BackgroundFatigue is common in Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis remains poorly understood.AimsThis study aimed to assess changes in fatigue prevalence during the first year after diagnosis and examine the association between disease course and substantial fatigue (SF) at the 1-year follow-up.MethodsAdults with newly diagnosed CD or UC were recruited from the population-based IBSEN III cohort. Fatigue was assessed at diagnosis and the 1-year follow-up using the Fatigue Questionnaire. Associations between SF at the 1-year follow-up and disease-related factors were quantified using multivariate logistic regression adjusted for sex, age and comorbidities.ResultsIn total, 596 patients were included (CD: 196, UC: 400). SF was present at both baseline and after one year of disease for 46.9% (n = 92/196) and 40.5% (n = 162/400) of patients with CD and UC, respectively. In CD, development of endoscopically non-passable stricture and/or surgically treated stricture within first year of disease (OR = 4.52, 95%CI [1.61;12.68]), self-reported flares since diagnosis (OR = 2.55, 95%CI [1.26;5.16]), female sex (OR = 3.12, 95%CI [1.53;6.37]) and comorbidities (OR = 4.05, 95%CI [1.89;8.69]) were independently associated with SF at the 1-year follow-up. In UC, SF was associated with current biological treatment (OR = 5.14, 95%CI [1.56;16.96]), increasing Mayo endoscopic score at the 1-year follow-up (OR = 1.54, 95%CI [1.01;2.35]), self-reported flares since diagnosis (OR = 2.66, 95%CI [1.24;5.72]) and female sex (OR = 2.20, 95%CI [1.06;4.57]).ConclusionsFatigue frequently persists through the first year after IBD diagnosis. Clinical factors reflecting a more severe disease course were associated with SF one year after diagnosis in both CD and UC.

Objective: A positive surgical margin (PSM) after radical prostatectomy (RP) is considered an adverse surgical feature, but the clinical implications have been debated. Further motive to aim for negative margins (NSM) may be patient anxiety due to PSM, but studies on psychological consequences are lacking. We explored associations between psychological factors and PSM on a consecutive group of men after RP. Material and methods: Men with suspected prostate cancer were invited to a study on psychological factors. Patient reported outcome measurement questionnaires were collected before diagnosis, and at 6, 12 and 24 months from those who underwent RP. Multivariable mixed models and post hoc pairwise comparisons were used to explore associations between PSM and psychological outcomes. Results: In total, 387 men had RP and 94 (24%) had PSM. General psychological outcomes were not associated with margin status. At 12 months, men with PSM considered their personal risk of recurrence 6% (30% vs. 24%) points higher and had clinical fear of recurrence (FoR) 14% (47% vs. 33%) more often than men with NSM. In adjusted and stratified analyses, men with pathological (p-)T2-stage and NSM had less FoR than the rest of the sample. In pT3-disease, PSM had no additional impact on FoR. A limitation was the small size of the pT2 group with PSM and the lack of information on how patients were informed. Conclusions: After RP, PSM was associated with higher FoR, particularly in men with pT2-cancer. Improved counselling and further research into causes and mitigation of FoR, is warranted.

BackgroundPatients with Hashimoto’s thyroiditis frequently experience fatigue and impaired health-related quality of life (HRQOL) despite biochemical euthyroidism, suggesting that immune-mediated mechanisms beyond thyroid hormone deficiency contribute to symptom generation. The role of specific inflammatory mediators - including interleukin-1 receptor antagonist (IL-1Ra), heat shock protein 90α (HSP90α), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and anti-TPO antibodies - in relation to patient-reported outcomes (PROMs) has not been systematically examined.MethodsIn a cross-sectional study of 36 euthyroid patients with confirmed Hashimoto’s thyroiditis, serum/plasma levels of IL-1Ra, HSP90α, IL-6, and TNF-α were measured alongside anti-TPO. PROMs included the SF-36 General Health subscale (inverted; iGH), the Fatigue Visual Analog Scale (fVAS), and the Fatigue Severity Scale (FSS). Spearman correlations, univariable and multivariable linear regression, and principal component analysis (PCA) were applied.ResultsThe cohort displayed severe fatigue at baseline (median fVAS 85, FSS 6.7, SF-36 GH 16). IL-1Ra was the most consistent biomarker correlate of symptom burden, independently associated with poorer general health and more fatigue across all regression models. HSP90α showed an inverse and independent association with fatigue in multivariable models, suggesting a potentially protective role. IL-6 contributed in correlation analysis only, while TNF-α and anti-TPO were not significantly associated with any PROM in any analytical approach.ConclusionIL-1Ra and HSP90α, but not anti-TPO, are independently associated with fatigue and general health in euthyroid Hashimoto’s thyroiditis, pointing to IL-1 pathway activity as associated with symptom burden and potentially playing a key role in this condition.

