Factors associated with quality of care in inflammatory bowel diseases: a view from patient's side using the IQCARO quality of care decalogue.

BACKGROUND: Quality of care (QoC) is a highly important topic in inflammatory bowel disease (IBD). We recently elaborated a decalogue of QoC indicators (IQCARO-QoC) developed by IBD patients. The aim of the present study was to assess the factors associated with patients' evaluation of QoC in Spain using the IQCARO-QoC Decalogue recently developed by IBD patients. METHODS: A survey including patients' socio-demographic and clinical characteristics, and the IQCARO-QoC Decalogue, was completed by IBD patients. We described patients' assessment of QoC across Spanish patients. A univariable and multivariable analysis was performed to explore the associations between patients' characteristics and QoC. RESULTS: Questionnaires from 788 participant patients were analysed. Participants' mean age was 43.4 years, 63% were females and 58% had Crohn's disease. The mean QoC score was 8.1 (± 2.4 SD) points out of a maximum of 10. Items with the lowest score were related to the provision of information and the implication of the medical team throughout the entire patient care. Factors associated with better QoC scores included: being employed better disease control, fewer numbers of unscheduled visits, and being followed by a gastroenterologist specialized in IBD. CONCLUSIONS: Spanish patients' reported QoC seems to be globally good although there is room for improvement, especially in providing adequate information to patients. Care provided by specialized IBD gastroenterologists seems to be related with higher QoC scores.

Fungal and Bacterial Loads: Noninvasive Inflammatory Bowel Disease Biomarkers for the Clinical Setting.

Microbiome sequence data have been used to characterize Crohn's disease (CD) and ulcerative colitis (UC). Based on these data, we have previously identified microbiomarkers at the genus level to predict CD and CD relapse. However, microbial load was underexplored as a potential biomarker in inflammatory bowel disease (IBD). Here, we sought to study the use of fungal and bacterial loads as biomarkers to detect both CD and UC and CD and UC relapse. We analyzed the fecal fungal and bacterial loads of 294 stool samples obtained from 206 participants using real-time PCR amplification of the ITS2 region and the 16S rRNA gene, respectively. We combined the microbial data with demographic and standard laboratory data to diagnose ileal or ileocolonic CD and UC and predict disease relapse using the random forest algorithm. Fungal and bacterial loads were significantly different between healthy relatives of IBD patients and nonrelated healthy controls, between CD and UC patients in endoscopic remission, and between UC patients in relapse and non-UC individuals. Microbial load data combined with demographic and standard laboratory data improved the performance of the random forest models by 18%, reaching an average area under the receiver operating characteristic curve (AUC) of 0.842 (95% confidence interval [CI], 0.65 to 0.98), for IBD diagnosis and enhanced CD and UC discrimination and CD and UC relapse prediction. Our findings show that fecal fungal and bacterial loads could provide physicians with a noninvasive tool to discriminate disease subtypes or to predict disease flare in the clinical setting.IMPORTANCE Next-generation sequence data analysis has allowed a better understanding of the pathophysiology of IBD, relating microbiome composition and functions to the disease. Microbiome composition profiling may provide efficient diagnosis and prognosis tools in IBD. However, the bacterial and fungal loads of the fecal microbiota are underexplored as potential biomarkers of IBD. Ulcerative colitis (UC) patients have higher fecal fungal and bacterial loads than patients with ileal or ileocolonic CD. CD patients who relapsed harbor more-unstable fungal and bacterial loads than those of relapsed UC patients. Fecal fungal and bacterial load data improved prediction performance by 18% for IBD diagnosis based solely on clinical data and enhanced CD and UC discrimination and prediction of CD and UC relapse. Combined with existing laboratory biomarkers such as fecal calprotectin and C-reactive protein (CRP), microbial loads may improve the diagnostic accuracy of IBD and of ileal CD and UC disease activity and prediction of UC and ileal CD clinical relapse.

Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study.

BACKGROUND AND AIMS: The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. METHODS: This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. RESULTS: A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn's disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37-45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6-3.7], depression [OR = 2.4, 95% CI = 1.4-3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1-2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4-5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3-14.2], anxiety [RC = 25.8, 95% CI = 20.0-31.5], depression [RC = 30.6, 95% CI = 24.3-37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3-20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. CONCLUSIONS: The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.

Perception of lactose intolerance impairs health-related quality of life.

