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P679 Mental health is associated with disease course in a sub-group of inflammatory disease bowel patients with Crohn’s disease and ulcerative colitis: a multicentre observational study by the Osaka Gut Forum

M. Araki*1, S. Shinzaki1, H. Iijima1, S. Hiyama1, T. Yamada2, S. Arimitsu3, M. Komori4, N. Shibukawa5, A. Mukai6, S. Nakajima7, K. Kinoshita8, T. Miyagi9, S. Kitamura10, Y. Murayama11, H. Ogawa12, Y. Yasunaga13, M. Oshita14, E. Masuda15, H. Tanimukai16, M. Tsujii1, 4, T. Takehara1

1Osaka University Graduate School of Medicine, Department of Gastroenterology and Hepatology, 2-2 Yamadaoka, Suita, Japan, 2Osaka Medical Centre, National Hospital Organisation, Department of Gastroenterology, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Japan, 3Kinshukai, Infusion Clinic, Osaka, Japan, 4Osaka Rosai Hospital, Department of Gastroenterology, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, Japan, 5NTT-west Hospital, Department of Gastroenterology, 2-6-40, Karasugatsuji, Tennoji-ku, Osaka, Japan, 6Sumitomo Hospital, Department of Gastroenterology, 5-3-20, Nakanoshima, Kita-ku, Osaka, Japan, 7Toyonaka Municipal Hospital, Department of Gastroenterology, 4-14-1, Shibahara-cho, Toyonaka, Osaka, Japan, 8Otemae Hospital, Department of Gastroenterology, 1-5-34, Otemae, Chuo-ku, Osaka, Japan, 9Yao Municipal Hospital, Department of Gastroenterology, 1-3-1, Ryukacho, Yao, Osaka, Japan, 10Sakai City Hospital, Department of Gastroenterology, 1-1-1, Minamiyasui-cho, Sakai-ku, Sakai, Osaka, Japan, 11Itami City Hospital, Department of Gastroenterology, 1–100, Koyaike, Itami, Hyogo, Japan, 12Nishinomiya Municipal Central Hospital, Department of Gastroenterology, 8–24, Hayashida-cho, Nishinomiya, Hyogo, Japan, 13Hyogo Prefectural Nishinomiya Hospital, Department of Gastroenterology, 13–9, Rokutanji-cho, Nishinomiya, Hyogo, Japan, 14Osaka Police Hospital, Department of Gastroenterology, 10–31, Kitayama-cho, Tennoji-ku, Osaka, Japan, 15Osaka Minami Medical Centre, National Hospital Organisation, Department of Gastroenterology, 2-1, Kidohigashimachi, Kawachinagano, Osaka, Japan, 16Graduate School of Medicine and Faculty of Medicine, Kyoto University, Department of Clinical Oncology, Pharmacogenomics, and Palliative Medicine, Kyoto, Japan

Background

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a refractory disease repeating remission and flare. Although psychological stress and sleep disturbance play an important role in disease course, there are few studies reported about these factors in detail. In this study we aimed to clarify the association between mental health and disease course of IBD.

Methods

This was a multicentre observational study conducted by Osaka Gut Forum (OGF) comprising 20 institutions in Japan. In total, 1,078 IBD patients (303 CD patients, 775 UC patients) were enrolled. Data were collected using survey forms from doctors and questionnaires from patients from November 2013 to August 2014. Active disease was defined as CDAI ≥ 150 or PMS ≥ 2. A depressive mood was defined as CES-D scale ≥ 7. Patients were asked if disease activity was affected by altered mental state and how much they felt their daily life had been precluded by their sleep during the past week. Sleep disturbance was evaluated on a Likert scale from 1 (not at all) to 5 (exceedingly) and Likert scale ≥ 3 was defined as a sleep disturbance. Statistical analysis was performed using Pearson’s chi-square test and Mann–Whitney U test.

Results

75% of IBD patients answered that disease activity was affected by altered mental state. CES-D scale was significantly higher in the active patients than patients in remission (p < .0001). Disease activity was positively correlated with CES-D scale in patients who answered that disease activity was affected by altered mental state (group A; CD: r = 0.26, p = 0.0004, UC: r = 0.21, p < .0001), whereas there was no correlation in patients who did not (group B; CD: r = -0.04, p = 0.98, UC: r = 0.1, p = 0.17). Sleep disturbance was observed in 25 percent of IBD patients. The proportion of patients with sleep disturbance was significantly higher in active disease than in remission (p < .0001). When divided into 2 groups by mental state as above, patients with sleep disturbance scored higher disease activity than those without sleep disturbance in group A (CD: p = 0.001, UC: p = 0.02), whereas there was no association between sleep disturbance and disease activity in group B (CD: p = 0.08, UC: p = 0.73).

Conclusion

The association between disease activity and mental state or sleep disturbance is observed only in IBD patients who have experienced worsened disease activity by altered mental state, suggesting that there can be a sub-group of IBD patients in whom mental health affects the disease course.