BACKGROUND:Distinguishing irritable bowel syndrome (IBS) from inflammatory bowel disease (IBD) flare-ups is challenging. This study used objective remission markers to accurately determine IBS prevalence in a population-based cohort of patients with IBD. METHODS:Adults with ulcerative colitis and Crohn's disease were recruited from the IBD in South-Eastern Norway III cohort study. Irritable bowel-like symptoms were assessed using the Rome IV criteria for patients in remission from IBD at 1- and 3-year follow-ups. Remission was defined objectively using the biochemical marker fecal calprotectin (FC) ≤ 250 µg/g, and comparisons to remission based on endoscopic indices were made at 1-year follow-up. RESULTS:Among patients with FC ≤ 250 µg/g, IBS prevalences were 21.9% (n = 62/283) and 16.1% (n = 49/304) at the 1- and 3-year follow-ups, respectively, which were higher than that in the Norwegian population (9.5%; P < .005). Of patients in endoscopic remission at 1-year follow-up, 19.2% (n = 43/224) reported IBS-like symptoms, which was not significantly different from IBS prevalence for patients with FC ≤ 250 µg/g. Irritable bowel syndrome was independently associated with substantial fatigue (odds ratio: 3.05 [95% CI, 1.48-6.27]) and female sex (odds ratio: 2.67 [95% CI, 1.34-5.32]) at the 1-year follow-up. Patients with IBS reported significantly reduced health-related quality of life (HRQoL) scores. CONCLUSIONS:The prevalence of IBS among patients in remission from IBD was approximately twice as common as that in the Norwegian population. Irritable bowel syndrome was independently associated with substantial fatigue, female sex, and reduced HRQoL.

OBJECTIVES:Pediatric inflammatory bowel disease (PIBD) incidence has increased in recent decades but may be stabilizing, prompting exploration of incidence changes, disease distribution, and severity. METHODS:From 2017 to 2019, patients under 18 years with PIBD symptoms were recruited from nine hospitals in South-Eastern Norway for Inflammatory Bowel Disease in South-Eastern Norway III (IBSEN III), a population-based inception cohort study. The primary outcome was a diagnosis of any PIBD subtype as defined by revised Porto criteria. Paris classification system defined disease phenotypes, and descriptions of covariates were gathered from patients in IBSEN III. RESULTS:We identified 324 PIBD patients, with 216 consenting to the IBSEN III study. The crude incidence rate was 17.8 per 100,000 person-years (PY) (95% confidence interval [CI]: 15.9-19.8). Crohn's disease (CD) was found in 118 patients (54.6%); 48% had ileocolonic distribution, 40% had upper gastrointestinal disease, and 12.8% had perianal disease. Complications (stricturing and/or penetrating) were noted in 18%. Ulcerative colitis (UC) was diagnosed in 78 patients (36.1%), predominantly pancolitis (41%), with 30% having proctitis. One in five suffered severe disease. IBD unclassified was found in 20 patients (9.3%). PIBD incidence in those under 16 was 13.6/100,000 PY, up from 4.7 in the IBSEN study 27 years ago. Terminal ileitis (11%-23%) and proctitis (14%-25%) rose from IBSEN (1990-1993) to IBSEN III, while stricturing/penetrating disease changed insignificantly (17%-16%). CONCLUSIONS:The incidence of PIBD has risen in South-Eastern Norway, with increased cases of terminal ileitis in CD, unchanged stricturing/penetrating disease, and increased proctitis in UC compared to the original IBSEN study. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02727959.

