Posttraumatic stress symptoms afflict patients with IBD

Survey results supported prior research that found one-quarter to one-third of patients with inflammatory bowel diseases report posttraumatic stress symptoms linked to their disease experience.

By Kate Burba

To better characterize posttraumatic stress (PTS) in patients with IBD, researchers surveyed 797 patients registered with the Crohn’s and Colitis Foundation/University of North Carolina IBD Partners database (Crohn’s disease n = 452; ulcerative colitis n = 345). The Post Traumatic Stress Disorder Checklist-5th edition supplemented this survey. According to study results, 5.6% of respondents reported existing PTS diagnoses as a direct result of IBD experiences while 9.6% of respondents met IBD-related PTS diagnostic criteria. Researchers noted female sex, younger age and less education as well as non-white race and Hispanic race correlated with higher levels of PTS symptoms. Further, increased PTS correlated with increased rates of anxiety, depression, pain interference, fatigue and health care use.

Healio Gastroenterology spoke with study author Tiffany Taft, PsyD, MIS, Northwestern University Feinburg School of Medicine, to gain a better understanding of the implications these results have on the care of patients with IBD going forward.

Healio Gastroenterology: Why did your team undertake this study?

Tiffany N. Taft: Through patient encounters and social media posts, we realized undiagnosed posttraumatic stress is likely occurring in some patients with IBD. When we looked at the existing research, we were very surprised to see only one study existed in Switzerland.

The present research is a follow-up to our first study with a much smaller group of patients that found around 30% had clinically significant symptoms of posttraumatic stress. We wanted to replicate the study in a larger group, so we used the IBD Partners database and were able to recruit almost 800 patients.

In addition to assessing if the rate of PTS symptoms remained high, which it did, we also wanted to evaluate how other patient outcomes already captured in the IBD Partners database like disease severity hospitalizations, and surgeries are related to PTS symptoms.

Healio: What is the most important take-home message?

Taft: If you treat IBD patients, screen them for medical PTS. Ask them questions about PTS symptoms, especially if they report anxiety, trouble sleeping or are having difficulty with following their treatment plan. Alternatively, you can use the Primary Care PTSD screener, which is free and available online.

Patients do not have to have an extensive number of hospital stays or surgeries to have PTS, rather it can come from a single traumatic incident including IBD symptoms; screening is especially important after a bad flare up, hospitalization or surgery.

When diagnosed early and treated properly, the prognosis is good for people with PTS. If left untreated, it can last for decades and undermine many physical and mental health outcomes.

Healio: How do these results inform IBD/post-traumatic stress care going forward?

Taft: We hope that any clinician involved in treating patients with IBD will become mindful of how routine procedures can be very anxiety provoking, even terrifying, to patients.

Check in with how your patients are doing emotionally during their encounters, especially difficult procedures like nasogastric tube placement. Communication and information quality are vital to easing patient fears, making a point to ask patients if they understand what they were just told and filling in any gaps can go a long way to mitigate PTS development.

Healio: Is there anything else you’d like to mention about the topic?

Taft: It is a good idea for any practice working with IBD patients to connect with therapists in their area who specialize in posttraumatic stress disorder. Thankfully, there are many more trauma-focused psychologists and social workers than those who specialize in psychogastroenterology.

Original source here.

Fitness With Crohn’s or Colitis

If you are in the middle of a flare-up or hit by a wave of fatigue, exercising might be the last thing you feel like doing.

But research has proven time and time again that physical activity has huge benefits for overall health, including reducing stress and improving heart function.

So how do you keep active when dealing with IBD symptoms, without pushing your limits too far for the sake of an extra five minutes on the treadmill?

As you will find in the IBD Toolkit for CCA members, the key is scaling your activities – learn what you are capable of when in remission, when experiencing low to mid-level symptoms, and when in full-on flare mode.

Even low-intensity activities such as a 30-minute walk or a light bike ride can help keep your fitness levels up. If you can manage this three times a week, you will be able to maintain fitness that you can build on when in better health.

Any significant changes to your lifestyle should be accompanied by a discussion with your doctor or IBD nurse, particularly if you are experiencing complications or symptoms, or need to recover from surgery.

CCA staff member Kerry McBride, who has lived with Crohn’s disease since her teens, says she is always trying different types of exercise depending on how her body is responding at the time.

“When I’m feeling good, I love doing plenty of high-energy activities like boxing and interval training. But if it’s one of those weeks (or months!), I’ll turn to light yoga, stretches or walking to keep my fitness up.”

Consider the following tips to see how you can incorporate fitness into your IBD management, the results might surprise you!

• If in flare-up, focus on strength maintenance and low-impact activities such as walking. Work on one muscle group at a time, rest when you need to, and stop when your body tells you.
• Take full advantage of symptom-free periods, and use this time to increase your fitness. Take on a new challenge, increase your weight training, or step up your fitness goals. Improvements made during this time will serve you well during flares or times of high stress.
• Plan exercise activities that allow for bathroom breaks if necessary, such as short exercise classes or circuits at a gym, or routes around your own neighbourhood within easy distance of your home or a friend’s.
• Learn ‘good stress’ and ‘bad stress’ – Sweating is not bad! Learn to recognise the signs of your body responding to exercise versus your body rejecting an activity. If you can recognise the difference, you will know when to keep going and when to let your body rest.
• Meet with a professional to discuss your personal fitness needs and figure out a plan for the good days and the bad. This will help you gradually build your strength and fitness, without aggravating symptoms or adding too much stress to your body.

What do you do to keep fit, even if you aren’t feeling 100 per cent?