Clinical implications
Our results confirmed the association between GI symptoms and mental
health (e.g. anxiety/depression) in pwCF. This reinforces the importance
of mental health screening and psychological care, which is already
embedded in many CF centers in the Netherlands with the inclusion of a
psychologist/social worker as part of the multidisciplinary
team.15 In the CF mental health guidelines, annual
mental health screening and treatment is recommended beginning at age 12
through adulthood.13 National implementation of these
guidelines has been highly successful,43 partly
because of the development of a mental health “toolbox” and additional
mental health training sessions at national conferences. This study
highlights the importance of investigating GI symptoms in CF in addition
to anxiety and depression. The Dutch GI Symptom Tracker is now
available. It can be used to facilitate collaborative patient-provider
discussions to manage gastrointestinal symptoms, guide nutritional
interventions, and improve adherence to pancreatic enzymes to improve
outcomes in cystic fibrosis. Therefore, we recommend that the Dutch GI
Symptom Tracker can be implemented into regular CF care in Dutch CF
centers. GI screening can be incorporated into the International Mental
Health Guidelines13 as well.
In conclusion, this is the first study investigating the association
between GI symptoms -assessed by the Dutch GI Symptom Tracker-,
anxiety/depression and HRQoL in Dutch pwCF. We observed a significant,
positive association between more GI symptoms and elevated anxiety,
depression and worse HRQoL Additional research is needed to better
understand how mental and physical health are linked in CF.