Factors contributing to flares of ulcerative colitis in North India- a case-control study.
Adherence
Antibiotics
Cost
Crohn’s disease
Inflammatory bowel disease
NSAIDs
Stress
Ulcerative colitis
Journal
BMC gastroenterology
ISSN: 1471-230X
Titre abrégé: BMC Gastroenterol
Pays: England
ID NLM: 100968547
Informations de publication
Date de publication:
28 Sep 2023
28 Sep 2023
Historique:
received:
24
02
2023
accepted:
26
09
2023
medline:
2
10
2023
pubmed:
29
9
2023
entrez:
28
9
2023
Statut:
epublish
Résumé
Ulcerative colitis is a relapsing and remitting disease that may be associated with flares. The causes of flares in the Indian setting are not well recognized. The present prospective case-control study was conducted at a single center in North India. Cases were defined as patients admitted for flare of ulcerative colitis, while controls were patients in remission enrolled from the outpatient department. The basis of the diagnosis of flare was a simple clinical colitis activity index (SCCAI) of ≥ 5 and endoscopic activity, while remission was based on SCCAI < 4 and a normal fecal calprotectin. A questionnaire evaluating recent infections, stress, drug intake (antibiotics, pain medication), adherence to therapy, and use of complementary and alternative therapy (CAM) was administered. We included 84 patients (51 with flare and 33 in remission) with a median age of 38 years, of whom 47 (55.9%) were males. The two groups were similar for baseline parameters, including age (38, 23-50 and 38, 25.5-48.5 years), male gender (52.9% and 60.6%), extent of disease, extraintestinal manifestations (21.6% and 12.1%), use of 5-aminosalicylates (76.5% and 90.9%). The thiopurine use was lower in those having a flare (15.7% and 36.4%). Amongst the predictors of flare, the recent infections (39.2% and 30.3%), recent travel (31.4 and 27.3%), eating outside food (47.1% and 39.4%), consumption of milk products (88.2% and 75.8%), use of pain medication (43.1% and 33.3%) and recent stress (62.7% and 60.6%) were similar between cases and controls. The rates of antibiotic use (29.4% and 6.1%), lack of adherence (50.9% and 15.2%), and intake of CAM (70.6% and 33.3%) were higher in those with flare. Patients attributed a lack of adherence to the cost of therapy, presumed cure (due to lack of symptoms), and fear of adverse effects. Lack of adherence to inflammatory bowel disease therapies and recent CAM and antibiotic intake was higher in patients with flares of UC. The study makes ground for educational intervention(s) promoting knowledge and adherence to IBD therapies.
Sections du résumé
BACKGROUND
BACKGROUND
Ulcerative colitis is a relapsing and remitting disease that may be associated with flares. The causes of flares in the Indian setting are not well recognized.
METHODS
METHODS
The present prospective case-control study was conducted at a single center in North India. Cases were defined as patients admitted for flare of ulcerative colitis, while controls were patients in remission enrolled from the outpatient department. The basis of the diagnosis of flare was a simple clinical colitis activity index (SCCAI) of ≥ 5 and endoscopic activity, while remission was based on SCCAI < 4 and a normal fecal calprotectin. A questionnaire evaluating recent infections, stress, drug intake (antibiotics, pain medication), adherence to therapy, and use of complementary and alternative therapy (CAM) was administered.
RESULTS
RESULTS
We included 84 patients (51 with flare and 33 in remission) with a median age of 38 years, of whom 47 (55.9%) were males. The two groups were similar for baseline parameters, including age (38, 23-50 and 38, 25.5-48.5 years), male gender (52.9% and 60.6%), extent of disease, extraintestinal manifestations (21.6% and 12.1%), use of 5-aminosalicylates (76.5% and 90.9%). The thiopurine use was lower in those having a flare (15.7% and 36.4%). Amongst the predictors of flare, the recent infections (39.2% and 30.3%), recent travel (31.4 and 27.3%), eating outside food (47.1% and 39.4%), consumption of milk products (88.2% and 75.8%), use of pain medication (43.1% and 33.3%) and recent stress (62.7% and 60.6%) were similar between cases and controls. The rates of antibiotic use (29.4% and 6.1%), lack of adherence (50.9% and 15.2%), and intake of CAM (70.6% and 33.3%) were higher in those with flare. Patients attributed a lack of adherence to the cost of therapy, presumed cure (due to lack of symptoms), and fear of adverse effects.
