Ulcerative Colitis: Häuser W

Häuser W, Grandt D. · Medizinische Klinik I (Gastroenterologie, Hepatologie, Stoffwechsel- und Infektionskrankheiten, Psychosomatik), Klinikum Saarbrücken, Germany. · Z Gastroenterol. · Pubmed #12215952 No free full text.

Abstract: Tobacco smoking is an independent risk factor in the etiology of Crohn's disease, functional dyspepsia, GERD, chronic pancreatitis and gastrointestinal carcinomas (oesophagus, stomach, colon, pancreas and liver). The current knowledge of the effects of tobacco smoking on the gastrointestinal tract is summarised. Non-smoking should be recommended to everybody as primary prevention against cardiopulmonary and gastrointestinal diseases. Despite lacking of clinical studies tobacco abstinence should be recommended as a secondary preventive therapy of Crohn's disease, functional dyspepsia, GERD and chronic pancreatitis because of epidemiological studies and pathophysiological considerations. All gastroenterologists should help patients with the above mentioned diseases to stop smoking. Evidence based methods of smoking cessation and methods suited to routine clinical care are presented. Pharmacological (nicotine replacement therapy) and psychological therapies (cognitive behavioural group therapies) should be adapted to the prior experiences of the patient, his stage of motivation to stop smoking and his co-morbidity. In refractory ulcerative colitis controlled tobacco smoking can be recommended to ex-smokers.

Janke KH, Steder-Neukamm U, Bauer M, Raible A, Meisner C, Hoffmann JC, Gregor M, Klump B, Häuser W. · Universitätsklinikum Tübingen, Abteilung Innere Medizin I, Kompetenznetz CED -- Core Facility Tübingen. · Gesundheitswesen. · Pubmed #16217720 No free full text.

Abstract: BACKGROUND: Health-related quality of life (HRQOL) is an important outcome-parameter in health research and care. The aim of the working group Quality of Life in the Competence Network Inflammatory Bowel Disease (IBD; in the original German: "Kompetenznetz chronisch entzündliche Darmerkrankungen") is to generate instruments for assessment of HRQOL and its implementation as standards in clinical trials, health care and research in IBD. METHODS: The Inflammatory Bowel Disease Questionnaire (IBDQ) is an international validated disease specific instrument for HRQOL-assessment. A German version of the IBDQ was elaborated and tested in 415 outpatients with Crohn's disease (CD, n = 306) and ulcerative colitis (UC, n = 109). The aim of the study was to compare the results of HRQOL-assessment (IBDQ-D) with international investigations, to correlate HRQOL results with disease activity and to preform a pretest of psychometric properties. RESULTS: International data suggest that the IBDQ-D is a suitable instrument for HRQOL-assessment in CD and UC. For both disease a statistically significant negative correlation with disease activity was found. Tested psychometric properties do not suggest that a revision of the IBDQ-D is required. The IBDQ-D offers the HRQOL-assessment as an primary or secondary outcome in clinical trials in IBD in Germany.

Schmidt C, Häuser W, Giese T, Stallmach A. · Department of Gastroenterology, Hepatology and Infectology, Friedrich Schiller University Jena, Germany. · Inflamm Bowel Dis. · Pubmed #17712839 links to  free full text

Abstract: BACKGROUND: Pouchitis and irritable pouch syndrome (IPS) are 2 of the most frequent sequelae of ileal pouch-anal anastomosis (IPAA) after restorative proctocolectomy in patients with ulcerative colitis. These complications can compromise the gain in health-related quality of life (HRQOL) substantially. The pathophysiological mechanisms underlying IPS and the predictors of HRQOL in IPS have not been studied so far. METHODS: In IPAA patients in remission (n = 10), patients with pouchitis (n = 18) and patients with IPS (n = 15) symptoms, endoscopical and histological patterns, anxiety and depressiveness (Hospital Anxiety and Depression Scale HADS), and HRQOL scores (Inflammatory Bowel Disease Questionnaire, IBDQ-D) were assessed. Mucosal expression of 5 proinflammatory gene transcripts (MRP-14, IL-1beta, IL-8, MIP-2alpha, and MMP-1) were quantified using real-time polymerase chain reaction. RESULTS: Clinical symptoms and HRQOL differed significantly (P < 0.01) between patients in remission on the one hand and those with pouchitis or IPS on the other. However, between IPS and pouchitis no such differences could be found. Depressiveness scores differed between IPS and patients in remission (P = 0.05). HRQOL in IPS was predicted by depressiveness (P < 0.001). Cytokine transcripts discriminated between pouchitis and IPS (P < 0.01), whereas between IPS patients and asymptomatic patients no such differences were observed. CONCLUSIONS: Patients with IPS and pouchitis cannot be differentiated by clinical symptoms or HRQOL, which is associated with depressiveness in IPS patients. IPS is a noninflammatory sequela in IPAA patients that shares clinical features with IBD. Quantification of mucosal proinflammatory gene transcripts differentiates objectively and simply between IPS and pouchitis.

