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Multidisciplinary Approaches to Inflammatory Bowel Disease Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 7303

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Special Issue Editors

Prof. Dr. Gary Edward Wild

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Guest Editor

Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
Interests: digestive disorders; inflammatory bowel disease; Crohn's disease; stress and disease; immune system

Dr. Kimberly Carrière

E-Mail Website
Guest Editor

Psychologist, Inflammatory Bowel Disease Clinic, Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G1A4, Canada
Interests: digestive disorders; inflammatory bowel disease; stress management and chronic disease; integrative care; mind-fulness; acceptance and commitment therapy

Special Issue Information

Dear Colleagues,

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic and recurrent conditions associated with inflammation in the gastrointestinal tract. These diseases have a wide prevalence throughout an individual's lifespan. The underlying mechanisms leading to chronic gastrointestinal inflammation involve intricate interactions among genetic factors, immune dysregulation, gut microbiota, and various psychosocial determinants that can either predispose or protect against the disease. The brain-gut axis (BGA) plays a crucial role in modulating these elements and determining the phenotypic expression of IBD, incorporating the psychological state and overall human experience of individuals living with IBD.

An increasing body of evidence highlights the significance of psychosocial factors as influential determinants of quality of life, clinical outcomes, and healthcare utilization in individuals with IBD. However, our understanding of protective factors, resilience, optimism, and coping mechanisms in this population remains limited.

In light of this, the implementation of integrated multidisciplinary models of IBD patient care becomes crucial to ensure a comprehensive biopsychosocial approach that proactively addresses patient well-being. Such models aim to incorporate various healthcare disciplines and foster holistic patient care.

This Special Issue focuses on exploring the evidence and application of integrated multidisciplinary approaches to IBD patient care. The scope of this issue includes original research and review papers examining topics such as medical and psychological outcomes within multidisciplinary clinics, the role of the brain-gut axis in influencing psychosocial outcomes, mindfulness-based therapeutic strategies, the impact of resilience, acceptance, and commitment, novel approaches to psychological support, the utilization of telemedicine in multidisciplinary IBD clinical care, and the importance of institutional support for integrated IBD patient care and support.

Prof. Dr. Gary Edward Wild
Dr. Kimberly Carrière
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

inflammatory bowel disease
integrated healthcare
psychosocial determinants of chronic disease
multidisciplinary healthcare
biopsychosocial model

Published Papers (7 papers)

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Research

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18 pages, 2299 KiB

Open AccessFeature PaperArticle

Intestinal Microbiome Changes and Clinical Outcomes of Patients with Ulcerative Colitis after Fecal Microbiota Transplantation

by Artem Y. Tikunov, Valeria A. Fedorets, Evgenia V. Shrainer, Vitaliy V. Morozov, Valeria I. Bystrova and Nina V. Tikunova

J. Clin. Med. 2023, 12(24), 7702; https://doi.org/10.3390/jcm12247702 - 15 Dec 2023

Viewed by 956

Abstract

Background and Aims: Ulcerative colitis (UC) is a chronic inflammatory disease that affects many people. One of the possible ways to treat UC is fecal microbiota transplantation (FMT). In this study, changes in the intestinal microbiome and clinical outcomes of 20 patients with UC after FMT were estimated. Methods: FMT enemas were administrated ten times, once a day, and fecal microbiota from three donors was used for each enema. The clinical outcomes were assessed after eight weeks and then via a patient survey. The 16S rRNA profiles of the gut microbiota were compared between three samplings: samples from 20 patients with UC before and after FMT and samples from 18 healthy volunteers. Results: Clinical remission was achieved in 19 (95%) patients at week 8. Adverse events occurred in five patients, including one non-responder. A significant increase in average biodiversity was shown in samples after FMT compared to samples before FMT, as well as a decrease in the proportion of some potentially pathogenic bacteria. Conclusion: The efficacy of FMT for UC treatment was confirmed; however, the duration of remission varied substantially, possibly due to different characteristics of the initial microbiota of patients. Targeted analysis of a patient’s microbiome before FMT could increase the treatment efficacy. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

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15 pages, 631 KiB

Open AccessArticle

Development and Validation of an Educational Book on Self-Management in Inflammatory Bowel Disease Based on Patient Preferences and Expert Opinions: A Methodological Study

by Narges Norouzkhani, Ali Bahari, Mahbobeh Faramarzi, Javad Shokri Shirvani, Saeid Eslami and Hamed Tabesh

