The Influence of the Inflammatory Bowel Diseases on the Perceived Stress and Quality of Life in a Sample of the South-Western Romanian Population.

BACKGROUND: Inflammatory bowel diseases (IBD) represent a category of chronic diseases of gastrointestinal tract with a long-term evolution which includes flares and periods of remission. The aim of the study is to identify and quantify the relationship between IBD status, perceived stress, coping mechanisms, and patients QOL. METHODS: Cross-sectional study on two samples consisting of 70 IBD patients monitored in the Gastroenterology Department of the Emergency Clinical County Hospital Craiova, Romania, respectively 70 healthy volunteers. Collected data include socio-demographic details, personal and familial medical history, clinical status, presumed risk factors, perceived stress (Perceived Stress Scale-PSS), coping strategies (COPE questionnaire) and Health-Related Quality of Life (HRQOL-SF-36 scale). RESULTS: Perceived stress was considerably higher on IBD subjects (p<0.0001). The assessment of HRQOL has shown that patients had the best perception over their physical and emotional domains of SF-36 (p<0.0001), while the most often coping mechanisms used are those from the problem-focused category. CONCLUSIONS: There is a significant relationship between increased activity of IBD and higher level of stress, that led to the development of problem-focused coping strategies. We did not find a strong correlation between lower HRQOL levels and the items considered as potential risk factors.

The differential diagnosis of ulcerative colitis versus angiodysplasia of the colon with ischemic colitis.

Ulcerative colitis and Crohn's disease are the inflammatory bowel diseases with a continuously increasing of prevalence. Their exact causes are still not well known and, more than that, they are raising up serious issues of diagnosis. The same difficulties of diagnosis are encountered in the case of the colonic angiodysplasia or ischemic colitis (IC). Colonic angiodysplasia is a common vascular abnormality of the gastrointestinal tract, being diagnosed mostly in the elderly persons, in a similar manner to the IC. For all these diseases comorbidities plays their important role both as causes of the onset and aggravating factors during the evolution. The differential diagnosis between these three conditions needs a complex and multidisciplinary approach, involving at least clinical evaluation, endoscopic and imaging assessments, and histopathological exam.

Diagnosis and Psychotherapeutic Needs by Early Maladaptive Schemas in Patients With Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient's personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged 16-76 years. An increase in the domain overvigilance and inhibition score had a significant effect (Wald = 6.583, p = 0.010), with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme (nearly three-quarters) and dependence/incompetence, vulnerability to harm and illness and subjugation schemas (over 80%). The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme's intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition.

Development of a Software for Treat-To-Target Strategy Implementation and Increasing Quality of Life in Patients with Inflammatory Bowel Disease.

The management of each form of the inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD), represents a challenge for the clinician and patient. The treatment paradigm was shifted from achievement of a symptomatic control of the disease, to the prevention of bowel damage, disease progression and disability, and better quality of life. These goals were related with the treat-to-target (T2T) strategies developed for a proper treatment optimization. The T2T strategy is based on the assessments of the biochemical markers (C-Reactive Protein-CRP and fecal calprotectin-FCAL), clinical targets (multiple clinical scoring systems), endoscopic targets (resolution of ulceration and friability, and histologic targets. Another objective of the treatment is the obtaining of a higher level of improvement for the patient's quality of life (QoL). One of the most reliable ways for a better management of IBD is represented by the IT instruments. In this respect, we developed under the auspices of RCCC (Romanian Club of Crohn's and Colitis) between 2018-2019 a new software for collecting medical data of IBD patients, according to STRIDE recommendations, in order to have continuous access to their evolutionary history and all therapeutically aspects. The software proved to be a valuable tool for clinician with a positive impact on clinical, economic, and patient-centred outcomes in IBD.