Determinants of female sexual function in inflammatory bowel disease: a survey based cross-sectional analysis.

BACKGROUND: Sexual function is impaired in women with inflammatory bowel disease (IBD) as compared to normal controls. We examined disease specific determinants of different aspects of low sexual function. METHODS: Women with IBD aged 18 to 65 presenting to the university departments of internal medicine and surgery were included. In addition, a random sample from the national patients organization was used (separate analyses). Sexual function was assessed by the Brief Index of Sexual Function in Women, comprising seven different domains of sexuality. Function was considered impaired if subscores were <-1 on a z-normalized scale. Results are presented as age adjusted odds ratios with 95% CI based on multiple logistic regression. RESULTS: 336 questionnaires were included (219 Crohn's disease, 117 ulcerative colitis). Most women reported low sexual activity (63%; 17% none at all, 20% moderate or high activity). Partnership satisfaction was high in spite of low sexual interest in this group. Depressed mood was the strongest predictor of low sexual function scores in all domains. Urban residency and higher socioecomic status had a protective effect. Disease activity was moderately associated with low desire (OR 1.8, 95% CI 1.0 to 3.2). Severity of the disease course impacted most on intercourse frequency (OR 2.3, 95% CI 1.4 to 4.7). Lubrication problems were more common in smokers (OR 2.5, 95% CI 1.3 to 5.1). CONCLUSION: Mood disturbances and social environment impacted more on sexual function in women with IBD than disease specific factors. Smoking is associated with lubrication problems.

The incidence of inflammatory bowel disease in a rural region of Southern Germany: a prospective population-based study.

OBJECTIVE: Although important advances in understanding the aetiology and pathogenesis of inflammatory bowel disease (IBD) have been made, many questions remain unanswered. As the most recent data available on the incidence of IBD in Germany were collected about 15 years ago, we set up a new population-based cohort to determine current incidence data for a defined region in Germany and to establish a basic cohort for prospective follow-up. METHODS: All patients living in the region of Oberpfalz newly diagnosed with IBD between 1 January 2004 and 31 December 2006 were included in this study by setting up a network of reporting clinicians and general practitioners in hospitals as well as in private practices. Demographic and clinical characteristics such as age at first diagnosis, localization of the disease, extraintestinal manifestations or family history on IBD were documented. Age-adjusted incidence rates are presented with 95% Poisson confidence intervals (CIs), based on the European standard population. RESULTS: In total, 286 newly diagnosed patients with IBD were reported in this region, 168 patients suffering from Crohn's disease (CD), 105 patients with ulcerative colitis. Age-standardized incidence rates were 11.0/10(5) (95% CI: 9.1-11.6) for IBD, 6.6/10(5) (95% CI: 5.6-7.7) for CD and 3.9/10(5) (95% CI: 3.2-4.7) for ulcerative colitis. Peak incidences were found in the age interval of 16-24 years for both diseases, predominantly for CD. Age at first diagnosis was lower, extraintestinal manifestations and a positive family history on IBD were more common in patients with CD. CONCLUSION: The incidence rate in IBD seems to be stable in Germany as compared with previously reported data, as is the remarkable predominance of CD. Prospective follow-up studies will be based on this incidence cohort.

Determinants of male sexual function in inflammatory bowel disease: a survey-based cross-sectional analysis in 280 men.

BACKGROUND: Problems with intimacy and sexual performance are among the major concerns of patients with inflammatory bowel disease (IBD). This study was performed to identify disease-related factors associated with low sexual function in men. METHODS: Consecutive patients were surveyed using a standardized questionnaire. A random sample from the national patients' organization was also included. Low sexual function was defined as a score < -1 on a z-normalized scale of the International Index of Erectile Function. Results are presented as adjusted odds ratios (ORs) with 95% confidence interval (CI) based on multiple logistic regression. RESULTS: 280 questionnaires were available for analysis. Scores were similar between the groups and compared with general population means, with the exception of sexual desire. Of the clinical group, 44% felt severely compromised sexually due to their IBD. Erectile function was particularly sensitive to somatic problems (disease activity, OR 2.5, 95% CI: 1.3-4.9; diabetes, OR 7.0, 95% CI: 1.4-35.0). The influence of depressive mood was restricted to aspects of satisfaction (sexual satisfaction, OR 2.3, 95% CI 1.1-4.9; overall satisfaction OR 3.7, 95% CI: 1.7-8.3). CONCLUSIONS: Sexual function was relatively better with longer disease duration and was not affected by the long-term severity of the disease.

