No study has yet compared the respective psychological impact of corticotherapy and enteral nutrition in the treatment of Crohn's disease, and especially, the psychological problems linked to the wearing of a nasogastric tube 24 hours a day. The goal of this study was to collect comparative information regarding the real-life experience and the feeling of these two treatments.
Patients and methods: From September 1997 to February 1998 at the clinic of inflammatory bowel diseases of the hospital Necker-Enfants malades, 51 patients aged 12 to 18 (average 15) participated in this study. Thirty [15 on corticotherapy (CT); 15 on enteral nutrition (EN)] answered a questionnaire inspired by a similar Canadian questionnaire (Inflammatory Bowel Disease Questionnaire), and 21 passed Spielberger's anxiety tests, Beck's depression tests and a psychological interview.
Treatment: According to the 30 questionnaires the appreciation of the therapeutic results was similar in the two treatments, the majority of patients respected their treatment (only one patient on EN ate secretly and two on CT stopped their corticotherapy). Of the 15 EN questionnaires: nine out of 15 patients responded well to the suspension of oral feeding, two were hungry, nine experienced cravings and ten avoided meals during their treatment. From a cosmetic point of view, six/14 (43%) found it difficult putting up with the nasogastric tube 24 hours a day, and eight/15 (53%) on CT found the facial swelling difficult to bear. According to the 21 psychological interviews, eight patients deemed EN efficient, while only four felt the same about CT. Of the 11 EN psychological interview, no adolescent patients were hungry, eight had cravings and nine avoided meals during their treatment, seven mentioned they felt different and seven described how EN had upset the family's routine. Nine (82%) talked about how difficult it was to put up with the nasogastric tube 24 hours a day from a cosmetic standpoint while eight/ten (80%) on CT found the facial swelling difficult to live with. Seven complained that they had been the victims of verbal abuse. Quality of life: According to the 30 questionnaires, eight/15 patients on EN missed an average of 15 days of school against five/15 patients on CT, ten patients judged that EN restricted their daily lives and nine mentioned the daily difficulties to wear a tube 24 hours a day.
Tests: Spielberger's test of anxiety revealed that on average, the 11 patients on EN who were interviewed suffered the first level of anxiety, while the ten patients on CT felt the second level. As for the Beck's depression test, the 11 patients on NE suffered the first level of depression on average, while those on CT were subject to the second level.
Conclusion: This study demonstrated that EN was perceived as being more disruptive to patients daily lives than CT and defines the difficulties linked to the suspension of oral feeding and the wearing of a naso-gastric tube. The study also describes the difficulties involved in coping with the side effects of CT, one example being facial swelling which can be as unpleasant from a cosmetic point of view as wearing of a naso-gastric tube.