Abstract Background Fatigue is common in both Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis is still unclear. The primary aim of this study was to assess the odds for substantial fatigue (SF) and chronic fatigue (CF) one year after diagnosis based on the presence of SF at baseline. The secondary aim was to identify clinical factors that may be associated with SF one year after diagnosis. Methods Patients ≥18 years with a definite diagnosis of CD or UC at 1-year follow-up were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Patients who completed the Fatigue Questionnaire (FQ) at the time of diagnosis and at the 1-year follow-up were included. CF was defined as a dichotomized FQ score ≥4 (SF) with duration ≥ 6 months. Univariate binary logistic regression analysis was used to estimate the odds for SF/CF one year after diagnosis depending on the presence of SF at baseline. Associations between SF at the 1-year follow-up and possible predictive clinical factors were included in a multivariate logistic regression model. All analysis were performed stratified by type of diagnosis. Results In total, 596/1370 (43.5%) patients were included (CD: 196 (32.9%), UC: 400 (67.1%)). The presence of SF at the time of diagnosis compared to no initial fatigue, significantly increased the odds for SF (CD: OR=8.23, 95% CI [4.13; 16.39], UC: OR=6.67, 95% CI [4.24; 10.49]) and CF (CD: OR=6.38, 95% CI [2.71; 15.03], UC: OR=4.59, 95% CI [2.68; 7.83]) at the 1-year follow-up. Among patients with CD, development of non-passable stricture and/or surgically treated stricture within first year of disease (OR=4.37, 95%CI [1.58;12.11]), subjective flares since diagnosis (OR=2.22, 95%CI [1.11; 4.43]), female gender (OR=2.96, 95%CI [1.47; 5.95]) and presence of comorbidities (OR=4.36, 95%CI [2.06; 9.22]) were all independently associated with SF at the 1-year follow-up. For patients with UC, current biological treatment (OR=5.14, 95%CI [1.56; 16.96]), Mayo endoscopic score (0-3) at the 1-year follow-up (OR=1.54, 95%CI [1.01; 2.35]), subjective flares since diagnosis (OR=2.66, 95%CI [1.24; 5.72]) and female gender (OR=2.20, 95%CI [1.06; 4.57]) were independently associated with SF at the 1-year follow-up. Conclusion Fatigue may be expected to persevere during the first year of disease if present at the time of diagnosis. For patients with CD as well as UC, clinical factors reflecting severe disease, as severe stricturing disease in CD, biological therapy and higher Mayo endoscopic score in UC, were significantly associated with SF one year after diagnosis. Furthermore, comorbidities (only CD), female gender and subjective flares since diagnosis increased the odds for SF.

OBJECTIVE:Some Hashimoto-related symptoms, persistent despite medically obtained euthyroidism, are believed to be related to autoimmunity. Total thyroidectomy has proved beneficial for patient-reported outcome measures (PROMs), but with a certain risk of complications. Selection criteria for surgery have not been defined. Molecular evidence supporting an autoimmune cause is lacking, and a placebo effect of surgery cannot be excluded. Short of selection criteria for thyroidectomy and no pathophysiologic model to adequately explain persistent symptoms, we wanted to look into factors that may be related to patients' decision for surgery, thus aiming to facilitate patient-physician communication on treatment for persistent Hashimoto-related symptoms. METHODS:A total of 177 patients with persistent Hashimoto disease-related symptoms and highly motivated for thyroidectomy completed an 18-month watchful waiting period with biannual consultations before being offered thyroidectomy. PROMs were monitored before and after surgery. RESULTS:After 18 months of watchful waiting, 131 (74%) of 177 patients proceeded to thyroidectomy whereas 46 declined surgery. There was no difference between the surgery and no-surgery groups regarding sex, age, and thyroid peroxidase antibody levels at 18 months watchful waiting. Compared with the no-surgery group, PROM scores were consistently poorer in the surgery group for all domains in the PROM questionnaires used. CONCLUSIONS:A grace period of 18 months with biannual follow-up before thyroidectomy may be useful to modify exposure to surgery carrying a certain risk of complications. At 18 months, the fatigue score stands out as the most important factor influencing the odds for maintaining a choice to have surgery.

