Study the effect of infliximab on physical and mental health in Crohn’s disease patients with active anal fistula

doi:10.16138/j.1673-6087.2021.04.001

Abstract

Abstract:

Objective To understand whether the remission of active anal fistula (AAF) directly affects the quality of life, self-esteem and body image in the patients with Crohn’s disease (CD), and whether infliximab (IFX) treatment can improve their psychosocial disorders. Methods The data including baseline information of CD patients with AAF in the inflammatory bowel disease(IBD) database of our hospital, CD-related clinical features, anal fistula types, perianal CD activity index, IBD simplified questionnaire, body image scale, Rosenberg self-esteem scale, and 6-12 months follow-up information were collected and analyzed retrospectively. To evaluate the effect of IFX treatment on improving psychosocial state. Results Among the 297 CD patients, 103 patients (34.7%) had AAF. The remission rate of IFX treatment was 64.0% in CD patients with perianal fistula, which was significantly higher than that in the patients who did not receive IFX treatment (38.5%, P=0.010). In addition, compared with CD patients who did not receive IFX treatment for AAF, IFX treatment improved the quality of life, body image satisfaction and self-esteem in CD patients with AAF significantly(all P<0.05). Conclusions Anal fistula remission can improve the inferiority complex, body image satisfaction and quality of life in CD patients with AAF. IFX treatment promotes the physical and mental health of patients, and improves the quality of life through significantly alleviating the condition of anal fistula in the patients with CD.

Key words: Body image, Crohn’s disease, Fistula, Quality of life

CLC Number:

R574

ZHOU Jie, HONG Liwen, WANG Lei, ZHANG Chen, WANG Zhengting, ZHANG Tianyu, FAN Rong. Study the effect of infliximab on physical and mental health in Crohn’s disease patients with active anal fistula[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 225-229.

