Colonoscopic Bowel Cancer Screening is Associated With More Depression and Anxiety in Previously Healthy People Than Those With Inflammatory Bowel Disease

Background: Surveillance for colorectal cancer in Inflammatory Bowel Disease (IBD) is generally recommended, although more recent data suggest the risk of colorectal cancer in this population is less than previously supposed. Given this, it is important to determine if any psychological harm is occurring to patients on a surveillance program. Aims: To compare the psychological effect of colonoscopy in an IBD surveillance program with colonoscopy performed in response to a positive faecal immunohistochemical test in previously well individuals. Methods: 60 subjects aged over 40 yrs who underwent colonoscopy after a positive fecal immunohistochemical test in the National Bowel Cancer Screening Program (NBCSP) and without known previous bowel disease were mailed a questionnaire, along with IBD database patients meeting the criteria for 2 yearly colonoscopic screening for colonic dysplasia and cancer. Respondents would be age and gender matched across groups. The questionnaire incorporated the Speilberger State-Trait Personality Inventory for Anxiety, Depression, Anger and Curiosity, as well as demographic questions. Speilberger comparisons between groups were made using the independent sample t test, whilst demographic data were compared using the Chi-square test. Results : 42/60 NBCSP subjects returned a completed questionnaire (70%), whilst 139/286 (49%) IBD subjects responded, allowing 42 patients to be age and gender matched in each group. Mean age was 57.71 years (NBCSP) vs 57.73 years (IBD) p=0.89, 53% being male. The groups were demographically comparable apart from a higher rate of car ownership amongst IBD subjects (42 vs 38 (p=0.04). NBCSP subjects had higher Overall Anxiety (Speilberger Score 28.5 vs 24.9, p=0.00) and Overall Depression scores (27.4 vs 22.7, p=0.00) than their IBD counterparts. (Table 1) NBCSP patients had higher State Anxiety (20.54 vs 17.97, p=0.00) and Depression (22.23 vs 16.73, p=0.00) scores than people with IBD, whilst IBD patients had higher State Curiosity scores than previously healthy people (26.00 vs 22.92, p=0.03). Interestingly, Trait Anxiety scores were higher amongst NBCSP patients (15.92 vs 13.76, p=0.00), whilst Trait Depression scores were increased in people with IBD (11.92 vs 10.28, p=0.02). Conclusion: Patients who are previously healthy and undergo colonoscopy for a positive faecal immunohistochem- ical test suffer more anxiety and depression symptoms after colonoscopy than those who are previously aware of their increased risk of cancer due to Inflammatory Bowel Disease. This should be considered in planning Bowel Cancer Screening Programs in previously healthy populations.Reme E.Mountifield, Amanda Moseley, Ruth Prosser, Antonina A. Mikocka-Walus, Graeme P. Young, Jane M. Andrews, Peter A. Bampto

Pregnancy and breastfeeding in inflammatory bowel disease

Inflammatory bowel disease (IBD) is frequent in women during their peak reproductive years. Accordingly, a significant number of questions and uncertainties arise from this population regarding the risk of transmission of IBD to the offspring, the impact of the disease and therapies on the fertility, the role of the disease on the course of the pregnancy and the mode of delivery, the impact of the therapy on the pregnancy and fetal development as well as breastfeeding. The safety of medical therapy during pregnancy and lactation is a major concern for both pregnant women and their partners as well as for physicians. As a general rule, it can be stated that the benefit of continuing medical therapy in IBD during pregnancy outweighs the potential risks in the vast majority of instances. This article will review recent developments on this topic consistent with the European Crohn's and Colitis Organization guidelines