Abstract Background The present study aimed to estimate the prevalence of irritable bowel syndrome [IBS] symptoms and associated variables in a prospective cohort of patients with inflammatory bowel disease [IBD] in remission one year after diagnosis. Methods Adult patients [≥18 years old] with ulcerative colitis [UC] and Crohn’s disease [CD] were recruited from the Inflammatory Bowel Disease in South-Eastern Norway [IBSEN] III study, a population-based inception cohort. The prevalence of IBS-like symptoms was assessed using the Rome IV criteria for patients in remission one year after their IBD diagnosis was made. Three different definitions of remission were applied to evaluate IBS prevalence. Remission was defined as either endoscopic [Mayo endoscopic score 0 for UC, no visible ileal or colonic inflammation for CD] or biochemical [calprotectin ≤150 µg/g or ≤250 µg/g]. Results were compared to IBS prevalence in the general Norwegian population, as represented by data from the Trøndelag Health Study [HUNT4 study] 1. Demographic, psychosocial and disease-related factors associated with IBS-like symptoms were evaluated with uni- and multivariate logistic regression. Substantial fatigue was defined as a score of ≥4 on the Fatigue Questionnaire [FQ]. Results Of 1320 patients with UC or CD who met for one-year follow-up, 635 patients completed the Rome IV questionnaire [response rate 48.1%; 52.1% female; mean age 44 years]. For 151 patients in endoscopic remission, 16.6% [95% CI: 11.0-23.5] reported IBS-like symptoms compared to 19.7% [95% CI: 14.9-25.2] of 244 patients with calprotectin ≤ 150 µg/g, and 21.8% [95% CI: 17.2-27.1] of 284 patients with calprotectin ≤ 250 µg/g. All three definitions of remission resulted in significantly higher prevalence of IBS-like symptoms compared to the Norwegian population [HUNT4 study; 9.5%; 95% CI: 9.2-9.8; p<0.005]. In multivariate analysis, IBS-like symptoms were independently associated with substantial fatigue [odds ratio (OR) 3.05, 95% CI: 1.48-6.27, p=0.002] and female sex [OR 2.67, 95% CI: 1.34-5.32, p =0.005]. Conclusion Patients in IBD-remission one year after diagnosis reported a prevalence of IBS-like symptoms between 17% and 22%, depending on the definition of remission. This prevalence was significantly higher than that reported in the general Norwegian population. IBS-like symptoms were independently associated with substantial fatigue and female sex. Reference 1. Johansen SG, Ness-Jensen E. The changes in prevalence and risk of irritable bowel syndrome over time in a population-based cohort, the HUNT study, Norway. Scand J Gastroenterol 2022:1-7.

Background and Aims: Fatigue is commonly observed in Crohn's disease (CD) and ulcerative colitis (UC) but its association to achieving remission is not clearly established. In this study, we describe the odds for fatigue in patients with CD/UC 1 year after diagnosis based on different definitions of remission and identified factors associated with chronic fatigue (CF) among patients in endoscopic/radiological remission. Methods: Patients >= 18 years old with CD/UC were recruited from the IBSEN III cohort. Using the Fatigue Questionnaire, and dichotomizing the score, CF was defined as the presence of substantial fatigue (SF) for >= 6 months. Remission was divided into symptomatic (CD: Harvey-Bradshaw Index score < 5/UC: SCCAI score < 3), biochemical (fecal calprotectin <= 250 mu g/g), endoscopic/radiological (CD: normal intestinal MRI/CT combined with normal endoscopy/UC: Mayo endoscopic score 0), and histological (normal mucosal biopsies). Both the likelihood of SF/CF, depending on the definition of remission, and associations between CF and selected factors for CD/UC in endoscopic/radiological remission were evaluated using binary logistic regression analysis. Results: In total, 711/1416 patients were included. For both CD and UC, symptomatic remission significantly reduced the odds for SF and CF. In addition, the odds for SF were significantly reduced for UC in biochemical remission. Among those in endoscopic/radiological remission (n = 181), CF was independently associated with sleep disturbances (OR = 10.40, 95%CI [3.28;32.99], p < 0.001) and current treatment with infliximab (OR = 4.31, 95%CI [1.15;16.17], p = 0.03). Conclusions: Stricter definitions of disease remission were not associated with a decreased likelihood of fatigue. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current treatment with infliximab.

