Original Contribution | Published:

Inflammatory Bowel Disease

A Prospective Population-Based Study of Triggers of Symptomatic Flares in IBD

The American Journal of Gastroenterology volume 105, pages 19942002 (2010) | Download Citation



We aimed to determine whether any of the nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, infections, and stress trigger symptomatic flares of inflammatory bowel diseases (IBDs).


Participants drawn from a population-based IBD research registry were surveyed every 3 months for 1 year. They simultaneously tracked the use of NSAIDs, antibiotics, infections, major life events, mood, and perceived stress. Social networks, childhood socioeconomic status, and smoking were assessed at baseline. Disease flare was identified using the Manitoba Inflammatory Bowel Disease Index, a validated disease activity index. Across any two consecutive survey periods, participants were categorized as having a flare (inactive/active), having no flare (inactive/inactive), or remaining active (active/active). Potential triggers were evaluated for the first 3-month period to determine predictive rather than concurrent relationships. Data from only one pair of 3-month periods from an individual were analyzed.


A total of 704 participants completed the baseline survey; 552 (78.3%) returned all 5 surveys. In all, 174 participants who had a flare were compared with 209 who had no flare. Perceived stress, negative affect (mood), and major life events were the only trigger variables significantly associated with flares. There were no differences between those who flared and those who did not, in the use of NSAIDs, antibiotics, or in the presence of infections. Multivariate logistic regression analyses indicated that only high-perceived stress (adjusted odds ratio=2.40 (1.35, 4.26)) was associated with an increased risk of flare.


This study adds to the growing evidence that psychological factors contribute to IBD symptom flares. There was no support for differential rates of use of NSAIDS, antibiotics, or for the occurrence of (non-enteric) infections related to IBD flares.

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Author information


  1. IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada

    • Charles N Bernstein
    • , Sunny Singh
    • , Lesley A Graff
    • , John R Walker
    • , Norine Miller
    •  & Mary Cheang
  2. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    • Charles N Bernstein
  3. Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada

    • Lesley A Graff
    •  & John R Walker


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Competing interests

Guarantor of the article: Charles N. Bernstein, MD.

Specific author contributions: Study concept and design; analysis and interpretation of data; drafting of the paper; critical revision of the paper for important intellectual content; statistical analysis; obtained funding; technical or material support; study supervision: Charles N. Bernstein; acquisition of data; analysis and interpretation of data; critical revision of the paper for important intellectual content: Sunny Singh; study concept and design; analysis and interpretation of data; drafting of the paper; critical revision of the paper for important intellectual content; statistical analysis; study supervision: Lesley A. Graff; study concept and design; analysis and interpretation of data; drafting of the paper; critical revision of the paper for important intellectual content; statistical analysis: John R. Walker; acquisition of data; critical revision of the paper for important intellectual content; technical or material support: Norine Miller; analysis and interpretation of data; critical revision of the paper for important intellectual content; statistical analysis: Mary Cheang.

Financial support: Charles Bernstein is supported in part by a Research Scientist Award of the Crohn's and Colitis Foundation of Canada and holds the Bingham Chair in Gastroenterology. This study was sponsored in part by UCB Canada.

Potential competing interests: In the past year Dr Bernstein has served as a consultant to or on the advisory boards of Shire Canada and Abbott Canada and has received research funding from UCB Canada. The other authors declare no conflict of interest.

Corresponding author

Correspondence to Charles N Bernstein.

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