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Inflammatory Bowel Disease (IBD)

Long-lasting disorders that cause irritation and ulcers in the gastrointestinal tract. The most common disorders are ulcerative colitis and Crohn's disease.

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(Source: NIH - National Institute of Diabetes and Digestive and Kidney Diseases)

What works? Research summarized

Evidence reviews

Psychological interventions in inflammatory bowel disease

This review examined the effect of psychological interventions in patients with inflammatory bowel diseases (Crohn's disease and ulcerative colitis) on health related quality of life, emotional state and disease activity. Overall, 21 studies were included in the review, but not all provided sufficient data for the different study questions. All studies were of low methodological quality. Most studies examined combination therapies, often aimed at improving stress management. For example, a therapy might include patient information sessions, training in relaxation techniques and psychotherapy sessions, such as group therapy. Others were restricted to just providing information materials to patients. None of the included studies reported any side effects of psychological interventions.

Specialist nurse counselling interventions for patients with inflammatory bowel disease

The number and type of gastroenterology and inflammatory bowel disease specialist nurses is increasing, along with the variety of roles performed in patient care and management. This review included one low quality trial of a specialist nurse counselling intervention compared with routine outpatient clinic follow up. No data were reported on remission outcomes. Counselling by a specialist nurse might improve mental health related quality of life for some IBD patients in the short term. However, the poor quality of the one included study does not allow for any definitive conclusions regarding the impact of the nurse‐led counselling program. Better designed studies are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.

Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease

Patients with long‐standing ulcerative colitis and colonic Crohn's disease have an increased risk of colorectal cancer compared with the general population. This review shows that there is no conclusive evidence that surveillance colonoscopy prolongs survival in these patients. However, since the principal studies were completed it has become clear that numerous biopsies are needed to accurately identify pre‐cancerous lesions (dysplasia) and that the benefit of surveillance could have been greater if multiple biopsies had been performed. It has also since been demonstrated that targeted biopsy of dysplastic areas is enhanced by dye spraying at colonoscopy. There is evidence from case control studies that cancers tend to be detected at an earlier stage in patients who are undergoing surveillance and that these patients have a better chance for recovery. This evidence should be treated with caution since lead‐time bias (the period between early detection of disease and the time of its usual clinical presentation) may contribute substantially to this apparent benefit. It is unlikely that there will be a randomised trial of surveillance colonoscopy in patients with colitis. Lower quality evidence, however, supports the continued use of some form of surveillance for these patients. The nature of this surveillance is gradually evolving, with two important developments since the last version of this review in 2004. Firstly, it has become apparent that most pre‐malignant (dysplastic) lesions can be visualised with careful endoscopy. Secondly, patients who lack histological inflammation on colonoscopy are at low risk for cancer development.

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Summaries for consumers

Psychological interventions in inflammatory bowel disease

This review examined the effect of psychological interventions in patients with inflammatory bowel diseases (Crohn's disease and ulcerative colitis) on health related quality of life, emotional state and disease activity. Overall, 21 studies were included in the review, but not all provided sufficient data for the different study questions. All studies were of low methodological quality. Most studies examined combination therapies, often aimed at improving stress management. For example, a therapy might include patient information sessions, training in relaxation techniques and psychotherapy sessions, such as group therapy. Others were restricted to just providing information materials to patients. None of the included studies reported any side effects of psychological interventions.

Specialist nurse counselling interventions for patients with inflammatory bowel disease

The number and type of gastroenterology and inflammatory bowel disease specialist nurses is increasing, along with the variety of roles performed in patient care and management. This review included one low quality trial of a specialist nurse counselling intervention compared with routine outpatient clinic follow up. No data were reported on remission outcomes. Counselling by a specialist nurse might improve mental health related quality of life for some IBD patients in the short term. However, the poor quality of the one included study does not allow for any definitive conclusions regarding the impact of the nurse‐led counselling program. Better designed studies are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.

Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease

Patients with long‐standing ulcerative colitis and colonic Crohn's disease have an increased risk of colorectal cancer compared with the general population. This review shows that there is no conclusive evidence that surveillance colonoscopy prolongs survival in these patients. However, since the principal studies were completed it has become clear that numerous biopsies are needed to accurately identify pre‐cancerous lesions (dysplasia) and that the benefit of surveillance could have been greater if multiple biopsies had been performed. It has also since been demonstrated that targeted biopsy of dysplastic areas is enhanced by dye spraying at colonoscopy. There is evidence from case control studies that cancers tend to be detected at an earlier stage in patients who are undergoing surveillance and that these patients have a better chance for recovery. This evidence should be treated with caution since lead‐time bias (the period between early detection of disease and the time of its usual clinical presentation) may contribute substantially to this apparent benefit. It is unlikely that there will be a randomised trial of surveillance colonoscopy in patients with colitis. Lower quality evidence, however, supports the continued use of some form of surveillance for these patients. The nature of this surveillance is gradually evolving, with two important developments since the last version of this review in 2004. Firstly, it has become apparent that most pre‐malignant (dysplastic) lesions can be visualised with careful endoscopy. Secondly, patients who lack histological inflammation on colonoscopy are at low risk for cancer development.

See all (81)

More about Inflammatory Bowel Disease

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See Also: Crohn's Disease, Ulcerative Colitis

Other terms to know:
Gastrointestinal Tract (GI Tract), Ulcers

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