Background. Despite adequate hormone substitution in Hashimoto disease, some patients may have persistent symptoms with a possible autoimmune pathophysiology. A recent randomized trial (RCT) using patient-reported outcome measures as the primary endpoint showed benefit in total thyroidectomy, but at a cost of high complication rates. Objective. To verify results from the RCT in an observational study including a wider range of patients and explore means of predicting who may benefit from such surgery. Design. A total of 154 patients with Hashimoto disease, euthyroid with or without thyroid hormone substitution, and persistent Hashimoto-related symptoms were subjected to total thyroidectomy and followed for 18 months after surgery. The primary outcome was the General Health (GH) dimensional score in the Short Form-36 Health Survey (SF-36). Results. Eighteen months after surgery, a clinically significant improvement in GH was seen, similar to the findings in the previous RCT. Anti-TPO antibody titers were markedly reduced after surgery, but preoperative titers or other preoperative parameters could not predict the outcome of surgery. Three (1.9%) of 154 patients experienced permanent unilateral recurrent nerve palsy and six (3.9%) experienced hypoparathyroidism after surgery. Conclusions. Thyroidectomy had a beneficial symptom-reducing effect in euthyroid patients with Hashimoto disease and persistent symptoms. The pathophysiology of residual symptoms remains unclear, and surgical complication rates are high. If thyroidectomy is considered as a treatment option, it should be performed in dedicated centers with experienced endocrine surgeons and as part of further studies on persistent symptoms. This trial is registered with NCT-02319538.

Objective: To assess whether antibiotic exposure prenatally and before 2 years of age is associated with subsequent pediatric inflammatory bowel disease (PIBD), as earlier studies diverge substantially in risk estimations or do not include prenatal exposure. Methods: We performed a register-based cohort study including all children in Norway born 2004-2012 until study’s end on December 31, 2020. Exposures were defined as dispensed antibiotics to mothers during pregnancy and to children before 2 years of age. Main outcome was International Classification of Diseases, Tenth Revision, code registrations consistent with PIBD. Results: Among 536 819 children, 797 PIBD cases were identified. The aOR for developing PIBD if exposed to antibiotics before 2 years of age compared with no exposure was 1.33 (95% CI 1.15-1.53), adjusted for sex and prenatal antibiotic exposure. An adjustment for maternal smoking during pregnancy increased the aOR to 1.42 (1.22-1.66), but with minimal changes after further adjustments for potential confounders related to pregnancy, birth, or socioeconomic status. A dose-response association was observed in those receiving more than 2 antibiotic courses (aOR 1.47, 1.25-1.73), and with greater effect estimates for broad-spectrum antibiotics (aOR 2.57, 1.82-3.63). Antibiotic exposure during pregnancy was numerically but not significantly associated with offspring PIBD (aOR 1.15, 0.99-1.34). Conclusions: Children exposed to antibiotics before 2 years of age were more likely to develop pediatric IBD than controls. Exposure prenatally to maternal antibiotics was numerically but not statistically significant associated to subsequent PIBD.

Purpose Coeliac disease (CD) is a common disorder and affects about 1% of the population worldwide. CD in the Trøndelag Health Study (HUNT) is a population-based cohort study which was established to provide new knowledge about CD that can improve the diagnostics and management, prevent the onset or progression and expand the knowledge about the role of genetics of the disease.Participants The cohort is based on the fourth wave of the population-based HUNT study (HUNT4), Norway, performed during 2017–2019, also including linkage to hospital records and the Norwegian Patient Registry (NPR). A total of 54 541 HUNT4 participants with available sera were screened for CD by serology. All seropositive participants were invited to a clinical assessment, including endoscopy with duodenal biopsies, during 2019–2023.Findings to date A total of 1107 HUNT4 participants (2%) were seropositive for CD and 1048 were eligible for clinical assessment, including biopsy. Of these, 724 participants attended the clinical assessment and 482 were identified with CD. In addition, 371 participants with CD were identified through the hospital records and NPR. In total, 853 participants in HUNT4 with biopsy-verified CD diagnosis were identified.Future plans All participants in the study will be invited to a follow-up assessment after at least 1 year, including repeated standard serological testing, endoscopy and tissue sampling. The collected data and material will be used to establish the true population-based prevalence of CD. The consequences of CD, including symptoms, deficiencies and comorbidity, will be investigated and possible triggers and predictors, will be studied. With access to serum samples from the previous HUNT surveys in HUNT Biobank, serological signs of CD in prediagnostic samples of seropositive individuals will be used. Genetic studies will identify new CD markers, assess genotype–phenotype links and explore gene–environment correlations.Registration clinicaltrials.gov identifier: NCT04041622.