Figures/Tables 5

References 34

[1]	Roda G, Chien Ng S, Kotze PG, et al. Crohn’s disease[J]. Nat Rev Dis Primers, 2020, 6(1): 22. doi: 10.1038/s41572-020-0156-2 URL
[2]	Sun XL, Chen SY, Tao SS, et al. Optimized timing of using infliximab in perianal fistulizing Crohn’s disease[J]. World J Gastroenterol, 2020, 26(14): 1554-1563. doi: 10.3748/wjg.v26.i14.1554 URL
[3]	Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease[J]. N Engl J Med, 1999, 340(18): 1398-1405. doi: 10.1056/NEJM199905063401804 URL
[4]	Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease[J]. N Engl J Med, 2004, 350(9): 876-885. doi: 10.1056/NEJMoa030815 URL
[5]	Jäghult S, Saboonchi F, Johansson UB, et al. Identifying predictors of low health-related quality of life among patients with inflammatory bowel disease: comparison between Crohn’s disease and ulcerative colitis with disease duration[J]. J Clin Nurs, 2011, 20(11/12): 1578-1587. doi: 10.1111/j.1365-2702.2010.03614.x URL
[6]	Calixto RP, Flores C, Francesconi CF. Inflammatory bowel disease: impact on scores of quality of life, depression and anxiety in patients attending a tertiary care center in Brazil[J]. Arq Gastroenterol, 2018, 55(3): 202-207. doi: 10.1590/s0004-2803.201800000-54 URL
[7]	Jedel S, Hood MM, Keshavarzian A. Getting personal: a review of sexual functioning, body image, and their impact on quality of life in patients with inflammatory bowel disease[J]. Inflamm Bowel Dis, 2015, 21(4): 923-938. doi: 10.1097/MIB.0000000000000257 URL
[8]	Opheim R, Moum B, Grimstad BT, et al. Self-esteem in patients with inflammatory bowel disease[J]. Qual Life Res, 2020, 29(7): 1839-1846. doi: 10.1007/s11136-020-02467-9 pmid: 32144613
[9]	Trindade IA, Ferreira C, Duarte C, et al. Gender differences in inflammatory bowel disease: explaining body image dissatisfaction[J]. J Health Psychol, 2019, 24(7): 847-856. doi: 10.1177/1359105317742958 pmid: 29205057
[10]	Torres J, Mehandru S, Colombel JF, et al. Crohn’s disease[J]. Lancet, 2017, 389(10080): 1741-1755. doi: S0140-6736(16)31711-1 pmid: 27914655
[11]	中国医师协会外科学分会肠瘘外科医师委员会. 中国克罗恩病并发肠瘘诊治的专家共识意见[J]. 中华胃肠外科杂志, 2018, 21(12): 1337-1346.
[12]	克罗恩病肛瘘共识专家组. 克罗恩病肛瘘诊断与治疗的专家共识意见[J]. 中华炎性肠病杂志, 2019, 3(2): 105-110.
[13]	Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management[J]. J Crohns Colitis, 2017, 11(1): 3-25. doi: 10.1093/ecco-jcc/jjw168 URL
[14]	Liu R, Tang A, Wang X, et al. Assessment of quality of life in Chinese patients with inflammatory bowel disease and their caregivers[J]. Inflamm Bowel Dis, 2018, 24(9): 2039-2047. doi: 10.1093/ibd/izy099 URL
[15]	Blascovich J, Tomaka J. Measures of selfesteem[M]//Robinson JP, Shaver PR, Wrightsman LS, ed. Measures of personality and social psychological attitudes, 1991: 18.
[16]	Garros A, Siproudhis L, Tchoundjeu B, et al. Magnetic resonance imaging and clinical assessments for perianal Crohn’s disease: gain and limits[J]. Dig Liver Dis, 2014, 46(12): 1072-1076. doi: 10.1016/j.dld.2014.08.003 URL
[17]	Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease[J] N Engl J Med, 1999, 340(18): 1247-1248.
[18]	Magalhães J, Castro FD, Carvalho PB, et al. Quality of life in patients with inflammatory bowel disease: importance of clinical, demographic and psychosocial factors[J]. Arq Gastroenterol, 2014, 51(3): 192-197. doi: S0004-28032014000300192 pmid: 25296078
[19]	Mahadev S, Young JM, Selby W, et al. Quality of life in perianal Crohn’s disease: what do patients consider important?[J]. Dis Colon Rectum, 2011, 54(5): 579-585. doi: 10.1007/DCR.0b013e3182099d9e URL
[20]	Schilder E. Body image: bodily perceptions and their influence on health[J]. Nurs Stand, 1989, 4(13): 30-32.
[21]	Grogan S. Body image and health: contemporary perspectives[J]. J Health Psychol, 2006, 11(4): 523-530. pmid: 16769732
[22]	El Ansari W, Clausen SV, Mabhala A, et al. How do I look? Body image perceptions among university students from England and Denmark[J]. Int J Environ Res Public Health, 2010, 7(2): 583-595. doi: 10.3390/ijerph7020583 URL
[23]	Grodzinsky E, Walter S, Viktorsson L, et al. More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS—a case-control study in primary care[J]. BMC Fam Pract, 2015, 16: 6. doi: 10.1186/s12875-015-0225-x pmid: 25626450
[24]	Muller KR, Prosser R, Bampton P, et al. Female gender and surgery impair relationships, body image, and sexuality in inflammatory bowel disease: patient perceptions[J]. Inflamm Bowel Dis, 2010, 16(4): 657-663. doi: 10.1002/ibd.21090 pmid: 19714755
[25]	Brown C, Gibson PR, Hart A, et al. Long-term outcomes of colectomy surgery among patients with ulcerative colitis[J]. Springerplus, 2015, 4: 573. doi: 10.1186/s40064-015-1350-7 pmid: 26543708
[26]	Zhao M, Lo BZS, Vester-Andersen MK, et al. A 10-year follow-up study of the natural history of perianal Crohn’s disease in a Danish population-based inception cohort[J]. Inflamm Bowel Dis, 2019, 25(7): 1227-1236. doi: 10.1093/ibd/izy374 URL
[27]	McDermott E, Mullen G, Moloney J, et al. Body image dissatisfaction: clinical features, and psychosocial disability in inflammatory bowel disease[J]. Inflamm Bowel Dis, 2015, 21(2): 353-360. doi: 10.1097/MIB.0000000000000287 pmid: 25569732
[28]	Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease[J]. Gut, 2014, 63(9): 1381-1392. doi: 10.1136/gutjnl-2013-306709 URL
[29]	Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal Crohn’s disease in a population-based cohort[J]. Dis Colon Rectum, 2012, 55(7): 773-777. doi: 10.1097/DCR.0b013e31825228b0 pmid: 22706129
[30]	Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn’s disease[J]. Gastroenterology, 2006, 130(3): 650-656. pmid: 16530505
[31]	Yan X, Zhu M, Feng Q, et al. Evaluating the effectiveness of infliximab on perianal fistulizing Crohn’s disease by magnetic resonance imaging[J]. Gastroenterol Rep (Oxf), 2019, 7(1): 50-56.
[32]	Scott FI, Johnson FR, Bewtra M, et al. Improved quality of life with anti-TNF therapy compared with continued corticosteroid utilization in Crohn’s disease[J]. Inflamm Bowel Dis, 2019, 25(5): 925-936. doi: 10.1093/ibd/izy321 URL
[33]	Hossain A, Lördal M, Olsson AE, et al. Sustained clinical benefit, improved quality of life, and reduced intestinal surgery from maintenance infliximab treatment in inflammatory bowel disease[J]. Scand J Gastroenterol, 2020, 55(2): 178-183. doi: 10.1080/00365521.2020.1722738 URL
[34]	Cabalzar AL, Azevedo FM, Lucca FA, et al. Physical activity in daily life, exercise capacity and quality of life in patients with Crohn’s disease on infliximab-induced remission[J]. Arq Gastroenterol, 2019, 56(4): 351-356. doi: S0004-28032019000400351 pmid: 31618395