BACKGROUND/OBJECTIVES: Chronic conditions impair perception of well-being. Malabsorption of lactose is the most frequent form of malabsorption and manifests as lactose intolerance. There is a lack of information regarding their impact on self-perception of health. The objective of this study is to determine the subjective impact of self-reported lactose intolerance or objective lactose malabsorption on patient health by using a patient-reported outcome to measure health-related quality of life (HRQOL) and modification of lactose-containing food diet. SUBJECTS/METHODS: A 3-year prospective, cross-sectional study was performed in patients referred for a lactose hydrogen breath test. Patients were asked about their subjective opinion relative to their lactose tolerance and completed a validated, specific questionnaire to determine symptoms of intolerance during habitual consumption of dairy. A 50-g lactose breath test was then performed. Patients were grouped as absorbers vs malabsorbers and tolerant vs intolerants. RESULTS: A total of 580 patients were included (median age 30 years, 419 female). Overall, 324 patients (56%) considered themselves lactose intolerant and that perception was associated with avoidance of dairy consumption (55% vs only 9% of self-defined tolerants). Self-perception of intolerance was associated with lower HRQOL scores (median, 60 vs 70, P<0.01). In contrast, lactose objective malabsorption was not clearly associated with dairy avoidance (41% of malabsorbers avoided dairy vs 31% of absorbers). However, HRQOL scores were also significantly lower in malabsorbers than in absorbers (60 vs 70 respectively, P<0.001). CONCLUSIONS: Subjective perception of lactose intolerance affects the decision to avoid dairy even more than objective malabsorption. However, both self-perception of lactose intolerance and objective lactose malabsorption are associated with poorer perceived quality of life.

Colonisation by Faecalibacterium prausnitzii and maintenance of clinical remission in patients with ulcerative colitis.

BACKGROUND: Although incrimination of the intestinal microbiota in the pathogenesis of IBD is widely accepted, few data are available about the role of specific bacteria. Potentially, Faecalibacterium prausnitzii, bacteria with anti-inflammatory properties, might be deficient in ulcerative colitis (UC). AIM: To quantify F. prausnitzii in the faecal microbiota of UC patients in remission and determine its relationship with relapse. METHODS: A cross-sectional study included 116 UC patients in remission, 29 first-degree relatives and 31 healthy controls. A subset of eighteen patients, recruited during the first month of remission, underwent a 1-year follow-up. Total bacteria and F. prausnitzii were measured by quantitative Real Time PCR (qPCR, copies/g). Calprotectin was determined as inflammatory index (µg/g). RESULTS: We found that F. prausnitzii was reduced in patients (median, IQR: 1.4 × 108 , 5.1 × 107-4.5 × 108) and relatives (1.7 × 108, 9.3 × 107-5.1 × 108) vs. controls (6.5 × 108, 3.7 × 108-1.6 × 109, P < 0.0001). Moreover, low counts of F. prausnitzii were associated with less than 12 months of remission (8.0 × 107, 2.0 × 107-3.5 × 108 vs. 2.1 × 108, 1.0 × 108-7.9 × 108, P < 0.001) and more than 1 relapse/year (8.0 × 107, 3.2 × 107-3.8 × 108 vs. 1.9 × 108, 6.8 × 107-6.0 × 108, P < 0.01). When patients were followed up, F. prausnitzii increased steadily until reaching similar levels to those of controls if remission persisted (2.9 × 108, 9.3 × 106-1.2 × 109; calprotectin: 76, 19-212), whereas it remained low if patients relapsed (2.2 × 108, 1.4 × 106-3.3 × 108; calprotectin: 1760, 844-3662 P < 0.05 vs. controls). CONCLUSIONS: Defective gut colonisation by F. prausnitzii occurred in UC patients during remission and in their unaffected relatives. The recovery of the F. prausnitzii population after relapse is associated with maintenance of clinical remission.

Thiopurine methyl-transferase activity and azathioprine metabolite concentrations do not predict clinical outcome in thiopurine-treated inflammatory bowel disease patients.

