Stressful Life Events as a Risk Factor for IBD
Stressful Life Events as a Risk Factor for IBD
Background and Aims: Stress is often perceived by patients with inflammatory bowel disease (IBD) as the leading cause of their disease. The aim of this study was to assess whether stress, evaluated through life event (LE) occurrence, is associated with IBD onset.
Methods: Incident cases of IBD, including 167 patients with Crohn's disease (CD) and 74 with ulcerative colitis (UC), were compared with two control groups, one of 69 patients with acute self-limited colitis (ASLC) and another of 255 blood donors (BDs). Stress was assessed using Paykel's self-questionnaire of LEs. Only LEs occurring within 6 months before the onset of symptoms in IBD cases and ASLC controls and before blood donation in BD controls were registered. Anxiety and depression were assessed using Bate's and Beck's questionnaires, respectively.
Results: In univariate analysis, occurrence of LEs was more frequent in the 6-month period prior to diagnosis in CD cases than in UC cases or either control group. After adjustment for depression and anxiety scores as well as other characteristics such as smoking status and sociodemographic features, this association appeared no longer significant. No associations were noted between occurrence of LEs and onset of UC relative to controls.
Conclusions: Despite its separate association with CD, LE occurrence does not appear to be an independent risk factor for IBD onset.
Inflammatory bowel disease (IBD) results from an interaction between genetic susceptibility and environmental factors, leading to mucosal immune dysregulation. Among environmental factors, only active smoking and appendectomy have been identified as influencing both the risk of occurrence and the course of IBD. However, the relapsing and remitting course of IBD suggests the possible role of other modifiers, such as psychological stress. Stress is perceived by IBD patients as the leading causative agent of their disease. Animal models have provided evidence that stress may play a role in initiation and reactivation of IBD. Elucidation of the gut-brain-immune axis has also provided insight into the mechanisms by which stress may result in gut inflammation.
Clinical data have been less convincing so far. Previous studies have shown an association between occurrence of stressful life events (LEs) and the onset of relapses in patients with established IBD. However, these results remain controversial and have been shown to be influenced by anxiety or depression. The potential role of LEs as a risk factor for IBD onset has been addressed only in studies more than 30 yr old.
The aim of our study was to assess whether LEs are associated with IBD onset while accounting for mood disorders.
Abstract and Introduction
Abstract
Background and Aims: Stress is often perceived by patients with inflammatory bowel disease (IBD) as the leading cause of their disease. The aim of this study was to assess whether stress, evaluated through life event (LE) occurrence, is associated with IBD onset.
Methods: Incident cases of IBD, including 167 patients with Crohn's disease (CD) and 74 with ulcerative colitis (UC), were compared with two control groups, one of 69 patients with acute self-limited colitis (ASLC) and another of 255 blood donors (BDs). Stress was assessed using Paykel's self-questionnaire of LEs. Only LEs occurring within 6 months before the onset of symptoms in IBD cases and ASLC controls and before blood donation in BD controls were registered. Anxiety and depression were assessed using Bate's and Beck's questionnaires, respectively.
Results: In univariate analysis, occurrence of LEs was more frequent in the 6-month period prior to diagnosis in CD cases than in UC cases or either control group. After adjustment for depression and anxiety scores as well as other characteristics such as smoking status and sociodemographic features, this association appeared no longer significant. No associations were noted between occurrence of LEs and onset of UC relative to controls.
Conclusions: Despite its separate association with CD, LE occurrence does not appear to be an independent risk factor for IBD onset.
Introduction
Inflammatory bowel disease (IBD) results from an interaction between genetic susceptibility and environmental factors, leading to mucosal immune dysregulation. Among environmental factors, only active smoking and appendectomy have been identified as influencing both the risk of occurrence and the course of IBD. However, the relapsing and remitting course of IBD suggests the possible role of other modifiers, such as psychological stress. Stress is perceived by IBD patients as the leading causative agent of their disease. Animal models have provided evidence that stress may play a role in initiation and reactivation of IBD. Elucidation of the gut-brain-immune axis has also provided insight into the mechanisms by which stress may result in gut inflammation.
Clinical data have been less convincing so far. Previous studies have shown an association between occurrence of stressful life events (LEs) and the onset of relapses in patients with established IBD. However, these results remain controversial and have been shown to be influenced by anxiety or depression. The potential role of LEs as a risk factor for IBD onset has been addressed only in studies more than 30 yr old.
The aim of our study was to assess whether LEs are associated with IBD onset while accounting for mood disorders.
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