Alimentary Pharmacology and Therapeutics Letters to the Editors

Letter: psychological remission – a future endpoint in inflammatory bowel disease? M. Barreiro-de Acosta* & J. P. Gisbert† *Department of Gastroenterology, Hospital Clınico Universitario de Santiago de Compostela, Santiago, Spain. † Department of Gastroenterology and Centro de Investigaci on Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Hospital Universitario de La Princesa, Instituto de Investigaci on Sanitaria Princesa (IP), Madrid, Spain. E-mail: [email protected] doi:10.1111/apt.12766

SIRS, We read with interest the article by Panara et al.1 This is a very interesting well-designed study. The results confirm that the number of patients with inflammatory bowel disease (IBD) who develop depression is higher than the average in the general population. In this study, the authors report, as expected, higher depression rates in patients with a more aggressive disease phenotype. Some studies previously showed a clear association between depression and disease relapse,2 but in a study performed in patients with Crohn0 s disease (CD), 24% maintained depressive symptoms in spite of having been in remission for more than 6 months.3 This means that while physicians think that clinical remission is enough, in fact some patients may need more help in order to make a full recovery. With that in mind, perhaps we should try to include psychological stabilization among the treatment objectives? Some years ago, health-related quality of life (HRQOL) was barely evaluated in clinical trials and studies, but recently, restoring HRQOL in IBD patients

Letter: psychological remission - a future endpoint in inflammatory bowel disease? Authors’ reply A. J. Panara*, A. J. Yarur† & D. A. Sussman† *University of Miami Miller School of Medicine, Miami, FL, USA. † Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL, USA. E-mail: [email protected] doi:10.1111/apt.12784

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has become a very important endpoint. In a recent study performed in nearly 900 IBD patients, presence of depression was clearly associated with a poorer HRQOL regardless of IBD activity.4 As a result, we think that psychological status should be evaluated more frequently. It is true that data are scarce but depression can also affect the response to different treatments; in a study by the Leuven group, authors demonstrated that CD patients with depression had a poorer response to infliximab than those without depression and also needed earlier retreatment with this drug.5 Future studies like this one should help us obtain more information about this practical and increasingly important aspect.

ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Panara AJ, Yarur AJ, Rieders B, et al. The incidence and risk factors for developing depression after being diagnosed with inflammatory bowel disease: a cohort study. Aliment Pharmacol Ther 2014; 39: 802–10. 2. Mittermaier C, Dejaco C, Waldhoer T, et al. Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med 2004; 66: 79–84. 3. Iglesias M, Barreiro de Acosta M, Vazquez I, et al. Psychological impact of Crohn’s disease on patients in remission: anxiety and depression risks. Rev Esp Enferm Dig 2009; 101: 249–57. 4. Iglesias-Rey M, Barreiro-de Acosta M, Caama~ no-Isorna F, et al. Psychological factors are associated with changes in the healthrelated quality of life in inflammatory bowel disease. Inflamm Bowel Dis 2014; 20: 92–102. 5. Persoons P, Vermeire S, Demyttenaere K, et al. The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther 2005; 22: 101–10.

SIRS, We thank Drs. Barreiro-de Acosta and Gisbert for their insightful letter.1 They evaluate some important points, in particular the detrimental effect that inflammatory bowel disease (IBD) can have on the interplay between quality of life and mental health, and the intriguing possibility of psychiatric endpoints in IBD care. Recently, there has been a paradigm shift emphasising health-related quality of life in IBD. Clinical trials are now focusing on patient-centred outcomes for all diseases.

Aliment Pharmacol Ther 2014; 39: 1432-1442 ª 2014 John Wiley & Sons Ltd

Letter: psychological remission - a future endpoint in inflammatory bowel disease?

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