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Life Events and Inflammatory Bowel Disease Relapse

A Prospective Study of Patients Enrolled in Remission

Vidal, Angela, M.D.1; Gómez-Gil, Esther, M.D.2; Sans, Miquel, M.D.3; Portella, Maria J., M.D.1; Salamero, Manel, M.D.1; Piqué, Josep M., M.D.3; Panés, Julián, M.D.3

American Journal of Gastroenterology: April 2006 - Volume 101 - Issue 4 - p 775–781
ORIGINAL CONTRIBUTION: INFLAMMATORY BOWEL DISEASE
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OBJECTIVES The impact of life events in recurrence of inflammatory bowel disease (IBD) is unclear. We sought to determine whether stressful life events or the emotional impact of these events are associated with IBD relapses, hypothesizing that the exposure of life events among patients with inactive disease will increase the risk of subsequent relapses.

METHODS In this prospective study, 163 patients with inactive IBD, who had had at least one relapse in a 2-yr period before entry into the study, were enrolled. The Spanish version of the Social Readjustment Rating Scale (SRRS) (measuring life events), a measure of the emotional impact of these life events, and an IBD activity index were completed monthly up to the end of the study (maximum 11 months) or up to a relapse. Biological factors associated with an increased risk of relapse were identified in patients who relapsed.

RESULTS Fifty-one patients relapsed (32.9%), 104 remained in remission, and 8 dropped out. Multivariate Cox regression analysis with time dependent variables showed that the number of life events was not associated with the rate of relapse after adjustment for significant covariates on the subsequent month (hazard ratio = 0.88, 95% CI = 0.68–1.13, p = 0.33) or in the time-lagged analysis. The emotional impact of stressful events was also not associated with the risk of relapse. When patients who suffered a biological risk factor for relapsing were excluded in subsequent statistical analyses, similar results were obtained.

CONCLUSIONS Our results suggest that stressful life events do not trigger exacerbations in patients suffering from IBD.

1Department of Clinical Psychology, Hospital Clínic de Barcelona, Institut Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

2Department of Psychiatry, Hospital Clínic de Barcelona, Institut Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

3Department of Gastroenterology, Hospital Clínic de Barcelona, Institut Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

Reprint requests and correspondence: Julián Panés, Gastroenterology Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.

Received August 17, 2005; accepted October 26, 2005.

© The American College of Gastroenterology 2006. All Rights Reserved.
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