BACKGROUND: Low thiopurine-methyl-transferase (TPMT) activity and high 6-thioguanine-nucleotide (6TGN) concentrations have been linked to therapeutic success in inflammatory bowel disease patients treated with thiopurines; however, this has not been implemented in clinical practice. AIM: To identify a therapeutic threshold value for TPMT or 6TGN concentrations, and their capability to predict treatment safety and efficacy. METHODS: Prospective multicentre study including steroid-resistant/dependent patients starting thiopurines. The TPMT activity was determined at inclusion (>5 U/mL required). Azathioprine metabolites [6TGN, 6-methyl-mercaptopurine ribonucleotides (6MMP), and 6TGN/6MMP and 6TGN/TPMT ratios] were periodically monitored during steroid tapering and after withdrawal for 6 months or until a new flare occurred. RESULTS: A total of 113 patients were analysed (62% clinical response). Areas under the receiver operating characteristic (ROC) curve (AUC) relating clinical response and metabolite levels at 2, 4 and 6 months after steroid withdrawal were less than 0.7. The AUCs relating final response and initial TPMT activity or metabolite concentrations at 2, 4, 8 and 16 weeks after starting thiopurines were less than 0.7. No cut-off point with worthwhile sensitivity/specificity was found. Eight (7%) patients developed thiopurine-related toxicity that could not be linked to TPMT activity or 6TGN levels. CONCLUSIONS: Our results do not support determination of TPMT activity or 6TGN concentrations to predict treatment outcome, and no useful serum metabolites threshold value to adjust the drug's dose was identified.

Cutoff values of the Inflammatory Bowel Disease Questionnaire to predict a normal health related quality of life.

UNLABELLED: One of the objectives in the treatment of the inflammatory bowel disease (IBD) is improving the patient's quality of life. However, we do not dispose of validated criteria to determine the questionnaire's scoring threshold that has to be reached in order to be able to assert that the patients' quality of life has normalized. OBJECTIVE: To determine the normality punctuation cutoff in the IBD specific quality of life questionnaire IBDQ-36. METHOD: Cross-sectional study in a random sample of IBD patients, who have completed the questionnaires IBDQ-36 and EuroQol-5D. The IBDQ-36 normality was calculated according to its equivalence with the EuroQol-5D tariff ≥ 0.90, which corresponds to the 95% CI of the average obtained in a Spanish general population. RESULTS: 218 patients were included. According to the EuroQol-5D tariff, 70 patients were considered to have a normal quality of life and 148 a quality of life poorer than the general population. The IBDQ-36 scoring was significantly higher in the normal quality of life group (222.9 ± 22.8 vs. 171.4 ± 44.8 in the bad quality of life group, p<0.001). According to the linear regression between IBDQ-36 and EuroQol-5D, the cutoff point is 209, with a sensitivity and specificity to predict normality of 0.74 and 0.71 respectively. CONCLUSIONS: Scores of the IBDQ-36 equal or superior to 209 suggest quality of life comparable to that perceived by the general population. This study allowed to set a threshold of normality in the management of the inflammatory bowel diseases.

Factors that impact health-related quality of life in adults with celiac disease: a multicenter study.

AIM: To evaluate the factors involved in the impairment of health-related quality of life (HRQOL) in patients with celiac disease. METHODS: A multicenter, cross-sectional prospective study was performed in patients with celiac disease who completed two HRQOL questionnaires: the gastrointestinal quality of life index (GIQLI) and the EuroQol-5D (EQ). RESULTS: Three hundred and forty patients (163 controlled with a gluten-free diet, and 177 newly diagnosed with a normal diet) were included. The GIQLI score was significantly better in patients on a gluten-free diet (GFD) than in non-treated patients on their usual diet, both in terms of the overall score (3.3 vs 2.7, respectively; P < 0.001), as well as on the individual questionnaire dimensions. Both the preference value of the EQ as the visual analogue scale were significantly better in treated than in non-treated patients (0.93 vs 0.72 P < 0.001 and 80 vs 70 P < 0.001, respectively). Variables significantly associated with a worse HRQOL score were female gender, failure to adhere to a GFD, and symptomatic status. CONCLUSION: In untreated celiac disease, the most important factors that influence patient perception of health are the presence of symptoms and a normal diet. HRQOL improves to levels similar to those described in the general population in celiac disease patients well controlled with a GFD.

[Spanish translation, adaptation, and validation of the 32-item questionnaire on quality of life for inflammatory bowel disease(IBDQ-32)]. / Traducción, adaptación y validación al español del cuestionario de calidad de vida de 32 ítems (IBDQ-32) de la enfermedad inflamatoria intestinal.

