Anxiety, depression, and inflammation after restorative proctocolectomy

Venkata Subhash Gorrepati, August Stuart, Walter Koltun, Evangelos Messaris, Emmanuelle Williams, Matthew Coates, Sanjay Yadav

Research output: Contribution to journalArticle

Abstract

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1601-1606
Number of pages6
JournalInternational Journal of Colorectal Disease
Volume33
Issue number11
DOIs
StatePublished - Nov 1 2018

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Restorative Proctocolectomy
Colonic Pouches
Anxiety
Pouchitis
Depression
Inflammation
Inflammatory Bowel Diseases
Proctocolitis
Tertiary Care Centers
Adrenal Cortex Hormones
Adenomatous Polyposis Coli
Tobacco Use
Natural History
Crohn Disease
Colonic Neoplasms
Psychiatry
Registries
Cohort Studies
Retrospective Studies
Smoking

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

@article{9b2b5d8919fa4469897583600dfdc4f7,
title = "Anxiety, depression, and inflammation after restorative proctocolectomy",
abstract = "Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.",
author = "Gorrepati, {Venkata Subhash} and August Stuart and Walter Koltun and Evangelos Messaris and Emmanuelle Williams and Matthew Coates and Sanjay Yadav",
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language = "English (US)",
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Anxiety, depression, and inflammation after restorative proctocolectomy. / Gorrepati, Venkata Subhash; Stuart, August; Koltun, Walter; Messaris, Evangelos; Williams, Emmanuelle; Coates, Matthew; Yadav, Sanjay.

In: International Journal of Colorectal Disease, Vol. 33, No. 11, 01.11.2018, p. 1601-1606.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anxiety, depression, and inflammation after restorative proctocolectomy

AU - Gorrepati, Venkata Subhash

AU - Stuart, August

AU - Koltun, Walter

AU - Messaris, Evangelos

AU - Williams, Emmanuelle

AU - Coates, Matthew

AU - Yadav, Sanjay

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.

AB - Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.

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JO - International Journal of Colorectal Disease

JF - International Journal of Colorectal Disease

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