Stress and exacerbation in ulcerative colitis: A prospective study of patients enrolled in remission

OBJECTIVE: We sought to determine whether psychosocial factors influence th e course of ulcerative colitis, hypothesizing that high perceived stress am ong patients with inactive disease will increase the risk of subsequent exa cerbation. METHODS: Sixty-two patients with known ulcerative colitis were enrolled int o a prospective cohort study while in clinical remission. Their perceived s tress, depressive symptoms, and stressful life events were followed, along with potential confounders, for up to 45 months; exacerbation status was mo nitored 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 th e long-term (past 2 yr) baseline Perceived Stress Questionnaire significant ly increased the actuarial risk of exacerbation (hazards ratio = 2.8, 95% c onfidence interval 1.1-7.2). At any given study visit, high long-term stres s tripled the risk of exacerbation during the next 8 months (risk for the t hree tertiles, 8.3%, 16.7%, and 26.2%, p = 0.02). Shorter sleep time, brief er remission, histological activity, and use of nonsteroidal antiinflammato ry drugs, antibiotics, or oral contraceptives also increased the medium- an d/or long-term risk of exacerbation, but adjustment for these variables did not eliminate the associations with stress. Exacerbation was not associate d with stressful life events, depressive symptoms, short-term (past month) perceived stress, smoking, disease extent or duration, or severity of recen t 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. (C) 2000 by Am. Cell, of Gastroenterology .