Lars-Petter Jelsness-Jørgensen

Chronic fatigue is more prevalent in patients with inflammatory bowel disease than in healthy controls.

Background: Fatigue is a common symptom in chronic disease. Few studies, however, have focused on fatigue related to inflammatory bowel disease (IBD). The aim was to determine the prevalence of fatigue in IBD and to identify demographic and clinical factors that influence fatigue. Methods: Patients in remission and with mild and moderate IBD completed the Fatigue Questionnaire (FQ). Higher FQ scores indicate greater levels of fatigue. In addition, demographic and clinical variables were obtained. Corresponding FQ data from healthy controls (HC) are based on 2287 Norwegian citizens. Results: In total, 140 patients were included, mean age 43.9 years (SD 16.4), male/female = 61/79, ulcerative colitis (UC) / Crohns disease (CD) = 92/48. Total fatigue (TF) was 14.4, 14.7, and 12.2 for UC, CD, and HC, respectively. Chronic fatigue (CF), defined as substantial fatigue with duration more than 6 months, was reported in 29% (14/48) of CD and 22% (20/92) of UC compared to 11% (260/2287) of HC (P < 0.001 for both diagnoses). Linear regression analysis confirmed hemoglobin values, present gastrointestinal symptoms, and altered sleep to be the most important predictors of CF. Conclusions: Chronic fatigue is more common in patients with UC and CD compared with healthy controls. IBD symptoms, hemoglobin values, and altered sleep patterns are significant predictors of CF. (Inflamm Bowel Dis 2010)

Chronic fatigue is associated with impaired health‐related quality of life in inflammatory bowel disease

Aliment Pharmacol Ther 2011; 33: 106–114

Chronic fatigue is associated with increased disease-related worries and concerns in inflammatory bowel disease

AIM To investigate the impact of chronic fatigue on disease-related worries in inflammatory bowel disease (IBD) and the potential multicolinearity between subjective questionnaires. METHODS Patients in remission or with mild-to-moderate disease activity completed the fatigue questionnaire (FQ), the rating form of IBD patient concerns (RFIPC), the Short-Form 36 (SF-36), and IBD questionnaire (N-IBDQ). In addition, clinical and epidemiological data were obtained. RESULTS In total, 140 patients were included; of which 92 were diagnosed with ulcerative colitis and 48 with Crohns disease. The mean age of patients with chronic fatigue was 44.2 years (SD = 15.8) and for non-fatigued patients was 44.7 years (SD = 16.0). Chronic fatigued patients had clinically significantly increased levels of disease-related worries, as measured by Cohens d effect size. Worries about having an ostomy bag, loss of bowel control, and energy levels were most prominent in both chronic fatigued and non-chronic fatigued IBD patients. Variance inflation factor (VIF) and tolerance indicated that there were no problematic multicolinearity among the FQ, RFIPC, SF-36 and N-IBDQ responses (VIF < 5 and tolerance > 2). CONCLUSION Chronic fatigue is associated with increased levels of disease-related worries and concerns in IBD. Increased levels of worries were also associated with impaired health-related quality of life.

Worries and Concerns among Inflammatory Bowel Disease Patients Followed Prospectively over One Year

Disease-related worries are frequently reported in inflammatory bowel disease (IBD), but longitudinal assessments of these worries are scarce. In the present study, patients completed the rating form of IBD patient concerns (RFIPC) at three occasions during one year. One-way analysis of variance (ANO VA), t-tests, bivariate correlation, and linear regression analyses were used to analyse data. The validity and reliability of the Norwegian RFIPC was tested. A total of 140 patients were included (V1), ulcerative colitis (UC) n = 92, Crohns disease (CD) n = 48, mean age 46.9 and 40.0-year old, respectively. The highest rated worries included having an ostomy bag, loss of bowel control, and reduced energy levels. Symptoms were positively associated with more worries. A pattern of IBD-related worries was consistent over a period of one year. Worries about undergoing surgery or having an ostomy bag seemed to persist even when symptoms improved. The Norwegian RFIPC is valid and reliable.

Calprotectin Is a Useful Tool in Distinguishing Coexisting Irritable Bowel-Like Symptoms from That of Occult Inflammation among Inflammatory Bowel Disease Patients in Remission.