INTRODUCTION: The measurement of health-related quality of life (HRQoL) has an established relevance in the assessment, management, and follow-up of inflammatory bowel disease. The most commonly used measuring instrument is the 32-item version of Inflammatory Bowel Disease Questionnaire (IBDQ-32), which has never been adapted to Spanish. OBJECTIVE: To translate IBDQ-32 into Spanish, and to establish its validity, reliability, and sensitivity both in ulcerative colitis and Crohn s disease. METHOD: A prospective study in two phases -translation into Spanish and subsequent validation of IBDQ-32. Translation was based on the validated Spanish version of IBDQ-36, and IBDQ-32 items not included in IBDQ-36 were translated from scratch. Once the IBDQ32 translation was completed a comprehension-specific questionnaire was administered. To establish IBDQ-32 psychometric properties a group of patients completed both the validated Spanish version of IBDQ-36 and IBDQ-32. RESULTS: Eighty-four patients (53 with Crohn s disease and 31 with ulcerative colitis) were included. Median overall scores in both questionnaires for all 84 patients did not differ (6.1 vs. 6.2, p = ns), and Spearman s correlation was highly significant (r = 0.97, p < 0.001). The ability to discriminate between patients in flare-up or remission was also equivalent for both questionnaires (6.4 vs. 6.4 with r = 0.96 in remission and 3.8 vs. 3.9 with r = 0.95 active, p < 0.001 for remission vs. activity). These results were obtained in both the analyses for CD and UC independently (6.4 vs. 6.4 and 6.7 vs. 6.6, respectively; p = ns). CONCLUSION: The Spanish version of IBDQ-32 is valid and discriminating for patients with Crohn s disease or ulcerative colitis.

[Inflammatory bowel disease in celiac patients]. / Enfermedad inflamatoria intestinal en pacientes celíacos.

INTRODUCTION: A potential association between celic disease and inflammatory bowel disease hs been suggested, which may explain the fact that both disorders occasionally present in one patient or in his/her first-degree relatives more frequently than expected. OBJECTIVE: To establish the prevalence of Crohn s disease and ulcerative colitis in celiac patients and their relatives. METHOD: A cross-sectional, prospective epidemiological study in a group of celiac patients, their first-degree relatives, and a control group with similar epidemiological characteristics including the relatives of patients presenting at the ER for acute conditions. A semistructured interview was used to identify the presence of Crohn s disease and ulcerative colitis in celiac patients and their relatives. RESULTS: In all, 86 celiac patients and 432 relatives were included, who were compared to 809 control subjects (129 patients with acute conditions and 680 first-degree relatives). Three cases of Crohn s disease were identified among celiac patients, and 4 cases among their relatives. Only 1 case of Crohn s disease was detected in the control group (p < 0.01). No cases of ulcerative colitis were detected in any of the study groups. CONCLUSION: Patients with celiac disease and their relatives have a greater predisposition to Crohn s disease versus the control population.

Traducción, adaptación y validación al español del cuestionario de calidad de vida de 32 ítems (IBDQ-32) de la enfermedad inflamatoria intestinal / Spanish translation, adaptation, and validation of the 32-item quality of life questionnaire (IBDQ-32) for inflammatory bowel disease

Introducción: la medida de la calidad de vida relacionada conla salud (CVRS) tiene una reconocida importancia en la evaluación,el manejo y el seguimiento de la enfermedad inflamatoria intestinal.El instrumento de medida más utilizado es la versión de32 ítems del Inflammatory Bowel Disease Questionnaire (IBDQ-32), que no está adaptado al español.Objetivo: traducir la versión del IBDQ-32 al español y determinarsu validez, fiabilidad y sensibilidad tanto en la colitis ulcerosacomo en la enfermedad de Crohn.Método: estudio prospectivo en dos fases: traducción y posteriorvalidación del IBDQ-32 al español. La traducción se ha basadoen la versión al español validada del IBDQ-36, y los ítems delIBDQ-32 no incluidos en el IBDQ-36 se tradujeron “de novo”.Una vez terminada la traducción del IBDQ32, se aplicó un cuestionarioespecífico de comprensión. Para determinar las propiedadespsicométricas del IBDQ-32, un grupo de pacientes completóel IBDQ-36 ya validado al español y el IBDQ-32.Resultados: se han incluido 84 pacientes (53 con enfermedadde Crohn y 31 con colitis ulcerosa). La mediana de la puntuaciónglobal de ambos cuestionarios en los 84 pacientes no fue diferente(6,1 vs. 6,2, p = ns) y su correlación de Spearman fue muy significativa(r = 0,97, p < 0,001). La capacidad de discriminar entre pacientescon brote y remisión también fue equivalente en amboscuestionarios (6,4 vs. 6,4 con r = 0,96 en remisión y 3,8 vs. 3,9con r = 0,95 en actividad, p < 0,001 remisión vs actividad). Estosresultados se reprodujeron en el análisis para EC y CU independientemente(6,4 vs. 6,4 y 6,7 vs. 6,6 respectivamente, p = ns).Conclusión: la versión en castellano de 32 ítems del IBDQ esválida y discriminativa para ser aplicada en pacientes con enfermedadde Crohn o colitis ulcerosa