项目	治疗应答组	非治疗应答组	χ²/t	P
项目	(n=52)	(n=50)	χ²/t	P
AF类型[n(%)]			6.796	0.009
单纯型AF	30(57.7)	16(42.3)
复杂型AF	22(39.2)	34(60.7)
治疗[n(%)]			6.653	0.01
使用IFX	32(64.0)	18(36.0)
未使用IFX	20(38.5)	32(61.5)
PCDAI改善(分)	-0.90±2.89	0.70±2.97	2.763	0.007
SIBDQ改善(分)	12.6±6.68	-0.76±4.29	12.04	<0.001
RSE改善(分)	3.17±5.94	-1.16±6.01	3.662	<0.001
BIS改善(分)	-0.38±1.80	0.72±2.30	3.723	<0.001

项目	IFX治疗组	非IFX治疗组	χ²/t	P
项目	(n=50)	(n=52)	χ²/t	P
治疗应答[n(%)]	32(64.0)	20(38.5)	6.653	0.010
PCDAI改善(分)	-0.72±2.70	0.46±3.23	2.008	0.047
SIBDQ改善(分)	8.18±8.95	3.98±8.09	2.487	0.015
RSE改善(分)	2.32±5.74	-0.17±6.68	2.019	0.046
BIS改善(分)	-0.34±1.60	0.63±1.44	3.236	0.002

项目	治疗应答组 (n=32)	非治疗应答组 (n=18)	χ²/t	P
AF类型[n(%)]			1.937	0.164
单纯型AF	19(59.4)	7(38.9)
复杂型AF	13(40.6)	11(61.1)
PCDAI改善(分)	-1.34±2.67	0.39±2.45	-2.265	0.026
SIBDQ改善(分)	12.8±7.56	-0.11±3.63	8.168	<0.001
RSE改善(分)	3.66±5.47	-0.06±5.57	2.289	0.027
BIS改善(分)	-0.56±1.56	0.06±1.63	-1.322	0.192