Factors contributing to flares of ulcerative colitis in North India- a case-control study
Abstract Background Ulcerative colitis is a relapsing and remitting disease that may be associated with flares. The causes of flares in the Indian setting are not well recognized. Methods The present prospective case-control study was conducted at a single center in North India. Cases were defined a...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-023-02978-y |
| _version_ | 1797559346974949376 |
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| author | Vishavdeep Singh Rana Gaurav Mahajan Amol N. Patil Anupam K. Singh Vaneet Jearth Aravind Sekar Harjeet Singh Atul Saroch Usha Dutta Vishal Sharma |
| author_facet | Vishavdeep Singh Rana Gaurav Mahajan Amol N. Patil Anupam K. Singh Vaneet Jearth Aravind Sekar Harjeet Singh Atul Saroch Usha Dutta Vishal Sharma |
| author_sort | Vishavdeep Singh Rana |
| collection | DOAJ |
| description | Abstract Background Ulcerative colitis is a relapsing and remitting disease that may be associated with flares. The causes of flares in the Indian setting are not well recognized. Methods The present prospective case-control study was conducted at a single center in North India. Cases were defined as patients admitted for flare of ulcerative colitis, while controls were patients in remission enrolled from the outpatient department. The basis of the diagnosis of flare was a simple clinical colitis activity index (SCCAI) of ≥ 5 and endoscopic activity, while remission was based on SCCAI < 4 and a normal fecal calprotectin. A questionnaire evaluating recent infections, stress, drug intake (antibiotics, pain medication), adherence to therapy, and use of complementary and alternative therapy (CAM) was administered. Results We included 84 patients (51 with flare and 33 in remission) with a median age of 38 years, of whom 47 (55.9%) were males. The two groups were similar for baseline parameters, including age (38, 23–50 and 38, 25.5–48.5 years), male gender (52.9% and 60.6%), extent of disease, extraintestinal manifestations (21.6% and 12.1%), use of 5-aminosalicylates (76.5% and 90.9%). The thiopurine use was lower in those having a flare (15.7% and 36.4%). Amongst the predictors of flare, the recent infections (39.2% and 30.3%), recent travel (31.4 and 27.3%), eating outside food (47.1% and 39.4%), consumption of milk products (88.2% and 75.8%), use of pain medication (43.1% and 33.3%) and recent stress (62.7% and 60.6%) were similar between cases and controls. The rates of antibiotic use (29.4% and 6.1%), lack of adherence (50.9% and 15.2%), and intake of CAM (70.6% and 33.3%) were higher in those with flare. Patients attributed a lack of adherence to the cost of therapy, presumed cure (due to lack of symptoms), and fear of adverse effects. Conclusion Lack of adherence to inflammatory bowel disease therapies and recent CAM and antibiotic intake was higher in patients with flares of UC. The study makes ground for educational intervention(s) promoting knowledge and adherence to IBD therapies. |
| first_indexed | 2024-03-10T17:44:00Z |
| format | Article |
| id | doaj.art-984090cdf4b04479b52ce6c943a70586 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-03-10T17:44:00Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-984090cdf4b04479b52ce6c943a705862023-11-20T09:35:55ZengBMCBMC Gastroenterology1471-230X2023-09-012311710.1186/s12876-023-02978-yFactors contributing to flares of ulcerative colitis in North India- a case-control studyVishavdeep Singh Rana0Gaurav Mahajan1Amol N. Patil2Anupam K. Singh3Vaneet Jearth4Aravind Sekar5Harjeet Singh6Atul Saroch7Usha Dutta8Vishal Sharma9Department of Internal Medicine, Postgraduate Institute of Medical Education and ResearchDepartment of Gastroenterology, Postgraduate Institute of Medical Education and ResearchDepartment of Pharmacology, Postgraduate Institute of Medical Education and ResearchDepartment of Gastroenterology, Postgraduate Institute of Medical Education and ResearchDepartment of Gastroenterology, Postgraduate Institute of Medical Education and ResearchDepartment of Histopathology, Postgraduate Institute of Medical Education and ResearchDepartment of Surgical Gastroenterology, Postgraduate Institute of Medical Education and ResearchDepartment of Internal Medicine, Postgraduate Institute of Medical Education and ResearchDepartment of Gastroenterology, Postgraduate Institute of Medical Education and ResearchDepartment of Gastroenterology, Postgraduate Institute of Medical Education and ResearchAbstract Background Ulcerative colitis is a relapsing and remitting disease that may be associated with flares. The causes of flares in the Indian setting are not well recognized. Methods The present prospective case-control study was conducted at a single center in North India. Cases were defined as patients admitted for flare of ulcerative colitis, while controls were patients in remission enrolled from the outpatient department. The basis of the diagnosis of flare was a simple clinical colitis activity index (SCCAI) of ≥ 5 and endoscopic activity, while remission was based on SCCAI < 4 and a normal fecal calprotectin. A questionnaire evaluating recent infections, stress, drug intake (antibiotics, pain medication), adherence to therapy, and use of complementary and alternative therapy (CAM) was administered. Results We included 84 patients (51 with flare and 33 in remission) with a median age of 38 years, of whom 47 (55.9%) were males. The two groups were similar for baseline parameters, including age (38, 23–50 and 38, 25.5–48.5 years), male gender (52.9% and 60.6%), extent of disease, extraintestinal manifestations (21.6% and 12.1%), use of 5-aminosalicylates (76.5% and 90.9%). The thiopurine use was lower in those having a flare (15.7% and 36.4%). Amongst the predictors of flare, the recent infections (39.2% and 30.3%), recent travel (31.4 and 27.3%), eating outside food (47.1% and 39.4%), consumption of milk products (88.2% and 75.8%), use of pain medication (43.1% and 33.3%) and recent stress (62.7% and 60.6%) were similar between cases and controls. The rates of antibiotic use (29.4% and 6.1%), lack of adherence (50.9% and 15.2%), and intake of CAM (70.6% and 33.3%) were higher in those with flare. Patients attributed a lack of adherence to the cost of therapy, presumed cure (due to lack of symptoms), and fear of adverse effects. Conclusion Lack of adherence to inflammatory bowel disease therapies and recent CAM and antibiotic intake was higher in patients with flares of UC. The study makes ground for educational intervention(s) promoting knowledge and adherence to IBD therapies.https://doi.org/10.1186/s12876-023-02978-yInflammatory bowel diseaseCrohn’s diseaseUlcerative colitisStressAntibioticsNSAIDs |
| spellingShingle | Vishavdeep Singh Rana Gaurav Mahajan Amol N. Patil Anupam K. Singh Vaneet Jearth Aravind Sekar Harjeet Singh Atul Saroch Usha Dutta Vishal Sharma Factors contributing to flares of ulcerative colitis in North India- a case-control study BMC Gastroenterology Inflammatory bowel disease Crohn’s disease Ulcerative colitis Stress Antibiotics NSAIDs |
| title | Factors contributing to flares of ulcerative colitis in North India- a case-control study |
| title_full | Factors contributing to flares of ulcerative colitis in North India- a case-control study |
| title_fullStr | Factors contributing to flares of ulcerative colitis in North India- a case-control study |
| title_full_unstemmed | Factors contributing to flares of ulcerative colitis in North India- a case-control study |
| title_short | Factors contributing to flares of ulcerative colitis in North India- a case-control study |
| title_sort | factors contributing to flares of ulcerative colitis in north india a case control study |
| topic | Inflammatory bowel disease Crohn’s disease Ulcerative colitis Stress Antibiotics NSAIDs |
| url | https://doi.org/10.1186/s12876-023-02978-y |
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