Anxiety is associated with impaired tolerance of colonoscopy preparation in inflammatory bowel disease and controls

Abstract

Background and aim: Pain and nausea are often reported during bowel cleansing (BC) for ileocolonoscopy (IC). We aimed to explore putative mechanisms associated with impaired tolerance to BC.

Methods: A 1:1 (100 IBD and 100 controls) sex and age matched case-control study was performed. Patients completed the hospital anxiety and depression scale (HADS-A/HADS-D), visceral sensitivity index (VSI) and state-trait anxiety inventory, state scale (STAI-S), in addition to self-assessment of BC and abdominal pain and nausea ratings during BC. Endoscopists reported the Mayo score, Harvey Bradshaw index (HBI), simple endoscopic score for Crohn's disease, and Boston bowel preparation scale (BBPS).

Results: Higher VSI and depression scores were observed in IBD patients. VSI (P<0.0001) and age (P=0.008) showed a positive and negative association with abdominal pain during BC, respectively. HADS-A (P=0.009) and female sex (P=0.02) were positively associated with nausea during BC, while age (P=0.02) showed a negative association. Disease activity was not associated with worse BBPS or nausea during BC, while a higher HBI was associated with more pain during BC (P=0.0006). Nausea (P=0.007) and abdominal pain (P=0.003) during BC, and less previous ICs (P=0.03) were independently associated with anxiety prior to IC (STAI-S). Significant correlations were found between VSI and STAI-S and disease activity.

Conclusion: Higher gastrointestinal-specific anxiety and co-morbid anxiety are associated with increased pain and nausea during BC, respectively. Pain and nausea during BC were in turn associated with higher anxiety levels at the moment of IC, potentially creating a "vicious circle". Measures taken to reduce anxiety could improve BC and IC tolerance.

Keywords: Abdominal pain; BBPS; BC; Boston bowel preparation scale; Bowel cleansing; CI; GI; Gastrointestinal-specific anxiety; HADS; HBI; Harvey Bradshaw index; IBD; IC; IQR; Inflammatory bowel disease; OR; SES-CD; STAI-S; VAS; VSI; bowel cleansing; confidence interval; gastrointestinal; hospital anxiety and depression scale; ileocolonoscopy; inflammatory bowel diseases; interquartile range; odds ratio; simple endoscopic score for Crohn's disease; state-trait anxiety inventory, state scale; visceral sensitivity index; visual assessment scale.