Original Contribution

The American Journal of Gastroenterology (2006) 101, 775–781; doi:10.1111/j.1572-0241.2006.00476.x

Life Events and Inflammatory Bowel Disease Relapse: A Prospective Study of Patients Enrolled in Remission

Angela Vidal MD1, Esther Gómez-Gil MD2, Miquel Sans MD3, Maria J Portella MD1, Manel Salamero MD1, Josep M Piqué MD3 and Juláin Panés MD3

  1. 1Department of Clinical Psychology, Hospital Clínic de Barcelona, Institut Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
  2. 2Department of Psychiatry, Hospital Clínic de Barcelona, Institut Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
  3. 3Department of Gastroenterology, Hospital Clínic de Barcelona, Institut Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

Correspondence: Julián Panés, Gastroenterology Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.

Received 17 August 2005; Accepted 26 October 2005.

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Abstract

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.