Symptom Management of Inflammatory Bowel Diseases with Current Guideline Suggestions

Abstract

Inflammatory bowel disease (IBD) which includes ulcerative colitis and Crohn's disease is an uncontrolled inflammation of the intestinal mucosa, with idiopathic, chronic, relapse and remission periods.The most effective method for the management of IBD is to focus on the patient’s symptoms and to try to improve these symptoms because of chronic illness, difficult and long-term remission process, requiring important health care resources.In this context, the aim of treatment management of patients is to provide symptomatic remission with endoscopic recovery.Symptoms seen in inflammatory bowel diseases vary according to the activity and localization of the disease. Although major symptoms were similar in both diseases, the severity of the symptoms experienced by the patient was different than the severity of IBD. The aim of this review is to provide information about the course of IBD symptoms, their holistic evaluation and improvement. In addition, nursing interventions about how symptoms affect patients' quality of life, what nurses should address in patient education and prolonging the remission of the disease through effective symptom management are described.

Keywords

• Ulcerative colitis,Crohn’s disease,Symptom management,Nursing

Güncel Kılavuz Önerileriyle İnflamatuar Barsak Hastalıklarında Semptom Yönetimi

Abstract

İnflamatuar barsak hastalığı (İBH); Ülseratif kolit ve Crohn hastalığını içeren, idiopatik, kronik, relaps (alevlenme) ve remisyon (iyileşme) dönemleriyle seyreden intestinal mukozanın kontrolsüz inflamasyonudur. Kronik hastalık olması, remisyon sürecine girmenin zor ve uzun süreli olması, önemli sağlık bakım kaynakları gerektirmesi gibi nedenlerle İBH yönetiminde en etkili yöntem hastanın semptomlarına odaklanmak ve bu semptomları iyileştirmeye yönelmektir. Bu kapsamda hastaların tedavi yönetimindeki amaç da endoskopik iyileşmeyle birlikte semptomatik remisyonu sağlamaktır. İnflamatuar barsak hastalıklarında görülen semptomlar hastalığın aktivitesine ve lokalizasyonuna göre değişkenlik göstermektedir. Her iki hastalıkta da görülen majör semptomlar benzerlik gösterse de, İBH şiddetine göre hastanın deneyimlediği semptomların şiddeti farklı olmaktadır. Bu derlemede amaç; İBH semptomlarının seyrine, bu semptomların bütüncül olarak değerlendirilmesine ve iyileştirilmesine yönelik bilgilerin aktarılmasıdır. Bunun yanı sıra, semptomların hastaların yaşam kalitelerini nasıl etkilediğine, hemşirelerin hasta eğitiminde nelere değinmesi gerektiğine ve etkili bir semptom yönetimi sayesinde hastalığın remisyonda kaldığı sürenin uzatılmasına dair hemşirelik girişimlerine değinilmektedir.

Keywords

• İBH,Ülseratif kolit,Crohn hastalığı,semptom yönetimi,hemşirelik

References

1. 1. Tursi A, Elisei W, Picchio M. Incidence and prevalence of inflammatory bowel diseases in gastroenterology primary care setting. European J of Int Med. 2013;24:852–6.
2. 2. Haapamaki J, Turunen U, Roine RP, Färkkilä MA, Arkkila PE. Finnish patients with inflammatory bowel disease have fewer symptoms and are more satisfied with their treatment than patients in the previous European survey. Scand J Gastroenterol. 2008;43:821-30.
3. 3. Singh S, Blanchard A, Walker JR, Graff LA, Miller N, Bernstein CN. Common symptoms and stressors among individuals with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2011;9(9):769-75.
4. 4. Abraham BP. Symptom management in inflammatory bowel disease. Gastroenterol. Hepatol. 2015;9(7):953–67.
5. 5. Tezel A. Bölüm: Crohn Hastalığında Klinik Özellikler, Belirtiler, Bulgular ve Doğal Seyir. İçinde: Akçal T, Yamaner S, Hamzaoglu İ, editörler. İnflamatuvar bağırsak hastalıkları. 2012. s: 35-45. ISBN:978-605-86701-0-5
6. 6. Fitch M. Patient-initiated strategies for living with cognitive changes: implications for cancer nurses. Oncology Nursing Forum. 2007;34(2):580.
7. 7. Harver A, Mahler DA. The symptom of dyspnea. In: Mahler DA, editör. Dyspnea. Futura, Mount Kisco, NY, 1990. p.1-53.
8. 8. Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, et al. Advancing the science of symptom management. Journal of Advanced Nursing. 2001;33(5):668-76.

