sj-docx-1-tag-10.1177_17562848241228064 – Supplemental material for The drug-survival of low-dose thioguanine in patients with inflammatory bowel disease: a retrospective observational study

Supplemental material, sj-docx-1-tag-10.1177_17562848241228064 for The drug-survival of low-dose thioguanine in patients with inflammatory bowel disease: a retrospective observational study by Helena Gensmyr-Singer, Mårten Werner and Pontus Karling in Therapeutic Advances in Gastroenterology</p

Diagnosing colorectal cancer and inflammatory bowel disease in primary care: The usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency. A prospective study

<p><b>Objective:</b> Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests.</p> <p><b>Materials and methods:</b> This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients’ presenting symptoms were recorded. Patients were followed for 2 years.</p> <p><b>Results:</b> The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22–0.67).</p> <p><b>Conclusion:</b> A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.</p

Illustration of relative hypo- and hypercortisolism in relation to depression, anxiety, global functioning and life quality.

<p>Post-DST cortisol groups were formed by using the 25th and 75th percentiles among the controls as cut-offs to divide both controls and patients into 3 groups. A low post DST cortisol value (subjects below the 25th percentile) was used to identify subjects exhibiting relative hypocortisolism and a high post DST cortisol value (subjects above the 75th percentile) was used to identify subjects exhibiting relative hypercortisolism. Subjects showing post DST cortisol values between the 25th and 75th percentiles were identified as subjects exhibiting eucortisolism. The bars illustrate the differences in mean questionnaire scores relative to the mean of the whole bipolar patient sample which is indicated by the base-line. A bar marked with an asterisk denotes a significant difference, evaluated using Student's t-test, between relative hypocortisolism or relative hypercortisolism and the reference group exhibiting eucortisolism. The error bars represent standard errors. BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; DST, Dexamethasone Suppression Test; GAF, Global Assessment of Functioning (best period of three months last year); QOL, Overall Quality of Life and general health. *p<0.05.</p

Study participant characteristics.

<p>BDI, Beck Depression Inventory; BMI, body mass index; DST, dexamethasone suppression test; MADRS-S, Montgomery Åsberg Depression Rating Scale – Self assessment; SD, standard deviation. All values are means unless otherwise specified. Student's t-test was performed when testing for differences between two means and Pearson's chi-square test was employed when testing for differences in distribution of categorical data.</p>a<p>Patients, <i>n</i> = 73; control subjects, <i>n</i> = 84.</p>b<p>Patients, <i>n</i> = 145; control subjects, <i>n</i> = 144.</p>c<p>Current smoker.</p>d<p>Post-DST cortisol groups were formed by using the 25th and 75th percentiles among the controls as cut-offs to divide both controls and patients into 3 groups. A low post DST cortisol value (subjects below the 25th percentile, also denoted the low post DST group) was used to identify subjects exhibiting relative hypocortisolism and a high post DST cortisol value (subjects above the 75th percentile, also denoted the high post DST group) was used to identify subjects exhibiting relative hypercortisolism. Subjects showing post DST cortisol values between the 25th and 75th percentiles were identified as subjects exhibiting eucortisolism.</p>e<p>Number of patients on current medication.</p

The relationships between relative hypo- and hypercortisolism and depression as well as low global functioning and quality of life in bipolar disorder.

<p>BAI, Beck Anxiety Inventory; BSA-S, Brief Scale for Anxiety – Self assessment; BDI, Beck Depression Inventory; BMI, body mass index; CI, 95% confidence interval; DST, dexamethasone suppression test; GAF, Global Assessment of Functioning; MADRS-S, Montgomery Åsberg Depression Rating Scale – Self assessment; OR, odds ratio; QOL, Quality of Life.</p><p>The table describes the OR:s of the high or low post-DST groups as compared to the mid-group (the reference group) for exhibiting depression, anxiety, low quality of life and low global functioning. The logistic regression analyses were performed unadjusted and in a model adjusting for age, sex and diagnosis (bipolar type 1 or 2). The outcome variables of the logistic regression analyses were the questionnaire scores dichotomized according to established cut-offs when present (BDI, MADRS-S, BAI, See the statistical methods paragraph). The remaining questionnaire scores (BSA-S, GAF WHOQOL-100) which lacked established cut-offs were dichotomized comparing the lowest quartile with the rest. We also tested for additional potential confounding through individually including within the model the following variables: BMI, smoking, antidepressant medication, neuroleptic medication, sedative medication and medication with mood stabilizer (see statistical section). Significant adjusted analyses remained significant also after these additional potential confounders were added to the model except for one instance when BMI was added to the high vs. mid analyses with respect to MADRS-S where the cortisol group variable showed a trend toward significance (p = 0.054).</p>a<p>Post-DST cortisol groups were formed by using the 25th and 75th percentiles among the controls as cut-offs to divide both controls and patients into 3 groups. A low post DST cortisol value (subjects below the 25th percentile) was used to identify subjects exhibiting relative hypocortisolism and a high post DST cortisol value (subjects above the 75th percentile) was used to identify subjects exhibiting relative hypercortisolism. Subjects showing post DST cortisol values between the 25th and 75th percentiles were identified as subjects exhibiting eucortisolism.</p>b<p>Adjusted for sex, age and diagnosis (bipolar type 1 or 2).</p>c<p>In the GAF analyses <i>n</i> were as follows: low vs. mid cortisol group, <i>n</i> = 96; high vs. mid cortisol group, <i>n</i> = 105; low and high vs. mid cortisol group, <i>n</i> = 142.</p>d<p>In the Quality of Life analyses <i>n</i> were as follows: low vs. mid cortisol group, <i>n</i> = 96; high vs. mid cortisol group, <i>n</i> = 108; low and high vs. mid cortisol group, <i>n</i> = 144.</p

Characteristics of the patients with IBS in relation to val158met COMT polymorphism based on the symptom diary.

<p>54 IBS subjects (48 women) completed the symptom diary. The val/val genotype was significantly associated with multiple measures clustering towards IBS-diarrhea-like symptoms compared with the rest (val/met+met/met carriers). Statistics: Kruskal-Wallis (all three genotypes compared against each other in column 5, and val/val carriers compared with the other carriers grouped together in column 6).</p><p>*Statistically significant: p<0.05. Borderline statistically significant: p values between 0.05–0.15. ns = non-significant.</p