Can Stress Cause Ulcerative Colitis Flares?

IBD

Gursimran S. Kochhar, MD reviewing Sauk JS, Clin Gastroenterol Hepatol 2022 Aug 8.

Epidemiological studies have suggested a role of psychological stress in patients with inflammatory bowel disease (IBD). Approximately 70% of patients with IBD report stress as an important factor affecting their condition. Despite these data, the casualty between higher stress perception and clinical flares remains to be determined.

This large prospective study enrolled 110 patients with ulcerative colitis (UC) with a mean follow-up of 65.6 weeks. Patients with UC in clinical remission underwent clinical and behavioral assessment, morning salivary cortisol measurements, autonomic nervous system activity testing at baseline and every 2 weeks over 1 and 2 years, and testing of fecal calprotectin levels at the time of the flare. Patients in the high perceived stress (PS) group had 3.6 times higher odds of a clinical flare than those in the low PS group.

Comment:

This is an important study because patients with higher perceived stress were found to have more clinical flare-ups without evidence of biochemical flare. The findings of this study indicate that increased stress perception can cause clinical flares; however, biochemical evidence related to gut inflammation is not present. This brings forth a crucial point in disease management of patients with IBD, including the mental health and well-being of the patient. Mental health can be overlooked in routine care of patients with IBD because the focus is on medical management. It is imperative to emphasize the mental well-being of our patients with IBD because this study suggests that the perception of stress can bring forth clinical disease flares, which can result in unnecessary procedures, imaging, and even emergency department visits.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Gursimran S. Kochhar, MD

Bio and Disclosures

Citation(s):

Sauk JS, Ryu HJ, Labus JS, et al. High perceived stress is associated with increased risk of ulcerative colitis clinical flares. Clin Gastroenterol Hepatol 2022 Aug 8. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.07.025)