Introduction: the measurement of health-related quality oflife (HRQoL) has an established relevance in the assessment,management, and follow-up of inflammatory bowel disease. Themost commonly used measuring instrument is the 32-item versionof Inflammatory Bowel Disease Questionnaire (IBDQ-32), whichhas never been adapted to Spanish.Objective: to translate IBDQ-32 into Spanish, and to establishits validity, reliability, and sensitivity both in ulcerative colitisand Crohn’s disease.Method: a prospective study in two phases –translation intoSpanish and subsequent validation of IBDQ-32. Translation wasbased on the validated Spanish version of IBDQ-36, and IBDQ-32 items not included in IBDQ-36 were translated from scratch.Once the IBDQ32 translation was completed a comprehensionspecificquestionnaire was administered. To establish IBDQ-32psychometric properties a group of patients completed both thevalidated Spanish version of IBDQ-36 and IBDQ-32.Results: eighty-four patients (53 with Crohn’s disease and 31with ulcerative colitis) were included. Median overall scores inboth questionnaires for all 84 patients did not differ (6.1 vs. 6.2,p = ns), and Spearman’s correlation was highly significant (r =0.97, p < 0.001). The ability to discriminate between patients inflare-up or remission was also equivalent for both questionnaires(6.4 vs. 6.4 with r = 0.96 in remission and 3.8 vs. 3.9 with r =0.95 active, p < 0.001 for remission vs. activity). These resultswere obtained in both the analyses for CD and UC independently(6.4 vs. 6.4 and 6.7 vs. 6.6, respectively; p = ns).Conclusion: the Spanish version of IBDQ-32 is valid and discriminatingfor patients with Crohn’s disease or ulcerative colitis (AU)

Enfermedad inflamatoria intestinal en pacientes celíacos / Inflammatory bowel disease in celiac patients

Introducción: se ha sugerido una potencial asociación entrela enfermedad celíaca y la enfermedad inflamatoria intestinal, quepuede justificar que ambas enfermedades puedan presentarse enun mismo enfermo o en sus familiares de primer orden con mayorfrecuencia de lo esperado.Objetivo: determinar la prevalencia de la enfermedad deCrohn y la colitis ulcerosa en los enfermos celíacos y en sus familiares.Método: estudio epidemiológico prospectivo transversal en ungrupo de pacientes celíacos, sus familiares de primer grado y ungrupo control de características epidemiológicas similares, constituidopor familiares de pacientes que acuden al Servicio de Urgenciaspor un problema agudo. Para detectar la existencia de colitisulcerosa y enfermedad de Crohn en los celíacos y sus familiares,se realizó una entrevista semiestructurada.Resultados: se han incluido 86 celíacos y 432 familiares, quese han comparado con 809 controles (129 pacientes con una enfermedadaguda y 680 familiares de primer grado suyos). Se handetectado 3 casos de enfermedad de Crohn en el grupo de los enfermoscelíacos y 4 casos de enfermedad de Crohn en sus familiares.Sólo se ha detectado 1 caso de enfermedad de Crohn en elgrupo control (p < 0,01). No se ha identificado ningún caso decolitis ulcerosa en ninguno de los tres grupos de estudio.Conclusión: los pacientes con enfermedad celíaca y sus familiarestienen mayor predisposición a presentar una enfermedad deCrohn, que la población control

