Anxiety is associated with impaired tolerance of colonoscopy preparation in inflammatory bowel disease and controls
Abstract
BACKGROUND AND AIM: Pain and nausea are often reported during bowel cleansing (BC) for ileocolonoscopy (IC). We aimed to explore putative mechanisms associated with impaired tolerance to BC. METHODS: A 1:1 (100 IBD and 100 controls) sex and age matched case-control study was performed. Patients completed the hospital anxiety and depression scale (HADS-A/HADS-D), visceral sensitivity index (VSI) and state-trait anxiety inventory, state scale (STAI-S), in addition to self-assessment of BC and abdominal pain and nausea ratings during BC. Endoscopists reported the Mayo score, Harvey Bradshaw index (HBI), simple endoscopic score for Crohn's disease, and Boston bowel preparation scale (BBPS). RESULTS: Higher VSI and depression scores were observed in IBD patients. VSI (P<0.0001) and age (P=0.008) showed a positive and negative association with abdominal pain during BC, respectively. HADS-A (P=0.009) and female sex (P=0.02) were positively associated with nausea during BC, while age (P=0.02) showed a negative association. Disease activity was not associated with worse BBPS or nausea during BC, while a higher HBI was associated with more pain during BC (P=0.0006). Nausea (P=0.007) and abdominal pain (P=0.003) during BC, and less previous ICs (P=0.03) were independently associated with anxiety prior to IC (STAI-S). Significant correlations were found between VSI and STAI-S and disease activity. CONCLUSION: Higher gastrointestinal-specific anxiety and co-morbid anxiety are associated with increased pain and nausea during BC, respectively. Pain and nausea during BC were in turn associated with higher anxiety levels at the moment of IC, potentially creating a "vicious circle". Measures taken to reduce anxiety could improve BC and IC tolerance.
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Nine of 13 studies found significantly higher rates and/or levels of depression in IBD participants than in healthy controls.
“Nine found significantly higher rates and/or levels of depression in IBD participants than in healthy controls (n=3,517 IBD; n=12,212 controls) (9, 15, 16, 19-22, 24, 26).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [16]
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- Authors
- Bessissow, T., Van Keerberghen, C.-A., Van Oudenhove, L., Ferrante, M., Vermeire, S., Rutgeerts, P., & Van Assche, G.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Venue
- Journal of Crohn's and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-12
- Volume
- 7
- Issue
- 11
- Pages
- e580-e587
- ISSN
- 1873-9946 (ISSN-L)
- OpenAlex
- W1993658005
- Cited by
- 53
- References
- 26
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 6 · 2018: 2 · 2017: 2 · 2016: 4 · 2015: 5 · 2014: 2 · 2013: 1
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Crohn s and Colitis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- inflammatory bowel disease, bowel preparation
- MeSH terms
- Adult, Age Factors, Anxiety, Colonoscopy, Female, Humans, Therapeutic Irrigation, Male, Middle Aged, Nausea, Prospective Studies, Reference Values, Severity of Illness Index, Sex Factors, Stress, Psychological, Inflammatory Bowel Diseases, Abdominal Pain, Causality, Incidence, Confidence Intervals, Odds Ratio, Case-Control Studies, Risk Assessment
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