J. Clin. Med. 2023, 12(24), 7659; https://doi.org/10.3390/jcm12247659 - 13 Dec 2023

Cited by 1 | Viewed by 640

Abstract

Background: Self-management education resources for inflammatory bowel disease (IBD) using concepts remain infrequent. We aim to describe the development and evaluation process of educational material for self-management in IBD based on patient preferences and expert opinions. Research design and methods: The method of this study includes two main phases of development and validation in five steps in the following order: (1) identification of information needs for patients with IBD; (2) content development with a comprehensive literature review and scientific texts related to IBD; (3) measuring the face validity of the content based on the expert opinions in the field of IBD; (4) validation of the content with the experts in the field of IBD; and (5) validation by target audiences. Results: The expert panel comprises ten gastroenterologists, nutritionists, psychologists, gynecologists, and nurses. The total suitability score is 79.5%. The final draft version of the educational self-management material was presented to 30 IBD patients who were satisfied (n = 24; 80%) with the material. Conclusions: This study shows the development process and is validated for face and content validity by the academic multidisciplinary expert panel and target group. Patients and their caregivers can use this content to cope with their disease. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

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9 pages, 273 KiB

Open AccessArticle

Calprotectin Is Associated with HETE and HODE Acids in Inflammatory Bowel Diseases

by Małgorzata Szczuko, Paulina Komisarska, Justyna Kikut, Arleta Drozd and Diana Sochaczewska

J. Clin. Med. 2023, 12(24), 7584; https://doi.org/10.3390/jcm12247584 - 8 Dec 2023

Cited by 1 | Viewed by 870

Abstract

Background: Intestinal diseases are identified as autoimmune phenomena attributed to a specific virus that binds to the mucosal epithelium. The importance of precise diagnostic processes and identification is emphasized, but the multifaceted and complex etiological factors pose challenges for effective treatment. A recent supplementary study suggested a linkage between the secretion of calprotectin, a protein associated with inflammatory processes, and increased levels of hydroxyeicosatrienoic acids (HETE) and hydroxyoctadecadienoic (HODE) compounds. Methods: Sixty-two patients (average age: 14.06 ± 2.93 years) suffering from inflammatory bowel diseases were included in this study. Comparative analyses were performed to assess the concentrations of calprotectin against the levels of arachidonic acid derivatives. The calprotectin concentration was determined using the enzyme-linked immunosorbent assay (ELISA) method. The derivatives of HETE and HODE were identified through liquid chromatography. Results: Patients with Crohn’s disease (CD) displayed higher average concentrations of fatty acid metabolites; however, no correlation with calprotectin was observed. A dependency of 12S HETE concentration relative to age was noted in the CD group, and a similar trend was also identified in ulcerative colitis (UC), with the significant metabolites being 15 HETE and 5 oxoETE. In UC patients, a positive correlation was established between the calprotectin concentration and the acids 5-HETE and 12-HETE. Conclusions: These findings may be instrumental for monitoring the inflammatory states of patients and indicating a pathway for intervention. The metabolite 16RS HETE is associated with UC activity, and 15-HETE is related to the disease’s duration. A relatively more significant role of HETE acids in the progression of the disease was observed in UC. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

11 pages, 278 KiB

Open AccessArticle

Assessment of Fatigue and Associated Factors in Patients with Inflammatory Bowel Disease: A Questionnaire-Based Study

by Han Hee Lee, Tae-Geun Gweon, Sung-Goo Kang, Sung Hoon Jung, Kang-Moon Lee and Sang-Bum Kang

J. Clin. Med. 2023, 12(9), 3116; https://doi.org/10.3390/jcm12093116 - 25 Apr 2023

Cited by 4 | Viewed by 1292

Abstract

Although fatigue is common in patients with inflammatory bowel disease (IBD), it often goes unrecognized and untreated. We investigated the degree of fatigue and associated factors in patients with IBD. A multicenter study involving 147 IBD patients was conducted at five academic hospitals from August 2019 to December 2021. Fatigue was evaluated using the validated Korean version of the Multidimensional Fatigue Inventory (MFI-K). Among 97 ulcerative colitis patients and 50 Crohn’s disease patients, the mean total MFI-K score was 59.0 ± 5.5, which corresponded to a moderate-to-severe level of fatigue. Moderate-to-severe disease activity was found to be significantly associated with a higher general and physical fatigue subscale MFI-K score compared to remission-to-mild disease activity (17.6 ± 1.7 vs. 16.7 ± 2.0, p = 0.009), while the use of biologics was associated with a lower total MFI-K score (57.3 ± 5.0 vs. 59.5 ± 5.5, p = 0.031). In multiple linear regression, the total MFI-K score was positively correlated with a history of surgery for IBD, while it was negatively correlated with the use of biologics. Depression was positively correlated with the reduced motivation subscale score. The degree of fatigue in patients with IBD was high. Disease activity, the use of biologics, a history of surgery for IBD, and depression were associated with fatigue. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

Review

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18 pages, 2345 KiB

Open AccessReview

Dysbiosis in Inflammatory Bowel Disease and Spondyloarthritis: Still a Long Way to Go?

by Maria Consiglia Bragazzi, Federica Pianigiani, Rosanna Venere and Lorenzo Ridola

