Itta M. Minderhoud

IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior

The aim of this study was to assess the prevalence of irritable bowel syndrome-like symptoms in healthy controls and inflammatory bowel disease patients in remission using the Rome II criteria. Furthermore, the possible relation of irritable bowel syndrome-like symptoms with the quality of life and coping behavior was studied. Seventy-three ulcerative colitis patients in remission, 34 Crohns disease patients in remission, and 66 healthy controls completed questionnaires on irritable bowel syndrome, quality of life, and coping. Using the Rome II criteria, irritable bowel syndrome-like symptoms were found in one-third of ulcerative colitis patients and in 42% of Crohns disease patients in remission. The presence of irritable bowel syndrome-like symptoms impaired the quality of life of patients, while no relation was found between the presence of symptoms and coping strategies.

High prevalence of fatigue in quiescent inflammatory bowel disease is not related to adrenocortical insufficiency.

OBJECTIVES:Inflammatory bowel disease (IBD) patients, with active as well as quiescent disease, frequently complain of fatigue. This often has consequences for patients’ work and daily lives. The primary aim of this study was to assess the prevalence and severity of fatigue in IBD patients in remission. Furthermore, we studied the correlation between fatigue and disease activity, quality of life, and biochemical and hematological test results, and the role of (secondary) hypocortisolism.METHODS:Eighty subjects with proven IBD were included. Disease activity was assessed using the Clinical Activity Index for Ulcerative Colitis and the Crohns Disease Activity Index. Quality of life was measured by the Inflammatory Bowel Disease Questionnaire, and fatigue was assessed using the Multidimensional Fatigue Inventory (MFI). Routine biochemical and hematological tests were performed, and basal cortisol was determined. To evaluate adrenocortical reserve in subjects with a cortisol level of <0.4 μmol/L, a low dose adrenocorticotrophin hormone test was performed. Healthy age- and sex-matched subjects (n = 67) served as controls.RESULTS:More than 40% of the IBD patients in remission suffered from fatigue. Mean MFI scores of the IBD patients were comparable to mean MFI scores reported in cancer patients. The Inflammatory Bowel Disease Questionnaire showed a negative correlation with the MFI (r= − 0.735; p < 0.001). No correlation was found between fatigue and basal cortisol levels or other laboratory parameters.CONCLUSIONS:Fatigue is an important feature in IBD in remission, adversely affecting the quality of life. It does not, however, affect all patients, nor does it seem to be the result of hypocortisolism.

What predicts mucosal inflammation in Crohn's disease patients?

Abstract A number of disease‐specific instruments have been created over the last 30 years to assess disease activity in Crohns disease (CD). These disease activity indices are constituted of clinical and laboratory parameters and their role in predicting disease activity and the course of disease has been reviewed various times. Currently, the severity of mucosal inflammation, assessed by endoscopy, is considered the gold standard for disease activity in CD. In the present review the most frequently used endoscopic disease activity indices and the correlation between mucosal inflammation and clinical disease activity indices, quality of life questionnaires, and biochemical markers is critically appraised. We conclude that no clinical disease activity index or single laboratory parameter of inflammation reliably predicts the mucosal inflammatory disease activity. A new, easy‐to‐use and robust activity index predicting mucosal inflammation is highly needed to assess the response to investigational drugs in trials and the effect of therapeutical interventions in clinical practice. (Inflamm Bowel Dis 2007)

Gastric Emptying of a Solid Meal Starts during Meal Ingestion: Combined Study Using 13C-Octanoic Acid Breath Test and Doppler Ultrasonography