Background and Aim. In the inflammatory bowel diseases (IBDs), many symptoms are similar to the functional disorder irritable bowel syndrome (IBS). A challenge is thus to distinguish symptoms of IBD from IBS. The aim of this study was to investigate the levels of calprotectin in IBS-positive IBD patients in remission. Methods. Remission was defined as a simple clinical colitis activity index (SCCAI) or simple crohns disease activity index (SCDAI) score of less than three and less than four, respectively. The Rome II criteria were used to identify cases, and the calprotectin ELISA test was used to quantify calprotectin in stools. Results. The Rome II criteria were fulfilled in 24.6% of ulcerative colitis (UC) patients, while the comparable number for Crohns disease (CD) was 21.4%. There was a tendency for elevated fecal calprotectin levels in IBS-positive patients, regardless of diagnosis. However, these differences were only significant in CD. Conclusions. Calprotectin levels are elevated in subgroups of IBD patients that are in remission and have coexisting IBS-like symptoms. This study underscores the clinical usefulness of a noninvasive marker to distinguish patients in need of intensified followup from those that do not need further workup.

Fatigue and disease-related worries among inflammatory bowel disease patients in remission; is it a reflection of coexisting IBS-like symptoms? A short report

OBJECTIVES Irritable bowel syndrome (IBS) like symptoms and fatigue are frequently reported in quiescent inflammatory bowel disease (IBD). We hypothesized that coexisting IBS-like symptoms might be associated with increased levels of fatigue and disease-related worries. METHODS A total of 140 IBD outpatients were assessed. Cut-off for remission was <4 and <3 on the disease activity indices SCDAI and SCCAI. In addition patients on current steroid treatment were excluded. A diagnosis of IBS was based on the Rome criteria. Fatigue was measured with the Fatigue Questionnaire (FQ), disease related worries with the Rating Form of IBD Patient Concerns (RFIPC). RESULTS Eighty-nine patients fulfilled the criteria for remission. Of these 89 patients, 21 and 30 were IBS positive according to the Rome II and III criteria, respectively. FQ scores were significantly elevated in IBS positive UC patients. Clinical significant differences were also found in relation to RFIPC scores. CONCLUSION Coexisting IBS-like symptoms among IBD patients in remission are associated with an increased level of fatigue and disease-related worries.

Is patient reported outcome (PRO) affected by different follow-up regimens in inflammatory bowel disease (IBD)? A one year prospective, longitudinal comparison of nurse-led versus conventional follow-up

OBJECTIVE Specialist nurses have become increasingly involved in the management of Inflammatory Bowel Disease (IBD). The objectives of this study were to investigate the impact of nurse-led versus conventional follow-up on patient outcomes, such as quality of life, worries and time from relapse to start of treatment. METHODS Patients completed the Short Form 36 (SF-36), Inflammatory Bowel Disease Questionnaire (N-IBDQ) and the Rating Form of IBD Patient Concerns (RFIPC) at baseline and after 1 year. Socio-demographic and clinical variables were obtained at V1 and V2. In addition the amount of e.g., relapses, hospitalisations, time from relapse to start of treatment, sick-leave, unscheduled visits or telephone calls was recorded during the follow-up period. RESULTS A total of 140 patients were included; ulcerative colitis (UC) n=92, Crohns disease (CD) n=48, mean age 46.9 and 40.0 years old, respectively. One hundred and thirty three patients attended the follow-up after 1 year. After 1 year there were no differences between the groups in relation to quality of life, worries, amount of relapse, sick-leave, hospitalisations or surgery. Participants in nurse-led follow-up had a significantly (p<0.05) shorter interval from the start of a relapse to the start of treatment. CONCLUSIONS Nurse-led follow-up of IBD patients produces PRO results comparable to that of gastroenterologists and may shorten the interval from the beginning of a relapse to the start of treatment.