Introduction: a potential association between celic diseaseand inflammatory bowel disease hs been suggested, which mayexplain the fact that both disorders occasionally present in onepatient or in his/her first-degree relatives more frequently than expected.Objective: to establish the prevalence of Crohn’s disease andulcerative colitis in celiac patients and their relatives.Method: a cross-sectional, prospective epidemiological studyin a group of celiac patients, their first-degree relatives, and a controlgroup with similar epidemiological characteristics includingthe relatives of patients presenting at the ER for acute conditions.A semistructured interview was used to identify the presence ofCrohn’s disease and ulcerative colitis in celiac patients and theirrelatives.Results: in all, 86 celiac patients and 432 relatives were included,who were compared to 809 control subjects (129 patientswith acute conditions and 680 first-degree relatives). Three casesof Crohn’s disease were identified among celiac patients, and 4cases among their relatives. Only 1 case of Crohn’s disease wasdetected in the control group (p < 0.01). No cases of ulcerativecolitis were detected in any of the study groups.Conclusion: patients with celiac disease and their relativeshave a greater predisposition to Crohn’s disease versus the controlpopulation (AU)

Oral oligofructose-enriched inulin supplementation in acute ulcerative colitis is well tolerated and associated with lowered faecal calprotectin.

BACKGROUND: Inulin and oligofructose promote selective growth of saccharolytic bacteria with low inflammatory potential. OBJECTIVE: To test the effect of oligofructose-enriched inulin in patients with active ulcerative colitis. DESIGN: Prospective, randomized, placebo controlled pilot trial. Eligible patients had been previously in remission with mesalazine as maintenance therapy or no drug, and presented with a relapse of mild to moderate activity. They were treated with mesalazine (3 g/day) and randomly allocated to receive either oligofructose-enriched inulin (12 g/day, p.o., n = 10) or placebo (12 g/day of maltodextrin, p.o., n = 9) for 2 week. Primary endpoint was the anti-inflammatory effect as determined by reduction of calprotectin and human DNA in faeces. RESULTS: Rachmilewitz score decreased in both groups, reaching statistical significance at day 14 (P < 0.05). Oligofructose-enriched inulin was well-tolerated and dyspeptic symptoms scale decreased significantly with active treatment but not with placebo. At day 7, an early significant reduction of calprotectin was observed in the group receiving oligofructose-enriched inulin (day 0: 4377 +/- 659 microg/g; day 7: 1033 +/- 393 microg/g, P < 0.05) but not in the placebo group (day 0: 5834 +/- 1563 microg/g; day 7: 4084 +/- 1395 microg/g, n.s.). Changes in faecal concentration of human DNA were not significant. CONCLUSION: In active ulcerative colitis, dietary supplementation with oligofructose-enriched inulin is well tolerated and is associated with early reduction in faecal calprotectin.

Current epidemiology and accessibility to diet compliance in adult celiac disease.

BACKGROUND: The widespread of serologic diagnosis for celiac disease has brought about an epidemiologic shift. Little up-to-date information is available on relevant epidemiologic issues regarding diagnosis, information, and therapy. OBJECTIVE: To examine forms of presentation, diagnostic difficulties, follow-up, information sources, and treatment-related issues regarding celiac disease. METHOD: A cross-sectional observational study using a self-completed questionnaire. RESULTS: Seventy-three adult patients were included; 15.0% of cases were diagnosed over 60 years of age. Most were non-smokers (91.8%). The rate of first-degree relatives with celiac sprue was 10.9%. The disease had a classic presentation in only 54.7% of cases. A functional gastrointestinal disorder was initially suspected in 42.4% of patients. Diet adherence is adequate, with unintentional lack of compliance in 15.5% of patients. Diet results in absent or improved symptoms in virtually all patients, but most of them consider compliance a challenge. Forty percent had difficulty finding gluten-free food, and 50.8% had problems in labelling recognition. CONCLUSIONS: Celiac disease presents at any age, has a great variety of manifestations, and responds very well to gluten-free diet. It is crucial that patients be highly motivated and informed, and that they know for certain which foods and manufactured products are to be to used. Therefore, adequate control will result from coordination and cooperation regarding all resources involved, including medical care, and information provided by associations and other sources such as the Web.

Epidemiología actual y accesibilidad al seguimiento de la dieta de la enfermedad celiaca del adulto / Current epidemiology and accessibility to diet compliance in adult celiac disease

