Novel Questionnaire Could Identify Gastric Disease Anxiety in Patients with IBD

Kimberly Trieschmann, MD

A novel, self-reported scale was shown to correlate with irritable bowel syndrome (IBS) symptom severity, health-related quality of life (QoL) and gastrointestinal symptom-specific anxiety (GSA) among affected adult patients.

A new comparison analysis of the Visceral Sensitivity Index (VSI)—a 15-item, Likert-scale, self-reported questionnaire that gauges measures of fear, anxiety and hypervigilance associated with falsely appraised visceral sensations and discomfort—showed the tool distinctly differentiated patients with IBS and IBD versus healthy controls.

The investigators, led by Kimberly Trieschmann, MD, assistant professor of pediatrics in the Division of Gastroenterology at the Oregon Health & Science University, believe their research suggest a unique benefit of VSI in identifying anxiety and burden in patients with the chronic gastric diseases.

“Recent studies in IBS demonstrate that GSA may be a uniquely important variable in determining symptom persistence,” the team wrote. “There remains a need to better understand how GSA may impact patients with IBD in order to guide multidisciplinary management of symptoms and health-related QoL.”

Trieschmann and colleagues compared VSI scores among trial participants with IBS to healthy controls, while also assessing the questionnaire’s association with anxiety, health-related QoL and gastric disease activity through validated tests. Their assessment included 222 age- and sex-matched participants; 74 were diagnosed with IBD—23 with Crohn’s disease and 51 with ulcerative colitis—74 were diagnosed with IBS, and 74 were healthy controls.

The VSI questionnaire gauges patients on their severity of agreement on symptoms and sensations including a belief that eating causes discomfort and

Mean age of the patients with IBD or IBS was approximately 29 years old; 40% of all patients were female. Investigators reported significant differences in race and ethnicity among the 3 participant groups; patients with IBD were predominately Caucasian. Healthy control participants reported a significantly greater mean body mass index (BMI) than either patient group (P <.001). The IBS group reported significantly greater rates of usual and current gastric symptom severity versus patients with IBD (P <.001).

The team used the following metrics and surveys to quantify the association of VSI with GSA and health-related QoL:

1. Bowel Symptom Questionnaire (BSQ)
2. Hospital Anxiety and Depression Scale (HADs)
3. State-Trait Anxiety Inventory (STAI)
4. Medical Outcomes Study 12-Item Short Form Health Survey (SF-12)
5. Crohn’s Disease Activity Index (CDAI)
6. Powell-Tuck Index for Ulcerative Colitis (PTIUC)

Patients with IBD and IBS reported significantly greater VSI scores, indicating severe GSA (up to 75 points), versus healthy control participants. Group scores were as follows:

• IBD, 26.62±16.64 (P <.001)
• IBS, 38.83±15.06 (P <.001)
• Health controls, 3.42±5.06 (P <.001)

Investigators additionally observed a “modest” correlation of current anxiety (P = .002) and the physical components of health-related QoL (P = .0001) with VSI scores among patients with IBD or IBS, but a lesser correlation with the mental components of health-related QoL (P = .05).

The team concluded that VSI showed “good reliability and factor structure” among patients with IBD, and provided similar assessment performance among patients with IBS. What’s more, GSA per the 15-item assessment was related to general anxiety among patients with IBD, who had significantly greater VSI scores compared to health controls—though the limited data availability on disease activity in these patients made it difficult to establish meaningful conclusions on the link between VSI and IBD disease severity.

“In summary, the VSI overall appears to be a useful measure of GSA in IBD patients and is a novel tool that clinicians can use to help guide care and allocate limited resources in these complex patients that require a comprehensive biopsychosocial approach,” they concluded.

Trieschmann and colleagues noted future large-scale studies should look to validate the VSI scores of patients with IBD and seek out correlations with disease activity in both adult and pediatric patient populations.

“Finally, long-term longitudinal studies would be useful to evaluate the VSI and its relationship to GI symptoms, IBD disease activity, and health-related QoL in IBD patients over time and also if treating GSA, with interventions such as pharmacotherapy and behavioral therapy, impacts disease activity and health-related QoL,” they wrote.

The study, “The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease,” was published online in Neurogastroenterology & Motility.