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From Medscape Medical News

Posttraumatic Stress Exacerbates Crohn's Disease
Emma Hitt, PhD



December 8, 2010 — Patients with Crohn's disease are frequently affected by posttraumatic stress disorder (PTSD), which is, in turn, linked to exacerbated disease, according to a recent study.

Roland von Känel, MD, with Bern University Hospital, in Bern, Switzerland, and colleagues reported their findings December 2, 2010, in the online edition of Frontline Gastroenterology.

According to the researchers, Crohn's disease is similar to known causes of posttraumatic stress, such as "violence, accidents and natural disasters," as it may "preoccupy patients over longer periods similar to 'traditional' traumatic events."

The study authors noted that this association was likely not previously recognized because avoidance behavior is common in posttraumatic stress; furthermore, patients with Crohn's disease feel that "their psychological needs lack attention from the medical community."

To evaluate this issue further, the investigators recruited 597 patients into the Swiss Inflammatory Bowel Disease Cohort Study Group and assessed these patients for posttraumatic stress during an 18-month period using the Post-traumatic Diagnostic Scale (PDS; range, 0 - 51 points). A score of more than 15 points indicates fully developed PTSD. Patients were also monitored for exacerbation of Crohn's disease through the measurement of flares, extraintestinal manifestations, complications, and nonresponse to therapy.

The study reported 2 major findings: Crohn's disease posttraumatic stress is frequent, and the extent of posttraumatic stress and subsequent disease deterioration was also strongly associated.

Of the 468 patients who completed the study, 19.1% scored at least 15 points on the PDS. These patients also had a 4.3 times higher odds of exacerbation of Crohn's disease (95% confidence interval [CI], 2.6 - 7.2) vs 80.9% of patients scoring less than 15 points and 13 times higher odds (95% CI, 3.6 - 46.2) than 9.8% of patients scoring 0 points. In addition, the odds that disease was exacerbated was increased by 2.2 (95% CI, 1.6 - 2.8) with every SD increase in posttraumatic stress.

"Gastroenterologists may wish to ask about re-experiencing, avoidance and hyperarousal and, depending on the intensity of symptoms, may be advised to refer patients for psychological counselling or for a structured clinical interview to assess for PTSD," Dr. Känel and colleagues write.

According to the researchers, "it is reasonable to treat [PTSD] in the same way as post-traumatic stress caused by other traumatic events." They add that future studies may examine "whether treatment of posttraumatic stress protects from disease deterioration."

The study was funded by a grant from the Swiss National Science Foundation.

Frontline Gastroenterol. Published online December 2, 2010.

http://www.medscape....le/733818_print

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