Stress and Exacerbation in Ulcerative Colitis: A... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

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Stress and Exacerbation in Ulcerative Colitis: A Prospective Study of Patients Enrolled in Remission

Levenstein, Susan MD1; Prantera, Cosimo MD1; Varvo, Vilma PhD1; Scribano, Maria Lia MD1; Andreoli, Arnaldo MD1; Luzi, Carlo MD1; Arcà, Massimo PhD2; Berto, Eva MD1; Milite, Giustina1; Marcheggiano, Adriana MD3

1_Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy_

2_Epidemiological Observatory of the Latium Region, Rome, Italy_

3_Gastroenterology Department, Second Medical Clinic, “La Sapienza” University, Rome, Italy_

Reprint requests and correspondence: Susan Levenstein, MD, Via del Tempio 1A, 00186 Rome, Italy.

Received June. 14, 1999; accepted November. 2, 1999

Abstract

OBJECTIVE:

We sought to determine whether psychosocial factors influence the course of ulcerative colitis, hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation.

METHODS:

Sixty-two patients with known ulcerative colitis were enrolled into a prospective cohort study while in clinical remission. Their perceived stress, depressive symptoms, and stressful life events were followed, along with potential confounders, for up to 45 months; exacerbation status was monitored for up to 68 months.

RESULTS:

The 27 patients who experienced an exacerbation were compared with those who remained in remission. Having a score in the upper tertile on the long-term (past 2 yr) baseline Perceived Stress Questionnaire significantly increased the actuarial risk of exacerbation (hazards ratio = 2.8, 95% confidence interval 1.1–7.2). At any given study visit, high long-term stress tripled the risk of exacerbation during the next 8 months (risk for the three tertiles, 8.3%, 16.7%, and 26.2%, p = 0.02). Shorter sleep time, briefer remission, histological activity, and use of nonsteroidal antiinflammatory drugs, antibiotics, or oral contraceptives also increased the medium- and/or long-term risk of exacerbation, but adjustment for these variables did not eliminate the associations with stress. Exacerbation was not associated with stressful life events, depressive symptoms, short-term (past month) perceived stress, smoking, disease extent or duration, or severity of recent course.

CONCLUSIONS:

Short-term stress does not trigger exacerbation in ulcerative colitis, but long-term perceived stress increases the risk of exacerbation over a period of months to years.