Validation of the Italian translation of the perceived stigma scale and resilience assessment in inflammatory bowel disease patients

BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different. Resilience may in turn influence the perception of stigma. Patients with inflammatory bowel disease (IBD) are susceptible to stigma, although data are very limited. AIM To validate an Italian translation of the IBD perceived stigma scale (PSS) in relation to patients’ resilience. METHODS Consecutive IBD outpatients were prospectively enrolled (December 2018-September 2019) in an Italian, tertiary referral, IBD center. Clinical and demographic data were collected. Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale, respectively. The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality. Higher scores represent greater perceived stigma and resilience. Multivariable analysis for factors associated with greater stigma was computed. RESULTS Overall, 126 IBD patients (mean age 46.1 ± 16.9) were enrolled. The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied, with optimal data completeness. There was no ceiling effect, whilst floor effect was present (7.1%). The discriminant validity and the internal consistency reliability were good (Cronbach alpha = 0.87). The overall internal consistency was 95%, and the test-retest reliability was excellent 0.996. The median PSS score was 0.45 (0.20-0.85). Resilience negatively correlated with perceived stigma (Spearman’s correlation = -0.18, 95% confidence intervals: -0.42-0.08, P = 0.03). CONCLUSION We herein validated the Italian translation of the PSS scale, also demonstrating that resilience negatively impacts perceived stigma

Controlling Gut Inflammation by Restoring Anti-Inflammatory Pathways in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is caused by a dysregulated immune response against normal components of the intestinal microflora combined with defective functioning of anti-inflammatory pathways. Currently, all therapies approved for IBD manipulate the immune system by inhibiting pro-inflammatory mechanisms, such as tumor necrosis factor-α, gut-homing α4β7 integrin, interleukin-12/interleukin-23, and Janus kinases. However, some IBD patients are non-responders to these drugs, which are also associated with serious side effects. Thus, it has been hypothesized that therapies aimed at restoring anti-inflammatory signals, by exploiting the tolerogenic potential of cytokines (interleukin-10, transforming growth factor-β, granulocyte macrophage colony-stimulating factor), immune cells (regulatory T cells, tolerogenic dendritic cells), or mesenchymal stem cells, might offer promising results in terms of clinical efficacy with fewer side effects. In this review, we provide new insights into putative novel treatments aimed at restoring anti-inflammatory signaling pathways in IBD

Ruolo dei fattori psicologici nelle malattie infiammatorie croniche intestinali

Scopo del lavoro: Le malattie infiammatorie croniche intestinali (MICI) sono patologie estremamente disabilitanti, senza possibilit\ue0 di guarigione e dall'eziologia incerta. I fattori psicologici -stress, ansia, depressione - sembrano giocare un ruolo importante nell'insorgenza, decorso e nelle modalit\ue0 di gestione delle MICI. A fronte di una cospicua letteratura su aspetti psicologici \u201cclassici\u201d, sono carenti studi che valutino il ruolo dei meccanismi di difesa e fattori psichici specifici - quali l\u2019impulsivit\ue0/controllo, la rabbia/ostilit\ue0 - nell\u2019insorgenza e decorso della malattia, nonch\ue9 nell\u2019adattamento psicologico alla stessa e al trattamento. Il presente studio vuole indagare l'associazione tra specifici pattern psicologici e di personalit\ue0 e MICI con riferimento alle variabili psicologiche sopra menzionate. Materiale e Metodi: Saranno inclusi nello studio 200 pazienti con diagnosi di MICI (malattia di Crohn o colite ulcerosa) stratificati in rapporto alla diagnosi clinica (pazienti con patologia attiva vs. pazienti con patologia in remissione). 50 pazienti sono stati ad oggi arruolati e, previa sottoscrizione del consenso informato, hanno compilato la seguente batteria di questionari: Illness Perceptions Questionnaire Revised (IPQ-R), Symptoms Checklist-90 (SCL-90), Inflammatory Bowel Disease Questionnaire (IBDQ), Defense Mechanisms Inventory (DMI). Risultati: Si prevede di riscontrare differenze significative tra pazienti con MICI ed il campione normativo, nonch\ue9 tra pazienti in fase attiva di malattia e pazienti in remissione. Si ipotizza la presenza di pattern difensivi comuni a pazienti in fase attiva e pazienti in remissione. Nello specifico, ci si attende che i pazienti con MICI facciano maggiormente uso di strategie di difesa non esternalizzanti e primitive. Non sono attese differenze significative tra pazienti con malattia di Crohn e pazienti con colite ulcerosa. Conclusioni: I risultati del presente studio potrebbero mostrare evidenze preliminari circa la possibile associazione tra malattia di Crohn, colite ulcerosa e specifiche caratteristiche psicologiche, personologiche e difensive. Lo studio di fattori psicologici in questo tipo di pazienti pu\uf2 favorire una comprensione pi\uf9 approfondita di questa patologia, al fine di favorire l'adozione di pratiche di intervento psicologico-clinico efficaci nella cura delle MICI

Defective spleen function in autoimmune gastrointestinal disorders

Defective spleen function increases susceptibility to bacterial infections which can be prevented by vaccine prophylaxis. Splenic hypofunction can be found in a number of autoimmune disorders; however, no data are available regarding autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE) and autoimmune liver disease (AILD). Peripheral blood samples from patients with AAG (n = 40), AIE (n = 3) and AILD (n = 40) were collected. Patients affected by autoimmune disorders already known to be associated with splenic hypofunction, i.e. coeliac disease (CD) and ulcerative colitis (UC), were included as disease controls, while splenectomised patients and healthy subjects were evaluated as positive and negative controls, respectively. Counting of erythrocytes with membrane abnormalities, i.e. pitted red cells, was used as an indicator of spleen function (normal upper limit 4%). Defective splenic function was observed in 22 of the 40 patients with AAG (55.0%), in two of the three patients with AIE (66.6%) and in 35 of the 40 patients with AILD (87.5%). As expected, in untreated CD, refractory CD and UC there was a high prevalence of hyposplenism (43.7%, 88.2% and 54.4%, respectively). Due to the high prevalence of splenic hypofunction, patients with AAG, AILD and AIE should undergo pitted red cell evaluation and, if hyposplenic, they should be candidate to vaccine prophylaxis against encapsulated bacteria