Scintigraphy and the C-13-octanoic acid breath test are both applied to assess gastric emptying. Using the C-13-octanoic acid breath test, excretion curves show C-13 excretion immediately after ingestion of a solid egg meal, in contrast with scintigraphy where gastric emptying is observed after a lag phase. The aim of our study was to investigate whether transpyloric flow occurs during and directly after meal ingestion. Therefore, transpyloric flow was measured during and after ingestion of an egg meal labeled with C-13-octanoic acid, using Doppler ultrasonography. The breath test was performed simultaneously, with samples taken at regular intervals. The first emptying episode was observed 6.9 (3.9-16.2) min after start of meal ingestion. A significant relation between recovery of C-13 and total duration of gastric emptying during the first 20 min was observed (partial correlation coefficient r = 0.80, p <0.001). In conclusion, transpyloric flow starts during ingestion of a solid egg meal and results in detectable excretion of C-13. Copyright (C) 2004 S. Karger AG, Basel.Scintigraphy and the 13C-octanoic acid breath test are both applied to assess gastric emptying. Using the 13C-octanoic acid breath test, excretion curves show 13C excretion immediately after ingestion of a solid egg meal, in contrast with scintigraphy where gastric emptying is observed after a lag phase. The aim of our study was to investigate whether transpyloric flow occurs during and directly after meal ingestion. Therefore, transpyloric flow was measured during and after ingestion of an egg meal labeled with 13C-octanoic acid, using Doppler ultrasonography. The breath test was performed simultaneously, with samples taken at regular intervals. The first emptying episode was observed 6.9 (3.9–16.2) min after start of meal ingestion. A significant relation between recovery of 13C and total duration of gastric emptying during the first 20 min was observed (partial correlation coefficient r = 0.80, p < 0.001). In conclusion, transpyloric flow starts during ingestion of a solid egg meal and results in detectable excretion of 13C.

A Pilot Study on Chemospecific Duodenal Visceral Sensitivity in Inflammatory Bowel Disease in Remission

Background: Patients with inflammatory bowel disease (IBD) in remission frequently experience symptoms resembling irritable bowel syndrome (IBS). In IBS altered motility and visceral sensitivity are found throughout the whole gastrointestinal tract. We aimed to study chemospecific antroduodenal sensitivity in IBD patients. Methods: Antroduodenal manometry was performed in 10 IBD patients in remission and 13 controls. Small volumes of nutrients and acid were administered intraduodenally. Motility variables and sensation scores were compared before and after each infusion. Results: Acid and lipid infusion decreased the number of antral pressure waves in both groups (p < 0.05). After acid infusion the number of duodenal pressure waves in the sideholes just distal to the infusion port increased in IBD patients compared to the controls (p < 0.05). Lipid infusion increased the number of duodenal propagated pressure waves in both groups, but in controls they were also increased over longer distances (p < 0.005). None of the infusions significantly affected the sensation scores. Conclusion: Subtle alterations in chemospecific responses to lipids and acid in IBD patients in remission were observed, affecting duodenal motor activity but not duodenal perception. These changes are indicative of changes at the chemoreceptor level in the duodenal wall in this patient group.

Predicting Endoscopic Disease Activity in Crohn's Disease: A New and Validated Noninvasive Disease Activity Index (The Utrecht Activity Index)

Background:Mucosal healing is presently considered one of the primary goals in treatment of Crohns disease (CD), but this can only be confirmed by endoscopy. We aimed to design and validate a new disease activity index based on a combination of clinical characteristics and readily available laboratory parameters, which reliably predicts the presence and severity of endoscopic disease activity in patients with CD. Methods:Thirteen clinical characteristics and laboratory variables were selected for analysis. Endoscopic disease activity was assessed by the Crohns disease Endoscopic Index of Severity. A linear regression model was based on 93 ileocolonoscopies performed in 82 patients with CD and internally validated by bootstrap resampling. Subsequently, the newly developed model was validated in a cohort of 99 patients. Results:The number of liquid stools during 1 day × 0.25 + C-reactive protein (in milligrams per liter) × 0.1 + platelet count (×109/L) × 0.01 + fecal calprotectin (in milligrams per liter) × 0.001 − mean platelet volume (in femtoliters) × 0.2 optimally predicted the severity of endoscopic disease activity (bootstrap adjusted R2 = 0.50). The model demonstrated good agreement in the external validation (r = 0.7), especially for (ileo)colonic CD (r = 0.8). Using receiver operator characteristic statistics, a cutoff point of 3 on the new index indicated endoscopic disease activity with a sensitivity of 80% and a specificity of 92%. Conclusions:This newly developed, noninvasive, index was found to reliably predict endoscopic disease activity in patients with CD. This tool can facilitate clinical decision making and might prove valuable in clinical trials.