Journal List > Korean J Gastroenterol > v.65(2) > 1007403

Kim, Kim, Jung, Chung, Lee, and Jang: Discordance between Patients and Parents Regarding the Perceived Causes of Clinical Relapse in Young Inflammatory Bowel Disease Patients

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.

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.
crossref
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.
crossref
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.
crossref
5. Ananthakrishnan AN. Environmental triggers for inflammatory bowel disease. Curr Gastroenterol Rep. 2013; 15:302.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
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.
crossref
19. Hviid A, Svanström H, Frisch M. Antibiotic use and inflammatory bowel diseases in childhood. Gut. 2011; 60:49–54.
crossref
20. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology. 2008; 134:577–594.
crossref
21. Chassaing B, Darfeuille-Michaud A. The commensal microbiota and enteropathogens in the pathogenesis of inflammatory bowel diseases. Gastroenterology. 2011; 140:1720–1728.
crossref
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.
crossref
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.
crossref

Table 1.
Clinical Characteristics of IBD Patients
Characteristic Value
Patient (n) 26
Age (yr) 22.5 (15–34)
Male 17 (65.4)
Current smoker 1 (3.8)
Recent alcohol intake 3 (11.5)
Crohn's disease 23 (88.5)
Ulcerative colitis 3 (11.5)
Mean disease duration (mo) 39.8±30.3
Location of disease in CD  
 Ileum and colon 16 (69.6)
 Colon 7 (30.4)
Location of disease in UC  
 Extensive disease 3 (100)
Disease behavior in CD  
 Luminal type 16 (69.6)
 Stricture type 6 (26.1)
 Penetrating type 1 (4.3)
Treatment  
 5-ASA 26 (100)
 Azathioprine/6-MP 16 (61.5)
 Biologic agents 6 (23.1)

Values are presented as n only, median (range), n (%), or mean±S IBD, inflammatory bowel disease; CD, Crohn's disease; UC, ulcerati colitis; ASA, aminosalicylic acid; MP, mercaptopurine.

Table 2.
Perceived Possible Factors of Clinical Relapse by IBD Patients and Parents
Factor Patient Parent
Psychosocial stress 18 (69.2) 15 (57.7)
Non-adherence to medication 15 (57.7) 15 (57.7)
Dietary problem High physical activity 10 (38.5) 4 (15.4) 8 (30.8) 2 (7.7)
Use of antibiotics/NSAIDs 4 (15.4) 8 (30.8)

Values are presented as n (%).

IBD, inflammatory bowel disease.

Table 3.
Concordance of Main Perceived Causes of Clinical Relapse between IBD Patients and Parents
Cause Patient Parent Concordance rate
Non-adherence to medication 5 (19.2) 5 (19.2) 100
Psychosocial stress 13 (50.0) 11 (42.3) 73.1
Dietary problem 6 (23.1) 5 (19.2) 73.1
High physical activity 7 (26.9) 7 (26.9) 76.9
Use of antibiotics/NSAIDs 2 (7.7) 1 (3.8) 88.5

Values are presented as n (%) or percent only.

IBD, inflammatory bowel disease.

Table 4.
Perceived Main Factors Associated with Clinical Relapse and Their Concordances
Number Patient Parent Concordance
1 PA NA PA OM Yes
2 S D No
3 Al NA OM No
4 NA OM O No
5 PA PA D Yes
6 S PA S Yes
7 D S PA No
8 S S PA Yes
9 S Sm Al No
10 S PA NA No
11 NA S NA Yes
12 S PA S Yes
13 D PA No
14 S PA PA Yes
15 D D PA Yes
16 NA PA NA Yes
17 S PA S Yes
18 D S S Yes
19 D S No
20 S S PA Yes
21 NA OM OM Yes
22 S NA S Yes
23 O S No
24 O O Yes
25 O D No
26 D S S PA Yes

PA, high physical activity; NA, non-adherence to medication; S, stress; D, dietary problem; Al, alcohol intake; OM, use of antibiotics or NSAIDs; Sm, smoking; O, others (including recent illness such as upper respiratory infection and febrile sensation and chilling).

TOOLS
Similar articles