Introducción: la generalización del diagnóstico serológico dela enfermedad celiaca ha producido un cambio epidemiológico.Se dispone de poca información actualizada sobre aspectos epidemiológicosimportantes relativos al diagnóstico, información y tratamiento.Objetivo: analizar las formas de presentación de la celiaquía,dificultades en el diagnóstico, seguimiento, fuentes de informacióny aspectos relativos al tratamiento.Método: estudio observacional transversal mediante un cuestionarioautorrellenable.Resultados: se han incluido 73 pacientes adultos. El 15,0% decasos se diagnosticaron a partir de los 60 años de edad. La mayoríason no fumadores (91,8%). La tasa de familiares de primer gradocon celiaquía es del 10,9%. La enfermedad se presentó en su formaclásica en sólo el 54,7% de casos. En el 42,4% de pacientes la sospechadiagnóstica inicial fue de trastorno funcional digestivo. El seguimientode la dieta es correcto, con un incumplimiento no intencionadoen el 15,5% de pacientes. La dieta consigue ladesaparición o mejora de los síntomas en prácticamente todos lospacientes, pero la mayoría de ellos consideran que es difícil seguirla.El 40% tiene dificultades para encontrar alimentos sin gluten y el50,8% tiene problemas para reconocer el etiquetado.Conclusiones: La celiaquía se presenta a cualquier edad, semanifiesta de forma muy variada y responde muy bien a la dietasin gluten. Es esencial que los pacientes estén bien motivados e informadosy sepan con seguridad qué alimentos y productos manufacturadospueden consumir. El control idóneo de la enfermedadse alcanzará, por tanto, al conseguir la coordinación y colaboraciónde todos los recursos implicados, incluyendo la atención médica,la información mediante las asociaciones y otras fuentescomo internet

Background: the widespread of serologic diagnosis for celiacdisease has brought about an epidemiologic shift. Little up-to-dateinformation is available on relevant epidemiologic issues regardingdiagnosis, information, and therapy.Objective: to examine forms of presentation, diagnostic difficulties,follow-up, information sources, and treatment-related issuesregarding celiac disease.Method: a cross-sectional observational study using a selfcompletedquestionnaire.Results: seventy-three adult patients were included; 15.0% ofcases were diagnosed over 60 years of age. Most were non-smokers(91.8%). The rate of first-degree relatives with celiac sprue was10.9%. The disease had a classic presentation in only 54.7% ofcases. A functional gastrointestinal disorder was initially suspectedin 42.4% of patients. Diet adherence is adequate, with unintentionallack of compliance in 15.5% of patients. Diet results in absentor improved symptoms in virtually all patients, but most ofthem consider compliance a challenge. Forty percent had difficultyfinding gluten-free food, and 50.8% had problems in labellingrecognition.Conclusions: celiac disease presents at any age, has a greatvariety of manifestations, and responds very well to gluten-freediet. It is crucial that patients be highly motivated and informed,and that they know for certain which foods and manufacturedproducts are to be to used. Therefore, adequate control will resultfrom coordination and cooperation regarding all resources involved,including medical care, and information provided by associationsand other sources such as the Web

Percepción del estado de salud en la enfermedad celiaca / Perceived health status in celiac disease

Introducción: las enfermedades crónicas modifican la percepción de salud de los individuos que las padecen. Por este motivo, al ser la enfermedad celiaca una enfermedad crónica, podría causar un deterioro de la calidad de vida relacionada con la salud (CVRS).Objetivo: analizar el impacto de la enfermedad celiaca en las personas que la padecen. Método: estudio observacional transversal prospectivo en pacientescon enfermedad celiaca administrando dos cuestionariosgenéricos de medida de la CVRS: el EuroQol-5D y el GastroIntestinal Quality of Life (GIQLI). Resultados: se han incluido 54 pacientes controlados con dieta sin gluten durante una mediana de 60 meses y 9 recién diagnosticados y que aún no habían iniciado la dieta sin gluten. La puntuación global del GIQLI fue significativamente más alta, representativa de una mejor CVRS, en los celiacos tratados que en los que aún no habían iniciado la dieta (3,1 [2,7-3,5] vs. 2,4 [2,1-2,6], p < 0,01). Del mismo modo, el valor de preferencia del estado de salud del EuroQol fue también significativamente mejor en los celiacos tratados (0,87[0,8-1,0] vs. 0,7 [0,5-0,8], p < 0,01). La escala visual analógica del EuroQol fue también mejor puntuada,representativa de una mejor percepción de salud, en los celiacos tratados (80,0 [70,0-90,0] vs. 65,0 [40,0-71,0], p < 0,05). Comparados con los valores del EuroQol-5D en la población sana española, los valores de los celiacos tratados son similares a los de la población general.Conclusiones: la enfermedad celiaca deteriora la percepción de salud de los individuos que la padecen y mejora hasta alcanzar resultados equiparables a los de la población general cuando siguen la dieta sin gluten

