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• W4236861472 abstract "We thank Dr. Dorn for his stimulating comments. We agree with him that the psychosocial component of the clinical management of inflammatory bowel diseases (IBD) has been insufficiently taken into account up to now. In our IBD unit as in others, we have developed various forms of psychosocial support, and offer them to our patients, particularly those with a high level of anxiety and depression and/or those with a high level of long-term stress. However, in our study, it was neither possible nor appropriate to test at the time of diagnosis whether psychosocial factors are potential independent predictors of subsequent disabling Crohn’s disease. First, our patients do not undergo routinely a psychological evaluation at the time of the diagnosis, so that it was not possible to incorporate this nonexistent data in our retrospective study. Second, patients who are informed at the time of diagnosis that they suffer from a long-term potentially disabling disease often experience an acute adjustment reaction, with anxious or depressive features in reaction to the highly stressful diagnosis, making assessment of baseline psychological factors unreliable. The mean short-term objective at this time, for the patient and the physician, is to get rid of the symptoms of the first flare. Third, patient adaptation to a chronic disease such as CD may be highly dependent on the physician and the relationship with the patient. This point cannot be assessed during the first visits. Finally, the main objective of our study was to select a subgroup of patients who could be considered for an aggressive therapeutic approach (ie, immunosuppressants). We believe that such a decision should be based only on criteria that are objective and can be routinely collected. To our knowledge, it has not been demonstrated in the field of IBD that an evaluation of the psychological profile at the time of diagnosis would be accurate, reproducible, and predictive for the subsequent adaptive psychological changes of the patient. We would rather propose to evaluate prospectively whether the adaptive and coping psychological changes and the stress burden of the patients in the first year of the disease are independent predictors of disease severity markers, such as intestinal resections, within the subsequent years. Predictors of Crohn’s DiseaseGastroenterologyVol. 131Issue 1PreviewOver the past decade there has been a rapid increase the number of available therapies for Crohn’s disease (CD). Because these therapies can be associated with adverse effects, it is important to administer them only to those patients who are likely to benefit. Identifying these patients was the purpose of the study by Beaugerie et al1 published in the March 2006 issue of Gastroenterology. The authors first used data from retrospective chart reviews to classify patients as “disabled” if their disease “interfere[d] with [their] social, professional, and private life.” Baseline factors that predicted future disabling disease were then assessed through a logistic regression model. Full-Text PDF" @default.
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• W4236861472 date "2006-07-01" @default.
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• W4236861472 title "Reply" @default.
• W4236861472 doi "https://doi.org/10.1053/j.gastro.2006.05.036" @default.
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