9. 9. Carter MJ, Lobo AJ, Travis SPL. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53(Suppl 5):1-16.
10. 10. Tezel A, Dökmeci G, Eskiocak M, Ümit H, Soylu AR. Epidemiological features of ulcerative colitis in Trakya. Turkey. J Int Med Res. 2003;31:141-8.
11. 11. National Institute For Health and Clinical Excellence (NICE) Guideline. Crohn’s disease management in adults. children and young people; 2012.
12. 12. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Acosta MB, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. Journal of Crohn's and Colitis, 2017;649–70.
13. 13. Veloso FT. Extraintestinal manifestations of inflammatory bowel disease: do they influence treatment and outcome? Word J Gastroenterol. 2011;17(22):2702–7.
14. 14. Harbord M, Annese V, Vavricka SR, Allez M, Acosta MB, Boberg KM, et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. J of Crohn's and Colitis. 2016:239–54
15. 15. Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (NY). 2011;7(4):235–41.
16. 16. Waljee AK, Joyce JC, Wren PA, Khan TM, Higgins PD. Patient reported symptoms during an ulcerative colitis flare: a Qualitative Focus Group Study. Eur J Gastroenterol Hepatol. 2009;21(5):558–64.
17. 17. Farrell D, McCarthy G, Savage E. Self-reported symptom burden in individuals with inflammatory bowel disease. Journal of Crohn's and Colitis. 2016;315–22.
18. 18. Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M, et al. The second European evidence-based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. J Crohns Colitis 2010;4(1):7–27.
19. 19. Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis. 2012;6:965–90.
20. 20. Bielefeldt K, Davis B, Binion DG. Pain and inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:778–88.
21. 21. Deberry JJ, Bielefeldt K, Davis BM, Szigethy EM, Hartman DJ, Coates MD. Abdominal pain and neurotrophic system in ulcerative colitis. Inflammatory Bowel Disease. 2014;20(12):2330-9.
22. 22. Kalkan Ç, Soykan İ. Ülseratif kolit: Semptomlar, klinik bulgular ve doğal seyir. İçinde: Dağlı Ü, editör. İnflamatuvar Bağırsak Hastalığı. Ankara; Fersa Matbaacılık. 2014. s. 63-80.
23. 23. Managing flares and other IBD symptoms. Crohn’s and Colitis Foundation of America. Erişim tarihi: 04 Nisan 2015 Erişim adresi: http://www.crohnscolitisfoundation.org/assets/pdfs/Managing-flares.pdf
24. 24. Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;211-22.
25. 25. Gasche C1, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13(12):1545–53.
26. 26. Özgürsoy Uran BN, Ünsal Avdal E, Tokem Y. Chapter 45: Approach to Inflammatory Bowel Disease With Current Guidelines. Adik Çamlı, Bilal Ak, Ramiz Arabacı, Recep Efe, editors. Recent Advances in Health Sciences. St. Kliment Ohridski University Press, Sofia, 2016. p: 472-87. ISBN 978-954-07-4136-9.
27. 27. Shah SB, Hanauer SB. Treatment of diarrhea in patients with inflammatory bowel disease: concepts and cautions. Rev Gastroenterol Disord. 2007;7(Suppl 3):S3-10
28. 28. Elkjaer M, Shuhaibar M, Burish J, Bailey Y, Scherfig H, Laugesen B, et al. E-health empowers patients with ulcerative colitis: A randomized controlled trial of the web-guided “constant-care” approach. Gut. 2010;59:1652-61.
29. 29. O’Connor M, Bager P, Duncan J, Gaarenstrom. J. N-ECCO consensus statements on the European nursing roles in caring for patents with Crohn’s disease or ulcerative colitis. Journal of Crohn’s and Colitis. 2013;7:744-64.
30. 30. Greveson K, Woodward S. Exploring the role of the inflammatory bowel disease nurse specialist. British Journal of Nursing. 2013;22(17):16-22. 31. Bernstein KI, Promislow S, Carr R, Rawsthorne P, Walker JR, Bernstein CN. Information needs and preferences of recently diagnosed patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:590–8.
31. 32. Savard J, Woodgate R. Young peoples’ experience of living with ulcerative colitis and an ostomy. Gastroenterol Nurs 2009;32:33-41.
32. 33. Oktay E. Beşinci Bölüm: İnflamatuar barsak hastalıkları: etyopatogenez. semptomatoloji. tanı ve komplikasyonlar. İçinde: Göksoy E, Uzunismail H, editörler. Gastrointestinal Sistem Hastalıkları. İ.Ü.Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Sempozyum Dizisi Yayın No: 23. 2001:199-206.