Janke KH, Klump B, Steder-Neukamm U, Hoffmann J, Häuser W. · Medizinische Klinik und Poliklinik, Abteilung Innere Medizin I, Universitätsklinikum Tübingen. · Psychother Psychosom Med Psychol. · Pubmed #16715461 No free full text.

Abstract: The Inflammatory Bowel Disease Questionnaire (IBDQ) is the standard disease-specific instrument for assessment of health-related quality of life (HRQOL) in patients with inflammatory bowel diseases (IBD). A German translation has not been validated. 415 outpatient IBD-patients (Crohn's Disease n = 306, Ulcerative Colitis n = 109) completed the German version of the IBDQ (Competence network IBD, IBDQ-D), the Hospital Anxiety and Depression Scale German Version (HADS-D) and the Questions on Life Satisfaction FLZ. Face validity was assessed by a physicians' and patients' panel. Disease activity was measured by the German Inflammatory Bowel Disease Activity Index (GIBDI). With 97.3 % completed items the acceptance was high. The Cronbach's alpha for the subscales ranged from 0.88 to 0.89. The correlation coefficients with comparable subscales of other instruments ranged between 0.09 and 0.70. Patients in remission and different disease activities differed significantly (p < 0.001) in all IBDQ-D-subscales.

Häuser W, Janke KH, Stallmach A. · Department of Internal Medicine I, Klinikum Saarbrücken, D-66119 Saarbrücken, Germany. · Dis Colon Rectum. · Pubmed #15785887 No free full text.

Abstract: PURPOSE: The aim of this study was to determine if ileal pouch-anal anastomosis in patients with ulcerative colitis is a psychologic burden for patients, the frequency of mental disorders, the amount of psychologic distress, and their possible disease-related determinants. These factors were studied in patients with ulcerative colitis after ileal pouch anal anastomosis and were compared with ulcerative colitis patients without ileal pouch-anal anastomosis and the general German population. METHODS: A total of 37 patients with ulcerative colitis after ileal pouch-anal anastomosis (age 46.8 +/- 11.8 years; 35 percent female) and 62 patients with ulcerative colitis without ileal pouch-anal anastomosis (age 44.4 +/- 13.9 years; 37 percent female) completed the following questionnaires: medical and sociodemographic questionnaire of the German Competence Network "Inflammatory Bowel Diseases" and the German version of the Hospital Anxiety and Depression Scale. Disease activity was measured in patients with ileal pouch-anal anastomosis by the Pouch Disease Activity Index and in patients without ileal pouch-anal anastomosis by the German Inflammatory Bowel Disease Activity Index. Psychologic distress was assessed by the subscale scores of the Hospital Anxiety and Depression Scale. A probable mental disorder was identified if a patient scored 11 or higher in at least one subscale of the Hospital Anxiety and Depression Scale. RESULTS: The frequency of a probable psychiatric disorder in patients with ileal pouch-anal anastomosis (16 percent) and without ileal pouch-anal anastomosis (23 percent) did not differ from that in the general German population (17 percent). Ulcerative colitis patients with or without ileal pouch-anal anastomosis did not differ in the amount of psychologic distress. Ileal pouch-anal anastomosis patients had higher levels of anxiety than the general population (P < 0.01). Regression models of disease-related factors predicting mental disorder and psychologic distress showed no significant results. CONCLUSIONS: Ileal pouch-anal anastomosis neither increases nor decreases the frequency of mental disorders or the amount of psychologic distress in ulcerative colitis patients.

Häuser W, Dietz N, Steder-Neukamm U, Janke KH, Stallmach A. · Department of Internal Medicine I, Klinikum Saarbrücken, D-66119 Saarbrücken, Germany. · Inflamm Bowel Dis. · Pubmed #15475748 No free full text.

Abstract: BACKGROUND: In patients with ileal pouch anal anastomosis (IPAA) the influences of psychosocial variables and of extraintestinal manifestations of ulcerative colitis (UC) on health-related quality of life (HRQOL) have not been studied so far. METHODS: 61 patients with UC (age 52.7+/-13.9 years; 47% female) completed the German version of the Inflammatory Bowel Disease Questionnaire (IBDQ-D), the Short Form Health Survey (SF - 36), the German version of the Hospital Anxiety and Depression Scale (HADS-D) and the Giessener Symptom List (GBB 24). Independent of their current clinical activity 37 patients underwent endoscopies. Pouchitis was defined by the Pouch Disease Activity Score (PDAI) > or = 7. Where possible, IPAA-patients were compared with the data for the German general population and with a clinical sample of patients with UC and no IPAA. RESULTS: Patients with IPAA complained more about fatigue and arthralgia and a reduced physical and mental health (SF-36) than the German general population (P < 0.01). The IBDQ-total score could be predicted (adjusted R2 = 29.1, P < 0.01) by the number of operations due to IPAA-related complications (beta = -18.8) and HADS-D-Anxiety scores > or = 11 (beta = -29.1). The IBDQ-subscale score "Bowel" could be predicted (adjusted R2 = 13.7, P = 0.04) by PDAI > or = 7 (beta = -9.2) and the subscale score "Systemic" (adjusted R2 = 13.3, P = 0.04) by the number of extraintestinal manifestations (beta = -1.9). CONCLUSIONS: HRQOL of patients with UC and IPAA is determined not only by IPAA-related factors but also by anxiety and extraintestinal manifestations with associated musculoskeletal pain.

