Novel Perceived Stress and Life Events Precede Flares of Inflammatory Bowel Disease: A Prospective 12-Month Follow-Up Study

Abstract

Background and Aims: Inflammatory bowel disease [IBD] is characterized by recurrent disease flares. The impact of psychosocial wellbeing on the occurrence of flares is unclear. In this prospective study, we aimed to evaluate the association between patient-reported psychosocial wellbeing and disease flares using continuous monitoring. Methods: Consecutive IBD patients were recruited from the myIBDcoach telemedicine study cohort. Over 12 months, participants reported on disease activity together with anxiety, depression, fatigue, perceived stress and life events every 1-3 months. Flares were defined using a combination of clinical disease activity and additional measurements. Generalized estimating equation models were used to assess associations between psychosocial wellbeing and flares over time. The influences of both the presence of psychosocial symptoms in general as well as novel psychosocial symptoms were analysed. Results: In total, 417 patients were included. Forty-nine patients [11.8%] experienced a flare during the study period. The occurrence of life events in the preceding 3 months was positively associated with flares (odds ratio [OR] = 1.81; 95% confidence interval [CI] = 1.04-3.17), while the presence of anxiety, depression, fatigue and perceived stress in general was not. However, novel perceived stress [OR = 2.92; 95% CI = 1.44-5.90] was associated with flares. Conclusions: The occurrence of life events and novel perceived stress are associated with disease flares in the next 3 months, while the presence of perceived stress in general is not. These findings underline the importance of continuous personalized monitoring of IBD patients and may contribute to the prevention of disease flares.

The influence of the brain–gut axis in inflammatory bowel disease and possible implications for treatment

“…18 Finally, other investigators have demonstrated heightened response to psychological stressors in patients with IBD, 48 and that stressful life events may precede flares of disease activity. 15,63 This relationship between psychological wellbeing and disease activity, independent of the reporting of IBS-type symptoms, suggests that brain-gut axis dysfunction may also be implicated in the propagation of disease activity in IBD, mediated by aberrant brain-gut interactions. However, a major limiting factor in the examination of the temporal relationship between psychological disorders and longitudinal disease activity in many studies conducted to date is the lack of objective quantification of subsequent inflammatory activity.…”

Hospitalisation for Drug Infusion Did Not Increase Levels of Anxiety and the Risk of Disease Relapse in Patients with Inflammatory Bowel Disease during COVID-19 Outbreak

“…Notably, the present study shows that our patients with IBD were not particularly afraid of SARS-CoV-2 infection, since the levels of anxiety detected by HADS questionnaire are similar in patients who could remain at home and in those who needed to go to the hospital. It is worthy of note that anxiety and stressor events have been associated with an increased risk of disease relapse [7][8][9], In particular, a prospective study by Wintjens et al [9] showed that the occurrence of life events in the preceding three months was positively associated with IBD flares. A recent review by Sun et al [8] confirmed these findings, demonstrating that psychological stress could induce IBD relapses both in adult and in paediatric patients by several mechanisms, such as impaired intestinal barrier function, disturbance of the gut microbiota, intestinal dysmotility, and immune and neuroendocrine dysfunctions.…”

“…Both diseases are associated with a marked reduction in health-related quality of life, severe fatigue, and work impairment, as well as with depression and anxiety [6,7]. Indeed, several studies associated the risk of disease relapse to stressful events [7][8][9].…”

Multidimensional Assessment of Interoceptive Abilities, Emotion Processing and the Role of Early Life Stress in Inflammatory Bowel Diseases

“…The etiology of IBD is multifactorial including genetic, immune, and environmental factors. While the impact of the environment on the development of IBD is substantial, the role of specific factors is still poorly defined, one candidate being early life stress ( 3 – 5 ). Newer studies in IBD have suggested alterations in the brain-body communication, directly influencing the sensory and immune functions of the gastrointestinal tract ( 6 – 8 ).…”