33. 34. Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. Long-term complications. extraintestinal manifestations. and mortality in adult Crohn's disease in population-based cohorts. Inflamm Bowel Dis. 2011;17(1):471-8.
34. 35. Bernstein N. Osteoporosis and other complications of inflammatory bowel disease. Current Opinion in Gastroenterology. 2002;18(4):428-34.
35. 36. Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol. 2011;7(4):235–41.
36. 37. Su CG, Judge TA, Lichtenstein GR. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterology Clin North Am. 2002;31:307-27.
37. 38. Römkens TEH, van Vugt-vun Pinxteren MWJ, Nagengast FM, van Oijen MGH, de Jong DJ. High prevalence of fatigue in inflammatory bowel disease: A case control study. Journal of Crohn's and Colitis. 2011;5:332–7.
38. 39. Jelsness-Jørgensen LP, Bernklev T, Moum B. Fatigue and disease-related worries among inflammatory bowel disease patients in remission; is it a reflection of coexisting IBS-like symptoms? A short report. J Psychosom Res. 2012;73(6):469-72.
39. 40. Gisbert J, Gomollon FD. Common misconceptions in the diagnosis and management of anemia in inflammatory bowel disease. Am J Gastroenterol. 2008;103(5):1299-307.
40. 41. Graff LA, Clara I, Walker JR, Lix L, Carr R, Miller N, et al. Changes in fatigue over 2 years are associated with activity of inflammatory bowel disease and psychological factors. Clin Gastroenterol Hepatol. 2013;11(9):1140-6.
41. 42. Ko JM, Gottlieb AB, Kerbleski JF. Induction and exacerbation of psoriasis with TNF-blockade therapy: a review and analysis of 127 cases. J Dermatol Treat. 2009;20:100 –8.
42. 43. Rahier JF, Buche S, Peyrin-Biroulet L, Bouhnik Y, Duclos B, Louis E et al. Severe Skin Lesions Cause Patients With Inflammatory Bowel Disease to Discontinue Anti–Tumor Necrosis Factor Therapy. Clinical Gastroenterology and Hepatology. 2010;8(12):1048–55.
43. 44. Herrlinger KR, Noftz MK, Dalhoff K, Ludwig D, Stange EF, Fellermann K. Alterations in pulmonary function in inflammatory bowel disease are frequent and persist during remission. Am J Gastroenterol. 2002;97:377-81.
44. 45. Gondim FAAA, Brannagan TH, Wander HW, Chin RL, Latov N. Peripheral neuropathy in patients with inflammatory bowel disease. Brain. 2005;128:867-79.
45. 46. Figueroa JJ, Loftus EV, Harmsen WS, Dyck PJB, Klein CJ. Peripheral neuropathy incidence in inflammatory bowel disease: A population Based Study. American Academy of Neurology. 2013;80:1693–7.
46. 47. Vizzardi E, Sciatti E, Bonadei I, Bordonali T, Ricci C, Lanzarotto F, et al. Subclinical cardiac involvement in Crohn’s disease and ulcerative colitis: an echocardiographic case-control study. Panminerva Medica. 2016;58(2):115–20.
47. 48. Bunu DM, Timofte CE, Ciocoiu M, Floria M, Tarniceriu CC, Barboi OB, et al. Cardiovascular Manifestations of Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Preventive Strategies. Gastroenterology Research and Practice, 2019, 3012509. doi:10.1155/2019/3012509.
48. 49. Rungo C, Basit S, Ranthe MF, Wohlfahrt J, Langholz E, Jess T. Risk of ischaemic heart disease in patients with inflammatory bowel disease: A nationwide Danish cohort study. Gut. 2012;62(5):689-94.
49. 50. …Symptom management. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/symptom-management Available Date: 20.10.2019
50. 51. William SA, Schreier AM. The role of education in managing fatique, anxiety and sleep disorders in women undergoing chemotherapy breast cancer, Applied Nursing Research. 2005;18:138-47.
51. 52. Kemp K, Dibley L, Chauhan U, Greveson K, Jaghult S, Ashton K, et al. Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis. Journal of Crohn's and Colitis. 2018;760–76.
52. 53. Crohn’s & Colitis Foundation of America (CCFA). Information Resource Center. Managing Flares and Other IBD Symptoms. https://www.crohnscolitisfoundation.org Available: August 2019
53. 54. Karadağ F, Kalkan Oğuzhanoğlu N, Özdel O, Ergin Ş, Kaçar N. Psöriyazis hastalarında psikodrama: Stres ve stresle baş etme. Anadolu Psikiyatri Dergisi. 2010;11:220-22.