patients with late-adult-onset ulcerative colitis have better outcomes than those with early onset disease. Clin Gastroenterol Hepatol. 2010; 8:682–687.e1.
Article
5. Ananthakrishnan AN. Environmental triggers for inflammatory bowel disease. Curr Gastroenterol Rep. 2013; 15:302.
Article
6. Ananthakrishnan AN. Environmental risk factors for inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2013; 9:367–374.
7. Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976; 70:439–444.
8. Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011; 141:1194–1201.
Article
9. Reif S, Klein I, Arber N, Gilat T. Lack of association between smoking and inflammatory bowel disease in Jewish patients in Israel. Gastroenterology. 1995; 108:1683–1687.
Article
10. Björnsson S, Jóhannsson JH. Inflammatory bowel disease in Iceland, 1990–1994: a prospective, nationwide, epidemiological study. Eur J Gastroenterol Hepatol. 2000; 12:31–38.
11. Abernethy B. Searching for the minimal essential information for skilled perception and action. Psychol Res. 1993; 55:131–138.
Article
12. Levenstein S, Prantera C, Varvo V, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000; 95:1213–1220.
Article
13. Mittermaier C, Dejaco C, Waldhoer T, et al. Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med. 2004; 66:79–84.
Article
14. Mawdsley JE, Rampton DS. Psychological stress in IBD: new in- sights into pathogenic and therapeutic implications. Gut. 2005; 54:1481–1491.
15. Higgins PD, Rubin DT, Kaulback K, Schoenfield PS, Kane SV. Systematic review: impact of non-adherence to 5-aminosalicylic acid products on the frequency and cost of ulcerative colitis flares. Aliment Pharmacol Ther. 2009; 29:247–257.
Article
16. Hommel KA, Denson LA, Baldassano RN. Oral medication ad-herence and disease severity in pediatric inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2011; 23:250–254.
Article
17. Kane SV, Cohen RD, Aikens JE, Hanauer SB. Prevalence of non-adherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol. 2001; 96:2929–2933.
Article
18. Sewitch MJ, Abrahamowicz M, Barkun A, et al. Patient non-adherence to medication in inflammatory bowel disease. Am J Gastroenterol. 2003; 98:1535–1544.
Article
19. Hviid A, Svanström H, Frisch M. Antibiotic use and inflammatory bowel diseases in childhood. Gut. 2011; 60:49–54.
Article
20. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology. 2008; 134:577–594.
Article
21. Chassaing B, Darfeuille-Michaud A. The commensal microbiota and enteropathogens in the pathogenesis of inflammatory bowel diseases. Gastroenterology. 2011; 140:1720–1728.
Article
22. Singh S, Graff LA, Bernstein CN. Do NSAIDs, antibiotics, infections, or stress trigger flares in IBD? Am J Gastroenterol. 2009; 104:1298–1313. quiz 1314.
Article
23. Spooren CE, Pierik MJ, Zeegers MP, Feskens EJ, Masclee AA, Jonkers DM. Review article: the association of diet with onset and relapse in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013; 38:1172–1187.
Article
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