Exploring the relationship between IBD symptoms and stress

Although a connection between psychological stress and increased disease activity in IBD exists, most treatment modalities for IBD tend to be medication focused. Medication is of course extremely necessary; IBD can be an incredibly difficult thing to treat, and no one treatment option works for each patient. However, as nurses we always say to focus on the entire patient, not just the disease.

Although I do not have it within my power to create entire treatment plans for patients with the various forms of IBD, I have been slowly developing a way to maybe help them help themselves.

The Application

I used to work with a Gastroenterologist that would explore countless avenues for treating her patient's inflammatory bowel disease in addition to the standard prescription medications.

Some would do aromatherapy, others acupuncture. Smoking cessation, exercise, yoga, you name it -- she has had her patient's try it.

A lot of these patient's would be resistant to these additional treatment modalities, preferring to simply take the medication. I wanted to come up with a way to help people explore how these additional activities might help to reduce their IBD symptoms.

What came about after some brainstorming is the app IBDiary. Originally thought up as an entire calendar for tracking one's daily food, appointments, symptoms, diary entries, stress levels, medications and more.. has been scaled back to better illustrate an important relationship:

The correlation between one's daily stress and daily IBD symptoms.

You can take a closer look at my code here.

In the application the user self reports their overall stress level and the overall severity of their symptoms. This is completely based on the user's own personal scale, because the point of this app is to help them view their own personal relationship between stress and IBD symptoms.

After mapping out a full month of reflections, complete with stress and symptom data, the user is then able to view a graph that maps out all of the data points and provides them with some simple statistical analysis under the hood that tells them how strong the 2 variables are correlated.

I utilized the (MUI X Charts)[https://mui.com/x/react-charts/] to chart and display the data. I am still tinkering and exploring how to best visualize the user's data, but I find that this library is extremely easy to use.

All the user's reflections are saved to their profile so that the data can be accessed from their phone or desktop, really anywhere they would like. Having the data conveniently stored in a database, such as MongoDB, will make the quantitative portion of the next section much easier.

The Research

There are a multitude of articles that explore the relationship between stress and IBD flares.

For example, in 2007, Mawdsley et al. wrote that acute and chronic stress can both contribute to the development and relapse of GI inflammation. Milne at al. have found that stress management courses in addition to conventional treatments can significantly reduce disease activity in patients with Crohns.

My goal with this application is less focused on proving a relationship between environmental stress and IBD symptoms -- but on helping patients visualize the relationship and exploring whether or not it makes them more likely to accept additional forms of treatment in conjunction with conventional treatment.

I plan to create a study in which I collect quantitative data from the application as well as conduct interviews with the users before using the application and after 3 months of regular use. I will be able to collect data such as number of uses, missed days, general patient engagement with the quantitative data collected by the application.

I am not exactly sure what these 0 and 3 month interviews will look like quite yet. That is something that I will need to continue to explore as I go on.

References

Mawdsley, J. E., & Rampton, D. S. (2005). Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut, 54(10), 1481–1491. https://doi.org/10.1136/gut.2005.064261

Milne, B., Joachim, G., & Niedhardt, J. (1986). A stress management programme for inflammatory bowel disease patients. Journal of Advanced Nursing, 11(5), 561–567. https://doi.org/10.1111/j.1365-2648.1986.tb01288.x