Abstract Objectives To prospectively analyse the associations between pre‐diagnostic levels of anxiety and depression and patient‐reported urinary and sexual adverse effects after radical prostatectomy in a population‐based setting. Patients and Methods In three Norwegian county hospitals, men referred with a suspicion of prostate cancer were asked to fill out a patient‐reported outcome measurement (PROM) questionnaire prior to prostate biopsy. Those who later underwent radical prostatectomy were stratified into three distress groups according to their Hopkins Symptom Checklist 5‐score. Additional PROM questionnaires, including the EPIC‐26 to measure adverse effects, were collected at 6 and 12 months postoperatively. Multivariable mixed models were estimated and post hoc pairwise comparisons performed to explore differences in adverse effects between distress groups. Results A total of 416 men were included at baseline and of those, 365 (88%) returned questionnaires at 6 months and 360 (87%) at 12 months. After adjusting for confounders, men with high distress at baseline had worse urinary incontinence domain score (58.9 vs. 66.8, p = 0.028), more urinary bother (64.7 vs. 73.6, p = 0.04) and a higher risk of using incontinence pads (70.6% vs. 54.2%, p = 0.034) at 6 months than those with low distress. There was no difference in the sexual domain scores between distress groups postoperatively, but the high‐distress group expressed more sexual bother (24.9 vs. 37.5, p = 0.015) and the intermediate‐distress group had a greater probability of using sexual medications or devices (63.8% vs. 50.0%, p = 0.015) than the low‐distress group at 6 months. At 12 months scores generally improved slightly and differences between distress groups were less evident. Conclusion Men with higher levels of anxiety and depression before prostate biopsy report more urinary and sexual adverse effects after radical prostatectomy. This should be considered both in treatment decision‐making and during follow‐up after radical prostatectomy.

IntroductionThe effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation.MethodsBetween 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships.ResultsOverall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3–4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests.ConclusionsThese findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.