J. Clin. Med. 2024, 13(8), 2237; https://doi.org/10.3390/jcm13082237 - 12 Apr 2024

Viewed by 583

Abstract

The association between Inflammatory Bowel Disease (IBD) and Spondyloarthritis (SpA) has been known for years, as has the concept that IBD is associated with an altered intestinal bacterial composition, a condition known as “dysbiosis”. Recently, a state of intestinal dysbiosis has also been found in SpA. Dysbiosis in the field of IBD has been well characterized so far, as well as in SpA. The aim of this review is to summarize what is known to date and to emphasize the similarities between the microbiota conditions in these two diseases: particularly, an altered distribution in the gut of Enterobacteriaceae, Streptococcus, Haemophilus, Clostridium, Akkermansia, Ruminococcus, Faecalibacterium Prausnitzii, Bacteroides Vulgatus, Dialister Invisus, and Bifidubacterium Adolescentis is common to both IBD and SpA. At the same time, little is known about intestinal dysbiosis in IBD-related SpA. Only a single recent study has found an increase in Escherichia and Shigella abundances and a decrease in Firmicutes, Ruminococcaceae, and Faecalibacterium abundances in an IBD-related SpA group. Based on what has been discovered so far about the altered distribution of bacteria that unite both pathologies, it is appropriate to carry out further studies aiming to improve the understanding of IBD-related SpA for the purpose of developing new therapeutic strategies. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

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23 pages, 320 KiB

Open AccessReview

Coping Strategies and Inflammatory Bowel Disease: A Narrative Review

by Stefan L. Popa, Mihaela Fadgyas Stanculete, Simona Grad, Vlad Dumitru Brata, Traian-Adrian Duse, Andrei-Vlad Badulescu, Raquel-Vanessa Dragan, Paolo Bottalico, Cristina Pop, Abdulrahman Ismaiel, Daria-Claudia Turtoi, Dinu Iuliu Dumitrascu, Cristina Pojoga, Claudia Gherman and Liliana David

J. Clin. Med. 2024, 13(6), 1630; https://doi.org/10.3390/jcm13061630 - 12 Mar 2024

Viewed by 1207

Abstract

Background: Coping strategies play a crucial role in managing inflammatory bowel disease (IBD), influencing both health-related quality of life (HRQoL) and psychological well-being. This study systematically reviews the available literature to analyze coping mechanisms in IBD populations and their impact. Methods: Relevant English-language studies published until 2023 were identified through a comprehensive search of PubMed, EMBASE, EBSCOhost, and Cochrane Library. After applying inclusion and exclusion criteria, 57 articles underwent full analysis. Results: The findings highlight the diversity of coping strategies used by individuals with IBD and emphasize the need for a nuanced approach considering factors like disease severity, duration, and individual characteristics. This review underlines the influence of coping mechanisms on QoL and indicates their potential to aid IBD management and rehabilitation. Conclusions: This study underscores the value of investigating coping strategies to promote better outcomes for individuals with IBD. Future research should explore personalized interventions that address the heterogeneity of the IBD population. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

39 pages, 1507 KiB

Open AccessReview

The Interaction between Stress and Inflammatory Bowel Disease in Pediatric and Adult Patients

by Oana Belei, Diana-Georgiana Basaca, Laura Olariu, Manuela Pantea, Daiana Bozgan, Anda Nanu, Iuliana Sîrbu, Otilia Mărginean and Ileana Enătescu

J. Clin. Med. 2024, 13(5), 1361; https://doi.org/10.3390/jcm13051361 - 27 Feb 2024

Viewed by 1178

Abstract

Background: Inflammatory bowel diseases (IBDs) have seen an exponential increase in incidence, particularly among pediatric patients. Psychological stress is a significant risk factor influencing the disease course. This review assesses the interaction between stress and disease progression, focusing on articles that quantified inflammatory markers in IBD patients exposed to varying degrees of psychological stress. Methods: A systematic narrative literature review was conducted, focusing on the interaction between IBD and stress among adult and pediatric patients, as well as animal subjects. The research involved searching PubMed, Scopus, Medline, and Cochrane Library databases from 2000 to December 2023. Results: The interplay between the intestinal immunity response, the nervous system, and psychological disorders, known as the gut–brain axis, plays a major role in IBD pathophysiology. Various types of stressors alter gut mucosal integrity through different pathways, increasing gut mucosa permeability and promoting bacterial translocation. A denser microbial load in the gut wall emphasizes cytokine production, worsening the disease course. The risk of developing depression and anxiety is higher in IBD patients compared with the general population, and stress is a significant trigger for inducing acute flares of the disease. Conclusions: Further large studies should be conducted to assess the relationship between stressors, psychological disorders, and their impact on the course of IBD. Clinicians involved in the medical care of IBD patients should aim to implement stress reduction practices in addition to pharmacological therapies. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

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