Effect of Lifestyle Factors on Outcomes in Patients With Inflammatory Bowel Diseases

Abstract

Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life.

Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease

“…For IBD patients already in remission, depression is a factor in the development of irritable bowel-like symptoms [ 37 ]. Stressful life events are among the risk factors for IBD attacks [ 38 ], and maintaining a balanced and regular lifestyle may alleviate the severity of IBD [ 39 ]. Good sleep and exercise can help alleviate depression and reduce IBD episodes, while unhealthy lifestyle habits, such as smoking and alcohol consumption, invite a poor outcome of IBD [ 39 ].…”

“…Stressful life events are among the risk factors for IBD attacks [ 38 ], and maintaining a balanced and regular lifestyle may alleviate the severity of IBD [ 39 ]. Good sleep and exercise can help alleviate depression and reduce IBD episodes, while unhealthy lifestyle habits, such as smoking and alcohol consumption, invite a poor outcome of IBD [ 39 ]. Furthermore, nonadherence to treatment in IBD patients is strongly associated with disease relapse.…”

Czynniki środowiskowe zwiększające ryzyko aktywacji i rozwoju chorób zapalnych jelit

“…Wykazano że, stres psychiczny wpływa na zaburzenie homeostazy jelitowej poprzez zmianę działania osi mózgowo-jelitowej i może mieć krótko-lub długoterminowy wpływ na funkcje układu trawiennego, u chorych może wywołać nawrót lub zaostrzenie objawów NChZJ [55]. Współistnienie otyłości jest dodatkowo związane z większym odczuwaniem bólu, zmęczenia oraz depresją i lękiem [56].…”

“…Wykazano również częściowe działanie ochronne Akkermansji na otyłość i stany zapalne [64]. Dowiedziono, że otyłość zwiększa ryzyko nawrotu NChZJ, modyfikuje niekorzystnie farmakokinetykę czynników biologicznych oraz jest związana z wyższym ryzykiem niepowodzenia leczenia [56]. Podsumowując dane ekologiczne, wykazano dodatnią korelację między poziomem zanieczyszczenia powietrza, a hospitalizacją związaną ze schorzeniami zapalnymi jelit [65].…”

IL‑6/STAT3 signaling pathway regulates the proliferation and damage of intestinal epithelial cells in patients with ulcerative colitis via H3K27ac

“…Patients with UC exhibit different degrees of clinical symptoms (4). UC is mainly associated with infection, immunology, genetic and mental factors, among which the infection and immunology factors predominate (5,6).…”