Letters28 November 2023Thyroidectomy for Euthyroid Patients With Hashimoto Disease and Persisting SymptomsGeir Hoff, MD, PhD*, Tomm Bernklev, PhD*, Lene Johnsen, MD, Laurens Reitsma, MD, Dirk Sina, MD, Andromeda Lauzike, MD, Charlotte Gibbs, MD, PhD, Eivind Carlsen, MD, Tone Hoel Lende, MD, PhD, Jon Kristian Narvestad, MD, Rasmus Kildahl, MD, Roald Omdal, MD, PhD, Jan Terje Kvaløy, PhD†, Håvard Søiland, MD, PhD†Geir Hoff, MD, PhD*Department of Research, Telemark Hospital, Skien, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Tomm Bernklev, PhD*Institute of Clinical Medicine, University of Oslo, Oslo, and Department of Research, Vestfold Hospital, Tønsberg, Norway, Lene Johnsen, MDDepartment of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway, Laurens Reitsma, MDDepartment of Breast and Endocrine Surgery, Akershus University Hospital, Campus Oslo, Lørenskog, Norway, Dirk Sina, MDDepartment of Breast and Endocrine Surgery, Telemark Hospital, Skien, Norway, Andromeda Lauzike, MDDepartment of Breast and Endocrine Surgery, Telemark Hospital, Skien, Norway, Charlotte Gibbs, MD, PhDDepartment of Medicine, Telemark Hospital, Skien, Norway, Eivind Carlsen, MDDepartment of Pathology, Telemark Hospital Skien, Norway, Tone Hoel Lende, MD, PhDDepartment of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway, Jon Kristian Narvestad, MDDepartment of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway, Rasmus Kildahl, MDDepartment of Surgery, Telemark Hospital, Skien, Norway, Roald Omdal, MD, PhDDepartment of Research, Stavanger University Hospital, Stavanger, and Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway, Jan Terje Kvaløy, PhD†Department of Research, Stavanger University Hospital, and Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway, Håvard Søiland, MD, PhD†Department of Research, Stavanger University Hospital, Stavanger, and Department of Clinical Science, University of Bergen, Bergen, NorwayAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1593 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Even when thyroxine is adequately replaced for hypothyroidism, patients with Hashimoto disease may report persistent extrathyroidal symptoms, including chronic fatigue, muscle and joint tenderness, dry mouth and eyes, and poor sleep quality (1).It has been hypothesized that these persistent symptoms may be related to extrathyroidal autoimmune reactions and that complete removal of thyroid tissues may attenuate autoimmune responses and relieve symptoms (2). This hypothesis was tested in a randomized trial of thyroidectomy plus medical management versus medical management alone with 18-month follow-up (3) (ClinicalTrials.gov: NCT02319538). At inclusion, patients in the control group were given the option of having ...References1. Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine. 2004;71:275-283. [PMID: 15288851] doi:10.1016/j.jbspin.2003.06.005 CrossrefMedlineGoogle Scholar2. Promberger R, Hermann M, Pallikunnel SJ, et al. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis. Am J Surg. 2014;207:974-979. [PMID: 24070662] doi:10.1016/j.amjsurg.2013.05.005 CrossrefMedlineGoogle Scholar3. Guldvog I, Reitsma LC, Johnsen L, et al. Thyroidectomy versus medical management for euthyroid patients with Hashimoto disease and persisting symptoms. A randomized trial. Ann Intern Med. 2019;170:453-464. [PMID: 30856652] doi:10.7326/M18-0284 LinkGoogle Scholar4. Liu T, Yu CP. Placebo analgesia, acupuncture and sham surgery. Evid Based Complement Alternat Med. 2011;2011:943147. [PMID: 21785643] doi:10.1093/ecam/neq030 CrossrefMedlineGoogle Scholar5. Wartolowska K, Judge A, Hopewell S, et al. Use of placebo controls in the evaluation of surgery: systematic review. BMJ. 2014;348:g3253. [PMID: 24850821] doi:10.1136/bmj.g3253 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Geir Hoff, MD, PhD; Tomm Bernklev, PhD; Lene Johnsen, MD; Laurens Reitsma, MD; Dirk Sina, MD; Andromeda Lauzike, MD; Charlotte Gibbs, MD, PhD; Eivind Carlsen, MD; Tone Hoel Lende, MD, PhD; Jon Kristian Narvestad, MD; Rasmus Kildahl, MD; Roald Omdal, MD, PhD; Jan Terje Kvaløy, PhD; Håvard Søiland, MD, PhDAffiliations: Department of Research, Telemark Hospital, Skien, and Institute of Clinical Medicine, University of Oslo, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, and Department of Research, Vestfold Hospital, Tønsberg, NorwayDepartment of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, NorwayDepartment of Breast and Endocrine Surgery, Akershus University Hospital, Campus Oslo, Lørenskog, NorwayDepartment of Breast and Endocrine Surgery, Telemark Hospital, Skien, NorwayDepartment of Medicine, Telemark Hospital, Skien, NorwayDepartment of Pathology, Telemark Hospital Skien, NorwayDepartment of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, NorwayDepartment of Surgery, Telemark Hospital, Skien, NorwayDepartment of Research, Stavanger University Hospital, Stavanger, and Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, NorwayDepartment of Research, Stavanger University Hospital, and Department of Mathematics and Physics, University of Stavanger, Stavanger, NorwayDepartment of Research, Stavanger University Hospital, Stavanger, and Department of Clinical Science, University of Bergen, Bergen, NorwayDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1593.Data Sharing Statement: The authors have indicated that they will not be sharing data. Additional context: There are restrictions by law in Norway making data sharing particularly difficult outside Norway.Corresponding Author: Geir Hoff, MD, PhD, Department of Research, Telemark Hospital, Vindalskroken 17, Skien, Norway 3728; e-mail, hofg@sthf.no.This article was published at Annals.org on 28 November 2023.* Drs. Hoff and Bernklev share first authorship.† Drs. Kvaløy and Søiland share senior authorship. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current Issue January 2024Volume 177, Issue 1 Page: 101-103 Keywords 36 item short form health survey Quality of life Randomized trials Sleep Thyroidectomy ePublished: 28 November 2023 Issue Published: January 2024 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Purpose This unselected, population-based cohort study aimed to determine the level of health-related quality of life (HRQoL) in patients with Crohn’s disease (CD) and ulcerative colitis (UC) at the time of diagnosis compared with a reference population and identify the demographic factors, psychosocial measures, and disease activity markers associated with HRQoL. Methods Adult patients newly diagnosed with CD or UC were prospectively enrolled. HRQoL was measured using the Short Form 36 (SF-36) and Norwegian Inflammatory Bowel Disease Questionnaires. Clinical significance was assessed using Cohen’s d effect size and further compared with a Norwegian reference population. Associations between HRQoL and symptom scores, demographic factors, psychosocial measures, and disease activity markers were analyzed. Results Compared with the Norwegian reference population, patients with CD and UC reported significantly lower scores in all SF-36 dimensions, except for physical functioning. Cohen’s d effect sizes for men and women in all SF-36 dimensions were at least moderate, except for bodily pain and emotional role for men with UC and physical functioning for both sexes and diagnoses. In the multivariate regression analysis, depression subscale scores ≥ 8 on the Hospital Anxiety and Depression Scale, substantial fatigue, and high symptom scores were associated with reduced HRQoL. Conclusion Patients newly diagnosed with CD and UC reported statistically and clinically significantly lower scores in seven of the eight SF-36 dimensions than the reference population. Symptoms of depression, fatigue, and elevated symptom scores were associated with poorer HRQoL.

