Journal Article Annotations
2022, 2nd Quarter

GI Psychiatry

Annotations by Ashwini Nadkarni, MD
July, 2022

Venlafaxine as an Adjuvant Therapy for Inflammatory Bowel Disease Patients With Anxious and Depressive Symptoms: A Randomized Controlled Trial.
Prevalence and factors associated with fatigue in patients with ulcerative colitis in China: a cross-sectional study.

PUBLICATION #1 — GI Psychiatry

Venlafaxine as an Adjuvant Therapy for Inflammatory Bowel Disease Patients With Anxious and Depressive Symptoms: A Randomized Controlled Trial.

Chang Liang, Pingrun Chen, Yu Tang, Chuheng Zhang, Na Lei, Ying Luo, Shihao Duan, Yan Zhang1

Abstract: Front Psychiatry. 2022 May 19;13:880058. doi: 10.3389/fpsyt.2022.880058. eCollection 2022.

Background and aims:
The effect of antidepressant therapy on Inflammatory Bowel Disease (IBD) remains controversial. This trial aimed to assess whether adding venlafaxine to standard therapy for IBD improved the quality of life (QoL), mental health, and disease activity of patients with IBD with anxious and depressive symptoms.

Methods:
A prospective, randomized, double-blind, and placebo-controlled clinical trial was conducted. Participants diagnosed with IBD with symptoms of anxiety or depression were randomly assigned to receive either venlafaxine 150 mg daily or equivalent placebo and followed for 6 months. Inflammatory Bowel Disease Questionnaire (IBDQ), Mayo score, Crohn's disease activity index (CDAI), Hospital Anxiety and Depression Scale (HADS), and blood examination were completed before the enrollment, during, and after the follow-up. Mixed linear models and univariate analyses were used to compare groups.

Results:
Forty-five patients with IBD were included, of whom 25 were randomized to receive venlafaxine. The mean age was 40.00 (SD = 13.12) years old and 25 (55.6%) were male. Venlafaxine showed a significant improvement on QoL (p < 0.001) and disease course (p = 0.035), a greater reduction in HADS (anxiety: p < 0.001, depression: p < 0.001), Mayo scores (p < 0.001), and CDAI (p = 0.006) after 6 months. Venlafaxine had no effect on IL-10 expression, endoscopic scores, relapse rate, and use rate of biologics and corticosteroids, but did reduce serum level of erythrocyte estimation rate (ESR; p = 0.003), C-reactive protein (CRP; p < 0.001) and tumor necrosis factor-α (TNF-α; p = 0.009).

Conclusions:
Venlafaxine has a significantly beneficial effect on QoL, IBD activity, and mental health in patients with IBD with comorbid anxious or depressive symptoms. (Chinese Clinical Trial Registry, ID: ChiCTR1900021496).

Annotation

The finding:
This was a longitudinal double-blinded placebo randomized trial demonstrated that venlafaxine improved quality of life, alleviated depressive and anxious symptoms, improved Crohn’s disease activity index and Mayo scores, and reduced the blood levels of CRP, ESR, and TNF-α for patients with inflammatory bowel disease (IBD).

Strength and weaknesses:
This was a single-center trial with a small sample size. Additionally, the follow up time was only 6 months. Pain was not tracked in the study. However, as a double-blind, randomized controlled trial, the study minimizes allocation and selection bias. Additionally, it is one of a very limited number of controlled trials examining the impact of antidepressant usage on IBD.

Relevance:
This study informs the treatment of multiple psychological and pathological factors of IBD. C-L psychiatrists should strongly consider venlafaxine as a treatment option including for improving quality of life and disease activity for patients with IBD.

PUBLICATION #2 — GI Psychiatry

Prevalence and factors associated with fatigue in patients with ulcerative colitis in China: a cross-sectional study.

Feng Xu, Jingyi Hu, Qian Yang, Yuejin Ji, Cheng Cheng, Lei Zhu, Hong Shen

Abstract: BMC Gastroenterol. 2022 Jun 3;22(1):281. doi: 10.1186/s12876-022-02357-z.

Fatigue is one of the most common symptoms reported by patients with ulcerative colitis (UC), while it has not been fully recognized and taken seriously in clinical practice. We aimed to investigate the prevalence of fatigue in patients with UC and identify the factors associated with fatigue and its severity in China.

Methods:
A cross-sectional study was conducted in Affiliated Hospital of Nanjing University of Chinese Medicine from May 2020 to February 2021. Demographic and clinical characteristics were collected. Fatigue was evaluated with the Fatigue Severity Scale and the Multidimensional Fatigue Inventory. The Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Index Scale and the Malnutrition Universal Screening Tool were respectively used to evaluate the anxiety, depression, sleep disturbance and nutritional risk of patients with UC.

Results:
A total of 220 UC patients were enrolled in this study. The prevalence of fatigue in patients was 61.8%, of which in patients with disease activity was 68.2%, and in patients in remission was 40.0%. Univariate analysis indicated that the Montreal classification, disease activity, anemia, anxiety, depression, sleep disturbance and high nutritional risk were the factors associated with fatigue in Patients with UC. Multivariate logistic regression analysis showed that the Montreal classification (E3: E1, OR = 2.665, 95% CI = 1.134–6.216), disease activity (OR = 2.157, 95% CI = 1.055–4.410) and anxiety (OR = 2.867, 95% CI = 1.154–7.126) were related to an increased risk of fatigue. Disease activity (RC = 0.240, 95% CI = 0.193–0.674) and anxiety (RC = 0.181, 95% CI = 0.000–0.151) were associated with severity of fatigue.

Conclusions:
This study demonstrated that the prevalence of fatigue among UC patients in China. The Montreal classification, disease activity and anxiety are associated with an increased risk of fatigue.

Annotation

The finding:
This cross-sectional study found that rates of fatigue in UC in patients in China had a prevalence of 62%. Additionally, 68% patients with disease activity and 40% in the remission stage reported fatigue. Factors associated with fatigue were disease activity and anxiety. Fatigue was not associated with female gender, education level, disease duration, complication and extra-intestinal manifestations, or IBD-related surgery.

Strength and weaknesses:
This was a cross-sectional study with a small sample size limited to China. The extent to which the data would be applicable to US C-L patients is questionable. However, this is one of the few studies examining the prevalence and correlates of fatigue among patients with IBD.

Relevance:
Fatigue remains a debilitating symptoms for patients with IBD. This study provides some rudimentary information on an approach to fatigue in patients with IBD, including by treating anxiety, insomnia, and nutritional deficiencies.