Synergistic effects of troglitazone and oleate on the translatability of preproinsulin mRNA from INS-1 cells.

Glitazones are known to modulate fatty acid-induced effects on insulin secretion in the pancreatic beta-cell. The present study focused on combined effects of troglitazone and oleate on preproinsulin (PPI) biosynthesis. Insulin-producing INS-1 cells were incubated for 4 hr at 11.2mM glucose in the presence (O(+)) or absence (O(-)) of 200 microM oleate with (T(+)) or without (T(-)) 10 microM troglitazone. After cell lysis, cytoplasmic RNA was extracted and employed for Northern blotting and corresponding in vitro translation. Compared with untreated controls (CTRL=O(-)/T(-)), the cellular content of PPI-mRNA from cells which had been simultaneously treated by troglitazone and oleate (O(+)/T(+)) was significantly diminished (O(+)/T(+)=75+/-10% x CTRL; P=0.015). The PPI-mRNA content from those cells which had been exclusively exposed either to oleate (O(+)/T(-)) or troglitazone (O(-)/T(+)) did not significantly differ from that of the untreated controls. In spite of that decreased PPI-mRNA content, in vitro translation revealed the highest yield of newly synthesized PPI in RNA samples from those cells which had been simultaneously exposed to oleate and troglitazone before (O(+)/T(+)=1.6+/-0.3 x CTRL; P=0.01). It is concluded that troglitazone and oleate synergistically affect the translational rate at the level of the PPI-mRNA molecule.

Intracellular depletion of insulin: a comparative study with palmitate, oleate and elaidate in INS-1 cells.

OBJECTIVE: Free fatty acids (FFAs) deplete the intracellular insulin stores of pancreatic beta-cells. It has been suggested that this results from a lipotoxic dysregulation of both insulin secretion and insulin synthesis. In the present study, this hypothesis was tested within a 12-h time-course by directly relating the FFA-induced loss of intracellular insulin to corresponding parameters of insulin secretion and de novo biosynthesis. Palmitate, cis-monoenic oleate and the trans-monoenic elaidate were employed as model FFAs to elucidate potentially different effects due to chain length and configuration. METHODS: INS-1 cells were incubated for 1, 4 or 12 h with 11.2 mmol/l glucose with 200 micromol/l palmitate, oleate or elaidate and compared with non-FFA-exposed controls with respect to content and secretion of immunoreactive insulin (IRI). Biosynthesis of insulin was monitored by pulse-labeling experiments and by Northern blot analysis. RESULTS: IRI content dropped by 50-60% after a short-term exposure with all FFAs employed (P< or =0.001). It tended to recover after 12 h of treatment with oleate and elaidate but not with palmitate. FFA treatment increased insulin secretion by 25% (P< or =0.05) which could not account quantitatively for the intracellular loss. FFA-induced changes in insulin biosynthesis did not correlate clearly with the FFA-induced intracellular loss. CONCLUSIONS: The FFA-induced loss of IRI is an acute effect independent of the FFA employed. It cannot be sufficiently explained by FFA-induced perturbances of IRI secretion and biosynthesis. We therefore postulate an additional FFA-triggered mechanism, e.g. intracellular IRI degradation.

A survey-based index was validated for measuring disease activity in inflammatory bowel disease. An evaluation study.

OBJECTIVE: Crohn's disease is a highly distressful chronic disorder, characterized by frequent relapses. A symptom-based disease activity index was developed for use in epidemiological research. STUDY DESIGN AND SETTING: One hundred and six consecutive patients presenting to a tertiary referral hospital in Southern Germany in 2004-2005 participated in a questionnaire-based survey. As a reference standard, disease activity was assessed using a clinical index (Crohn's Disease Activity Index [CDAI], based on symptoms reported to physician, laboratory markers, and physician assessed signs). A linear regression equation was calculated based on the survey data on severity of symptoms (dependent variable: CDAI). Survey index scores (S-CDAI) were then calculated using the estimated coefficients for pain, stools, and general well-being in an independent data set. RESULTS: S-CDAI and CDAI showed moderate agreement (kappa=0.57 for relapse vs. remission). High activity (high S-CDAI) correlated negatively with high quality of life (disease specific: Short Inflammatory Bowel Disease Quality-of-Life Questionnaire; r=-0.67; generic: Short Form 36 physical summary score, r=-0.47). Test-retest reliability and sensitivity for change were good (intraclass correlation coefficient 0.81). CONCLUSION: A useful, valid, and reliable disease activity score was developed, which will facilitate meaningful survey research in this chronic disorder.