Background and Aims Although fatigue is common in inflammatory bowel disease [IBD], its pathogenesis remains unclear. This study aimed to determine the prevalence of fatigue and its associated factors in a cohort of patients newly diagnosed with IBD. Methods Patients >= 18 years old were recruited from the Inflammatory Bowel Disease South-Eastern Norway [IBSEN III] study, a population-based, observational inception cohort. Fatigue was assessed using the Fatigue Questionnaire and compared with data from a Norwegian general population. Univariate and multivariate linear and logistic regression analyses were performed to evaluate the associations of total fatigue [TF; continuous score] and substantial fatigue [SF; dichotomized score >= 4] with sociodemographic, clinical, endoscopic, laboratory, and other relevant patient data. Results In total, 983/1509 [65.1%] patients with complete fatigue data were included (ulcerative colitis [UC], 68.2%; Crohn's disease [CD], 31.8%). The prevalence of SF was higher in CD [69.6%] compared with UC [60.2%] [p < 0.01], and in both diagnoses when compared to the general population [p < 0.001]. In multivariate analyses, depressive symptoms, pain intensity, and sleep disturbances were associated with increased TF for both diagnoses. In addition, increased clinical disease activity and Mayo endoscopic score were significantly associated with TF in UC, whereas all disease-related variables were insignificant in CD. Similar findings were observed for SF, except regarding the Mayo endoscopic score. Conclusions SF affects approximately two-thirds of patients newly diagnosed with IBD. Fatigue was associated with depressive symptoms, sleep disturbances, and increased pain intensity in both diagnoses, while clinical and endoscopic activity were associated factors only in UC.

Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once-only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty-four thousand one hundred and fifty-nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.

Background. Kidney transplantation (KT) is considered the best treatment for end-stage kidney disease (ESKD). In the increasing elderly ESKD population, KT should be reserved for carefully selected candidates who are expected to experience favorable outcomes. We aimed to prospectively evaluate pretransplant recipient factors that may predict patient survival and can eventually guide therapeutic decisions in elderly with ESKD. Methods. Recipient factors were evaluated in KT candidates aged ≥65 y. Comorbidity was assessed at waitlisting according to the Liu comorbidity index (LCI). Health-related quality of life outcomes were measured using the Kidney Disease Quality of Life Short Form, version 1.3. The Cox proportional hazard regression was used to evaluate predictors of patient survival. Results. We included 192 recipients, with a mean age of 72.1 (4.1) y, who were transplanted with kidneys from deceased brain-dead donors. During a median observation period of 4.6 (3.2–6.3) y, 66 recipients died. Elevated LCI consistently predicted poor patient survival. In recipients with LCI ≥4, dialysis >2 y comprised a 2.5-fold increase in mortality risk compared with recipients on dialysis ≤2 y. Self-reported pretransplant physical function was also proven to be a significant positive predictor of survival. Conclusion. The implementation of LCI and a physical function score during the evaluation of older kidney transplant candidates may improve the selection and thereby optimize posttransplant outcomes.