Häuser W, Dietz N, Grandt D, Steder-Neukamm U, Janke KH, Stein U, Stallmach A. · Medizinische Klinik I, Klinikum Saarbrücken, Saarbrücken, Germany. · Z Gastroenterol. · Pubmed #14963785 No free full text.

Abstract: BACKGROUND AND AIMS: The inflammatory bowel disease questionnaire (IBDQ) is the standard instrument for assessment of health-related quality of life (HRQOL) in patients with inflammatory bowel diseases. It has not been validated for patients with ileal pouch anal anastomosis (IPAA) and ulcerative colitis (UC). METHODS: To determine acceptance (percentage of completed items), reliability (Cronbach's alpha of the IBDQ-D subscales) and convergent validity (correlations of the IBDQ subscales with the questionnaires used for validation) 61 patients with UC (age 52.7 +/- 13.9 years; 47 % female, 53 % male) and IPAA completed the German (Competence Network IBD) version of the Inflammatory Bowel Disease Questionnaire (IBDQ-D), the Short Form Health Survey (SF-36) the Hospital Anxiety and Depression Scale German Version (HADS-D) and the Giessener Symptom List (GBB 24). Face validity was assessed by a physicians' and patients' panel. All 37 patients underwent endoscopy making it possible to differentiate between patients with and without pouchitis (discriminant validity). RESULTS: With 97.7 % completed items the acceptance was high. Cronbach's alpha value for the subscales ranged from 0.71 to 0.93. Missing items covering extraintestinal manifestations of IBD were criticized by patients. The correlation coefficients with comparable subscales of other instruments ranged between 0.41 and 0.76. Patients with clinical pouchitis scored significantly lower in all subscales than patients without pouchitis (p < 0.001). CONCLUSION: The IBDQ-D has good acceptance, reliability, convergent and discriminant validity, but limited face and construct validity in patients with IPAA and UC.

Janke KH, Raible A, Bauer M, Clemens P, Meisner C, Häuser W, Steder-Neukamm U, Henrich G, Herschbach P, Gregor M, Klump B. · Competence Network IBD--Core Facility Tübingen, Department of Internal Medicine I, University Hospital Tübingen, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany. · Int J Colorectal Dis. · Pubmed #14586630 No free full text.

Abstract: BACKGROUND AND AIMS: When assessing quality of care the outcome in terms of quality of life (QOL) is of major significance. This study examined QOL in IBD outpatients and the contribution of individual expectations and various other factors including disease activity. PATIENTS AND METHODS: The study included 306 outpatients with Crohn's disease and 109 with ulcerative colitis (UC). General and health-related QOL was quantified using the instrument Questions on Life Satisfaction(Modules). Disease activity was assessed by a questionnaire. Data were compared with a normal population sample. RESULTS: Life satisfaction scores on general items and on health-related items were significantly lower than in a control sample (60.5+/-37.3 and 74.4+/-41.5, respectively) among both CD patients (54.3+/-33.2, 59.1+/-38.8) and UC patients (45.4+/-34.0, 52.1+/-40.7). Scores were significantly related to severity of disease activity. IBD patients attributed particular importance to health-related issues. CONCLUSION: Both health-related and general life satisfaction is compromised in IBD outpatients, and health-related topics have major impact. Not surprisingly, inflammatory activity compromises QOL, which underlines the importance of anti-inflammatory strategies. The importance attributed to health-related features is higher in IBD patients than in the normal population.

Häuser W, Lachiheb H, Grandt D. · Medizinische Klinik I, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany. · Z Gastroenterol. · Pubmed #12016565 No free full text.

Abstract: The occurrence of an opioid addiction within an opioid treatment of pain or diarrhoea in inflammatory bowel disease is rarely reported. We report on a 36-year-old male with a 14 years lasting left sided chronic ulcerative colitis who developed after the initiation of a therapy with tincture of opium because of abdominal pain and diarrhoea an opioid addiction with the consumption of opium and later buprenorphin. Additionally to the diagnostics and therapy of the ulcerative colitis a detoxication was carried out. The diarrhoea slightly increased during the buprenorphin withdrawal. Diarrhoea refractory to other treatment should be treated by loperamid because of its lacking effects on the central nervous system. In chronic abdominal or musculoskeletal pain in inflammatory bowel disease opioids can be used if no surgical or other medical pain relief is possible. A consequent control of the therapeutic and side effects of the opioid therapy is necessary, especially of an abuse of opioid medication. The published case reports of a therapeutic induction of opioid addiction demonstrate that psychiatric comorbidity is an essential or even necessary risk factor. A checklist with seven criteria of opioid addiction during opioid therapy is presented.