Anxiety, depression, and inflammation after restorative proctocolectomy.

Area of Science:

• Gastroenterology
• Psychiatry
• Surgical Outcomes

Background:

• Anxiety and depression (A&D) are frequently observed in patients with inflammatory bowel disease (IBD).
• Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a common surgical intervention for IBD, but can lead to pouch-related complications.
• The relationship between chronic inflammation in IPAA and the incidence of A&D requires further investigation.

Purpose of the Study:

• To test the hypothesis that chronic inflammatory conditions within the IPAA are associated with an increased incidence of A&D.
• To identify factors contributing to A&D in patients with IPAA.

Main Methods:

• A retrospective cohort study was conducted at a single tertiary care referral center.
• Data were abstracted from a consented IBD and colon cancer natural history registry, including demographic, clinical, surgical, and psychiatric history.
• Three cohorts were compared: ulcerative proctocolitis with IPAA (UC), Crohn's disease/indeterminate proctocolitis with IPAA (CDIC), and familial adenomatous polyposis with IPAA (FAP).

Main Results:

• CDIC patients exhibited a higher rate of A&D co-diagnosis (20.4%) compared to UC (12.7%) and FAP (12.1%) patients.
• UC patients with pouchitis had a significantly higher rate of A&D (19.8%) than those without pouchitis (8.8%).
• Independent predictors of A&D included pre-operative corticosteroid use, female gender, tobacco use, and pouch inflammation.

Conclusions:

• Anxiety and depression are more prevalent in patients with inflammatory conditions of the IPAA.
• IPAA alone does not significantly increase A&D risk; UC without pouchitis and FAP patients showed lower rates comparable to the general population.
• Factors such as pouch inflammation, corticosteroid use, smoking, and female gender are independently associated with A&D in IPAA patients.