Measuring health-related quality of life in non-complicated diabetes patients may be an effective parameter to assess patients at risk of a more serious disease course: a cross-sectional study of two diabetes outpatient groups

AIM To describe health-related quality of life in diabetes outpatients and investigate the impact of diabetic foot ulcers, by comparing a group of patients with and without diabetic foot ulcers complications. Secondary to study the impact of sociodemographic and clinical variables in the two groups. DESIGN Cross-sectional study. METHODS The study involved 130 diabetes outpatients and 127 diabetic foot ulcers patients. Health-related quality of life was measured with the generic questionnaire Short Form-36, consisting of eight dimensional scores. All scores were adjusted for differences in age and gender (estimated marginal means). Differences were compared with anova calculations, by the use of Predictive Analytics Software, PASW (version 17.0). RESULTS This study confirms that health-related quality of life differs significantly between disease subgroups when measured with Short Form-36. Diabetic foot ulcers had a major negative impact on 7/8 subscales on the Short Form-36 compared to the diabetes outpatients group. health-related quality of life decreased with increasing amount of complications and comorbidity in the diabetes outpatients group, with cardiovascular complications being the most pronounced predictor of lower health-related quality of life scores. CONCLUSION Patients who have developed diabetic foot ulcers reports much poorer health-related quality of life than compared to diabetes outpatients. Factors linked to the development of late complications were not detected in the diabetic foot ulcers group, such as cardiovascular comorbidity and neuropathy. RELEVANCE TO CLINICAL PRACTICE Health-related quality of life measurement in early stages of disease may detect patients at risk of a more serious disease course and who consequently are in need of a more intensive follow-up.

Vitamin D deficiency in inflammatory bowel disease: prevalence and predictors in a Norwegian outpatient population

Abstract Background and aim: Vitamin D deficiency is common in inflammatory bowel disease (IBD). The aims of the present study were to determine the prevalence of vitamin D deficiency and to identify clinical and epidemiological variables associated with vitamin D deficiency in an outpatient population with IBD. Methods: Participants were recruited from nine hospitals in the southeastern and western regions of Norway as part of an observational, multicentre study from March 2013 to April 2014. Clinical and epidemiological data were collected by interview and from medical records. All analyses of serum 25-hydroxyvitamin D (25-OH-D) were performed in the same laboratory. Results: In total, 49% (200/408) of the patients had a 25-OH-D concentration <50 nmol/L, including 53% (122/230) of the Crohn’s disease (CD) patients and 44% (78/178) of the ulcerative colitis (UC) patients. In CD patients, disease activity, measured as the HBI, was inversely associated with vitamin D deficiency. No such association was observed with the Simple Clinical Colitis Activity Index (SCCAI) scores in UC, but in UC patients, vitamin D deficiency was associated with elevated faecal calprotectin >100 mg/kg. In patients with CD, there were significantly more relapses during the previous year in patients with vitamin D deficiency. Conclusions: Vitamin D deficiency was common, especially in CD, and was associated with increased disease activity, a relapsing disease course and higher inflammatory activity.

Health-related quality of life after pulmonary embolism: a cross-sectional study

Objectives The psychological effects of acute pulmonary embolism (PE) have scarcely been studied. The aims of this study were to evaluate health-related quality of life (HRQoL) in patients with a history of PE compared with that of the general population and buddy controls, and to explore factors that may predict impaired HRQoL. Design Cross-sectional. Setting Haematology and thrombosis unit in Fredrikstad, Norway. Participants 213 consecutive patients treated for PE were identified from hospital registries. Eligible patients were scheduled for a single study visit, including a functional capacity test (6 min walking test). HRQoL was assessed using the EuroQol 5D dimensions 3-level (EQ-5D-3L) questionnaire, of which the results were compared with Danish population norms and age-matched and sex-matched buddy controls. The buddy controls were recruited by asking every patient to hand over the EQ-5D questionnaire to 2 age-matched and sex-matched friends or relatives. Multivariable regression analyses were used to examine possible determinants of reduced HRQoL. Results Mean age was 61 years (SD 15), 117 (55%) were males, and median time since diagnosis was 3.8 years (range 0.3–9.5). Mean EuroQol visual analogue scale (EQ VAS) was 67 in PE as compared with 81 in the general population (p<0.005) and corresponding EQ-5D index values were 0.80 and 0.86 (p<0.005). Patients reported more problems in all 5 EQ-5D compared with both the buddy controls and the general population, p<0.05. Shorter 6 min walking distance (β=0.09, p<0.005) and patient-reported dyspnoea (β=11.27, p<0.005) were independent predictors of lower EQ VAS scores. Conclusions Our findings show that patients with a history of PE have impaired HRQoL when compared with the general population and buddy controls. Reduced functional capacity and persistent dyspnoea were the main predictors of this impairment.