Anxiety, depression, and inflammation after restorative proctocolectomy
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Anxiety and depression (A&D) are more common in inflammatory bowel disease (IBD) and in IBD patients who undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Our aim was to test the hypothesis that chronic inflammatory conditions in IPAA are associated with increased incidence of A&D.
Retrospective cohort study at a single tertiary care referral center using a consented IBD and colon cancer natural history registry. Demographic and clinical factors, including surgical and psychiatric history, were abstracted.
We compared A&D rate in three cohorts: (1) ulcerative proctocolitis with IPAA (UC) (n = 353), (2) Crohn’s disease/indeterminate proctocolitis with IPAA (CDIC) (n = 49), and (3) familial adenomatous polyposis with IPAA (FAP) (n = 33). Forty-six CDIC patients (93.9%) demonstrated pouch-related inflammation, while 126 UC patients (35.7%) and 2 FAP patients (6.1%) developed pouchitis. CDIC had a higher rate of A&D co-diagnosis compared to UC and FAP (20.4 vs.12.7 vs.12.1% respectively; p < 0.05). UC patients with pouchitis also exhibited a higher rate of A&D than UC without pouchitis (19.8 vs.8.8%; p < 0.05). Multivariable analysis demonstrated that pre-operative corticosteroid use (OR = 4.46, CI = 1.34–14.87, p < 0.05), female gender (OR = 2.19, CI = 1.22–3.95, p < 0.01), tobacco use (OR = 2.92, CI = 1.57 = 5.41, p < 0.001), and pouch inflammation (OR = 2.37, CI = 1.28–4.39, p < 0.05) were each independently associated with A&D in these patients.
Anxiety and depression were more common in patients experiencing inflammatory conditions of the pouch. UC without pouchitis and FAP patients demonstrated lower rates of A&D (that were comparable to the general population), implying that having an IPAA alone was not enough to increase risk for A&D. Factors independently associated with A&D in IPAA included an inflamed pouch, corticosteroid use, smoking, and female gender.
KeywordsAnxiety Depression Inflammatory bowel disease Restorative proctocolectomy
The authors would like to thank Susan Deiling and Leonard Harris for their outstanding technical assistance in the procurement of data associated with this study.
Source of funding
This research was supported by the Peter and Marsha Carlino Early Career Professorship in Inflammatory Bowel Disease and the Margot E. Walrath Career Development Professorship in Gastroenterology.
Compliance with ethical standards
This study was approved by the Pennsylvania State University College of Medicine Institutional Review Board and conducted in accordance with their guidelines.
Conflict of interest
The authors declare that they have no conflict of interest.
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