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P458 Effect of cognitive behavioural therapy on clinical disease course in adolescents and young adults with inflammatory bowel disease and subclinical anxiety and/or depression: results of a randomised trial

G. van den Brink1, L. Stapersma2, A. S. Bom1, D. Rizopolous3, J. van der Woude4, R. Stuyt5, D. Hendriks6, J. van der Burg6, R. Beukers7, T. Korpershoek7, S. Theuns7, E. Utens2,8,9, J. Escher*1

1Erasmus MC-Sophia Children’s Hospital, Paediatric Gastroenterology, Rotterdam, The Netherlands, 2Erasmus MC-Sophia Children’s Hospital, Department of Child and Adolescent Psychiatry/Psychology, Rotterdam, The Netherlands, 3Erasmus MC, Department of Biostatistics, Rotterdam, The Netherlands, 4Erasmus MC, Department of Gastroenterology, Rotterdam, The Netherlands, 5Haga Hospital, Department of Gastroenterology, The Hague, The Netherlands, 6Juliana Children’s Hospital, Department of Paediatrics, The Hague, The Netherlands, 7Albert Schweitzer Hospital, Department of Paediatrics, Dordrecht, The Netherlands, 8University of Amsterdam, Research Institute of Child Development and Education, Amsterdam, The Netherlands, 9Academic Center for Child Psychiatry the Bascule, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands

Background

Anxiety and depressive symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence disease course. We investigated the effect of cognitive behavioural therapy (CBT) on clinical disease course in 10- to 25-year-old IBD patients with subclinical anxiety and/or depression.

Methods

In this multi-centre parallel group randomised controlled trial, patients were randomised to disease-specific CBT in addition to standard medical care (CBT + Care us usual [CAU]) or CAU only. Primary outcome was relapse rate in the first 12 months after randomisation. Secondary outcomes were clinical disease activity, faecal calprotectin and C-reactive protein (CRP). χ2-test and linear-mixed models were performed to compare groups.

Results

Seventy patients were randomised (mean age 18.3 years (±50% < 18 years), 31.4% male, 51.4% Crohn’s disease, 78.6% quiescent disease). After 12 months, relapse rate did not differ between patients in the CBT+CAU (n = 37; 43.2%) vs. CAU (n = 33; 48.5%) group (p = 0.66). Furthermore, clinical disease activity, faecal calprotectin and CRP, did not significantly change over time between and within both groups. Exploratory analyses in 10- to 18-year-old patients showed a different course of faecal calprotectin (p = 0.008) between both groups, with a 9% increase/month in the CAU (p = 0.004). In addition, in the same exploratory analysis for CRP, the difference between both groups approached significance (p = 0.054), with a 7% increase/month in the CAU group (p = 0.022).

Conclusion

CBT did not influence disease course in young IBD patients with subclinical anxiety and/or depression. However, exploratory analyses showed a possible positive effect of CBT on CRP and faecal calprotectin levels in children.