High Perceived Stress is Associated With Increased Risk of Ulcerative Colitis Clinical Flares

• Published in: Clinical gastroenterology and hepatology Vol. 21; no. 3; pp. 741 - 749.e3
• Main Authors: Sauk, Jenny S., Ryu, Hyo Jin, Labus, Jennifer S., Khandadash, Ariela, Ahdoot, Aaron I., Lagishetty, Venu, Katzka, William, Wang, Hao, Naliboff, Bruce, Jacobs, Jonathan P., Mayer, Emeran A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Colitis, Ulcerative - physiopathology; Colitis, Ulcerative - psychology; Feces - chemistry; Gastroenterology and Hepatology; Humans; Hydrocortisone; Inflammatory Bowel Disease; Inflammatory Bowel Diseases - physiopathology; Inflammatory Bowel Diseases - psychology; Leukocyte L1 Antigen Complex; Psychiatric Disorders; Stress, Psychological - physiopathology; Symptom Flare Up; Symptom Score or Index; Ulcerative Colitis; Symptom Score or Index; EDA; PS; UCLA; ANS; CI; HADS; IBD; SCCAI; Psychiatric Disorders; IQR; HRV; RMSSD; UC; sIBDQ; PSS; SD; IPIP-N; Ulcerative Colitis; HPA; LF; Inflammatory Bowel Disease; LF/HF; HF; Simple Colitis Clinical Activity Index; perceived stress; interquartile range; low frequency; Short Inflammatory Bowel Disease Questionnaire Scale; root mean squared standard deviation; heart rate variability; hypothalamic-pituitary axis; low frequency/high frequency; International Personality Item Pool-Neuroticism; University of California Los Angeles; autonomic nervous system; high frequency; Hospital Anxiety and Depression Scales; electrodermal activity; Perceived Stress Scale; confidence interval; standard deviation
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2022.07.025

Although perceived stress (PS) has been associated with symptomatic flares in inflammatory bowel disease, clinical and physiological measures associated with perceived stress and flare are not known. The aim of this study was to identify physiological factors associated with perceived stress in ulcerative colitis (UC) subjects, and their relationship with flare. Patients with UC in clinical remission (Simple Colitis Clinical Activity Index [SCCAI] score <5) underwent clinical and behavioral assessments, morning salivary cortisol measurements, autonomic nervous system activity testing (heart rate variability, electrodermal activity) at baseline with patient-reported SCCAI every 2 weeks over 1 to 2 years and fecal calprotectin at time of flare. Clinical flares (SCCAI ≥5) and biochemical flares (SCCAI ≥5 with fecal calprotectin ≥250 μg/g) were evaluated. One hundred ten patients with UC were enrolled, with mean follow-up of 65.6 weeks. Patients with UC with higher and lower PS were determined. Although the high PS group had 3.6 times higher odds of a clinical flare than the low PS group, no significant differences in biochemical flares were observed between the low and high PS groups. The high vs low PS group differed in tonic sympathetic arousal as indexed by significantly greater baseline electrodermal activity (4.3 vs 3.4 microsiemens; P = .026) in the high PS group, but not in terms of heart rate variability and morning cortisol levels. Increased fecal calprotectin was associated with cardioautonomic measures, suggesting lower parasympathetic activity. Increased PS assessed at baseline is associated with tonic sympathetic arousal and greater odds of clinical flares in patients with UC. [Display omitted]