Editorial: Cumulative Impact of Clinical Disease Activity, Biochemical Activity and Psychological Health on the Natural History of Inflammatory Bowel Disease During 8 Years of Longitudinal Follow-Up

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract, which has wide-ranging impacts for a patient. These can include severe gut symptoms, a period or lifetime of disability and significant effects on an individual's psychological health [1, 2]. Providing truly holistic care for a patient with IBD requires addressing both the inflammatory and noninflammatory burden of this debilitating disease.

Gut mucosal inflammation is a well-characterised contributor to the longitudinal course of IBD [2]. However, the impacts of the non-inflammatory burden on the longer term prognosis of IBD remain less certain. A recent study by Riggot et al. [3] explored this facet in a cohort of patients who were followed for 8 years. In this single-centre prospective cohort study, rates of IBD flares, glucocorticoid prescription, need for hospitalisation and/or intestinal resection were highest in those with clinical and biochemical disease activity with concomitant common mental health disorders. Of note, the presence of psychological comorbidity was associated with an increase in adverse outcomes even in individuals who were in biochemical disease remission at baseline assessment [3]. These findings reiterate the importance of considering brain–gut effects and the additive role of psychological morbidity on longer term IBD prognosis. However, the replication of such studies in ethnically and socioeconomically diverse cohorts is required to assess the impact of brain–gut effects in different populations living with IBD.

Screening for mental health issues is increasingly recognised as part of an integrated multidisciplinary approach to IBD care and is accepted by patients [4, 5]. The challenge, however, is in appropriately addressing these issues over the duration of the disease course to result in a sustained and meaningful improvement in long-term health outcomes. A previous meta-analysis of psychological therapies targeting the gut–brain axis in IBD has shown short-term improvements to psychological health and quality of life, but longer term benefits remain less clear [6]. Thus, appropriately identifying patients who are most likely to benefit from such therapies and finding a sustainable means to manage their psychological issues is a challenge for modern-day IBD practice. This is increasingly relevant given the rising costs of managing IBD and the increasing worldwide prevalence of this disease [7, 8].

Furthermore, aspects of IBD care such as medication adherence are also impacted by psychological health. Medication nonadherence in patients with IBD can result in uncontrolled disease and risk of disease-related complications, which are higher in patients with psychological health concerns [9]. Therefore, appropriately addressing these aspects of care may also help to improve medication adherence, patient activation and overall health outcomes [10].

The non-inflammatory burden remains a significant element of caring for patients with IBD. Addressing psychological health issues remains key in the holistic care of the patient and is important in reducing adverse outcomes.

Ben Massouridis: conceptualization, writing – original draft, writing – review and editing. Akhilesh Swaminathan: conceptualization, writing – original draft, writing – review and editing.

This article is linked to Riggott et al papers. To view these articles, visit https://doi.org/10.1111/apt.70068 and https://doi.org/10.1111/apt.70100.