Introduction: chronic conditions modify perceived health in affected individuals. For this reason celiac disease, being a chronic condition, may impair health-related quality of life (HRQOL). Objective: to analyze the impact of celiac disease in affected individuals. Method: observational, cross-sectional, prospective study in ;;patients with celiac disease by administering two HRQOL questionnaires: EuroQol-5D and GastroIntestinal Quality of Life (GIQLI). Results: 54 stable patients on a gluten-free diet for a median 60 months, and 9 newly diagnosed individuals still on their usual diet were included. Overall GIQLI score was significantly higher, meaning a better HRQOL, in treated celiac patients versus pretreated ;;celiac patients (3.1 [2.7-3.5] vs. 2.4 [2.1-2.6], p < 0.01). Similarly, EuroQol’s health status preference value was also significantly better in treated patients (0.87[0.8-1.0] vs. 0.7 [0.5-0.8], p < 0.01). EuroQol’s visual analogic scale had also better scores, ;;representing a better perceived health, among treated patients (80.0 [70.0-90.0] vs. 65.0 [40.0-71.0], p < 0.05). In comparison to EuroQol-5D scores among the healthy Spanish population, values obtained for celiac patients under treatment are similar to those seen in the general population. Conclusions: celiac disease impairs perceived health in affected individuals, which improves and reaches results similar to those in the general population when on a gluten-free diet

Impairment of health-related quality of life in patients with inflammatory bowel disease: a Spanish multicenter study.

BACKGROUND: Inflammatory bowel disease impairs patients' perception of health and has a negative impact on health-related quality of life (HRQOL). Most studies include patients from a single hospital. This may bias limit results through the use of small patient samples and/or samples within a restricted disease spectrum. METHODS: HRQOL was measured in patients with ulcerative colitis (UC) and Crohn's disease (CD) from 9 hospitals located in different geographical areas in Spain using 2 questionnaires: the Spanish version of the Inflammatory Bowel Disease Questionnaire (IBDQ) and the EuroQol. Results are expressed as medians. RESULTS: The study included 1156 patients (528 patients with UC and 628 with CD; median age, 35 yr; slight predominance of women, 617 versus 539). HRQOL worsened in parallel with disease severity to a similar extent in both UC (IBDQ scores of 6.1, 4.7, and 4.0 for the 3 disease severity groups, respectively) and CD (IBDQ scores of 6.1, 5.0, and 4.1, respectively). A similar inverse relation between clinical activity and quality of life was observed when EuroQol preference values were used. All 5 dimensions of the IBDQ showed significantly lower scores in patients with active UC and CD than in patients in remission. The pattern of scores by IBDQ dimensions differed between patients in relapse (who scored worse on the digestive symptoms dimension) and patients in remission. Variables related with disease activity, time of evolution since diagnosis and female sex, were significantly associated with having a worse perception of HRQOL. The type of disease or geographical area of residence did not influence results on the IBDQ. CONCLUSIONS: UC and CD impair patients' HRQOL, and the degree of impairment depends on disease activity but is independent of the type of disease and place of residence.

Perceived health status in celiac disease.

INTRODUCTION: Chronic conditions modify perceived health in affected individuals. For this reason celiac disease, being a chronic condition, may impair health-related quality of life (HRQOL). OBJECTIVE: To analyze the impact of celiac disease in affected individuals. METHOD: Observational, cross-sectional, prospective study in patients with celiac disease by administering two HRQOL questionnaires: EuroQol-5D and GastroIntestinal Quality of Life (GIQLI). RESULTS: 54 stable patients on a gluten-free diet for a median 60 months, and 9 newly diagnosed individuals still on their usual diet were included. Overall GIQLI score was significantly higher, meaning a better HRQOL, in treated celiac patients versus pre-treated celiac patients (3.1 [2.7-3.5] vs. 2.4 [2.1-2.6], p < 0.01). Similarly, EuroQol s health status preference value was also significantly better in treated patients (0.87[0.8-1.0] vs. 0.7 [0.5-0.8], p < 0.01). EuroQol s visual analogic scale had also better scores, representing a better perceived health, among treated patients (80.0 [70.0-90.0] vs. 65.0 [40.0-71.0], p < 0.05). In comparison to EuroQol-5D scores among the healthy Spanish population, values obtained for celiac patients under treatment are similar to those seen in the general population. CONCLUSIONS: celiac disease impairs perceived health in affected individuals, which improves and reaches results similar to those in the general population when on a gluten-free diet.