CONCLUSION
CONCLUSIONS
Lack of adherence to inflammatory bowel disease therapies and recent CAM and antibiotic intake was higher in patients with flares of UC. The study makes ground for educational intervention(s) promoting knowledge and adherence to IBD therapies.
Identifiants
pubmed: 37770831
doi: 10.1186/s12876-023-02978-y
pii: 10.1186/s12876-023-02978-y
pmc: PMC10540407
doi:
Substances chimiques
Mesalamine
4Q81I59GXC
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
336Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Inflamm Bowel Dis. 2016 Jun;22(6):1412-7
pubmed: 27120570
Gut. 1998 Jul;43(1):29-32
pubmed: 9771402
J Gastroenterol Hepatol. 2017 Oct;32(10):1698-1705
pubmed: 28220959
Am J Gastroenterol. 2009 May;104(5):1298-313; quiz 1314
pubmed: 19337242
Br Med J. 1978 Sep 16;2(6140):801-2
pubmed: 698740
Turk J Gastroenterol. 2022 Sep;33(9):743-750
pubmed: 35946875
Lancet Gastroenterol Hepatol. 2021 Nov;6(11):884-885
pubmed: 34626558
Dig Dis Sci. 2021 Apr;66(4):1189-1194
pubmed: 32356256
Am J Gastroenterol. 2010 Sep;105(9):1994-2002
pubmed: 20372115
Am J Gastroenterol. 1997 Dec;92(12 Suppl):1S-4S
pubmed: 9395345
Antibiotics (Basel). 2021 Sep 17;10(9):
pubmed: 34572705
JAAPA. 1999 Nov;12(11):69-74, 79-80, 83-4; quiz 85-6
pubmed: 10747646
Intest Res. 2018 Oct;16(4):571-578
pubmed: 30301333
Clin Gastroenterol Hepatol. 2005 May;3(5):459-65
pubmed: 15880315
Curr Med Res Opin. 2020 Feb;36(2):293-300
pubmed: 31580168
Inflamm Bowel Dis. 2023 Jun 12;:
pubmed: 37307420
Inflamm Bowel Dis. 2020 Jan 1;26(1):1-10
pubmed: 31112238
Gut Liver. 2022 Sep 15;16(5):736-745
pubmed: 35145044
Gut. 1990 Feb;31(2):179-83
pubmed: 2311975
Gastroenterology. 2022 Nov;163(5):1145-1150
pubmed: 36273830
J Crohns Colitis. 2019 Mar 30;13(4):410-416
pubmed: 30371776
Intest Res. 2019 Oct;17(4):496-503
pubmed: 31602961
Inflamm Bowel Dis. 2023 May 2;29(5):834-836
pubmed: 35972338
Aliment Pharmacol Ther. 2012 Feb;35(3):342-9
pubmed: 22176478
Am J Gastroenterol. 2023 Aug 1;118(8):1388-1394
pubmed: 36826512
Lancet Gastroenterol Hepatol. 2020 Nov;5(11):986-995
pubmed: 32818437
Dig Dis Sci. 2023 Jan;68(1):58-64
pubmed: 35503483
J Crohns Colitis. 2022 Jan 28;16(1):2-17
pubmed: 34635919
N Engl J Med. 1987 Dec 24;317(26):1625-9
pubmed: 3317057
World J Gastroenterol. 2014 Apr 21;20(15):4329-34
pubmed: 24764669