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Short-Term Stress, but Not Mucosal Healing Nor Depression Was Predictive for the Risk of Relapse in Patients with Ulcerative Colitis: A Prospective 12-Month Follow-up Study

Langhorst, Jost MD*; Hofstetter, Anna MD*; Wolfe, Fred MD†,‡; Häuser, Winfried MD§,‖

doi: 10.1097/MIB.0b013e3182a192ba
Original Clinical Articles

Background: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. Psychological factors such as depression and stress are under debate to contribute to the risk of relapse. The impact of mucosal healing to reduce the risk of relapse had not been studied prospectively. The aim of this study was to identify whether depression and stress increase and mucosal healing reduces the risk of clinical relapse in patients with UC in clinical remission.

Methods: Patients in clinical remission were followed prospectively for 1 year, or less if they relapsed. Endoscopy and histology score and long-term perceived stress (Perceived Stress Questionnaire) were measured at baseline. Mucosal healing was defined by a Mayo Endoscopy score of 0–1. Depression (Hospital Anxiety and Depression Scale) and acute perceived stress (Cohen Perceived Stress Scale) were measured at baseline and after 1, 3, 6, 9, and 12 months. A time-dependent multivariate Cox regression model determined the predictors of time to relapse.

Results: Seventy-five patients were included into final analysis, of which 28 (37.3%) relapsed. Short-term stress at the last visit before relapse (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 1.01–1.10) and male gender (HR = 2.38, 95% CI = 1.01–5.61), but not baseline mucosal healing (HR = 0.86, 95% CI = 0.35–2.11), baseline long-term stress (HR = 0.20, 95% CI = 0.01–3.31), and depression at the last visit before relapse (HR = 1.08, 95% CI = 0.95–1.22) were predictive for a relapse.

Conclusions: Short-term stress but not depression nor mucosal healing was predictive for the risk of relapse in patients with UC in clinical remission. Larger multicentre studies are necessary to confirm our findings.

Article first published online 12 August 2013

*Department Internal Medicine V (Integrative Medicine), Kliniken Essen-Mitte, Essen, Germany;

National Data Bank for Rheumatic Diseases, Wichita, KS;

University of Kansas School of Medicine, Wichita, KS;

§Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany; and

Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany.

Reprints: Jost Langhorst, Integrative Gastroenterology, Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, Essen D-45276, Germany (e-mail:

J. Langhorst has served as a speaker and received a honorarium for Repha GmbH, Techlab Inc, Falk Foundation and received research funding from Techlab Inc., Repha GmbH and Steigerwald Arneimittelwerk GmbH within the last 3 years. A. Hofstetter has nothing to declare. W. Huser received a consulting honorarium by Daiichi Sankyo and honororia for educational lectures by Abbott and Pfizer within the last 3 years. F. Wolfe has no conflicts of interest to declare.

Received May 12, 2013

Accepted June 20, 2013

© Crohn's & Colitis Foundation of America, Inc.
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