Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life. Correspondence: Siddharth Singh, MD, MS. E-mail: sis040@ucsd.edu. Received August 31, 2019 Accepted March 03, 2020 © The American College of Gastroenterology 2020. All Rights Reserved.

中文翻译：

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生活方式因素对炎症性肠病患者结局的影响。

各种生活方式因素，包括体育锻炼和肥胖，压力，睡眠和吸烟，可能会改变发生炎症性肠病（IBD）的风险。在已建立IBD的患者中，这些生活方式因素可能会显着影响自然病史和临床结局。娱乐性运动可降低IBD患者发作耀斑和疲劳的风险。相反，肥胖增加了复发的风险，并与更高的焦虑，抑郁，疲劳和疼痛以及更高的医疗保健利用率相关。肥胖症还不利地改变了生物制剂的药代动力学，并与更高的治疗失败风险相关。IBD患者的睡眠障碍非常普遍，与疾病活动无关，并增加了复发和慢性疲劳的风险。同样，压力，IBD患者尤其是感觉到的压力而不是主要的生活事件可能会引发IBD患者的症状性发作，尽管其对炎症的影响尚不清楚。吸烟与不良后果相关，包括克罗恩病患者皮质类固醇依赖，手术和疾病进展的风险；相反，抽烟并不会显着影响溃疡性结肠炎患者的结局，尽管一些研究表明，抽烟可能与较低的耀斑风险相关。酒精和大麻在IBD患者中的使用效果不一致，一些研究表明，大麻可以减轻IBD患者的慢性疼痛，而没有明显的生物学缓解作用。尽管这些生活方式因素可能会改变，但仅进行了一些干预研究。结构化运动和心理疗法的试验，包括基于冥想的疗法（如冥想和瑜伽）以及肠道定向催眠疗法，虽然可以改善整体生活质量，但并未始终证明其对IBD的临床和/或内镜疾病活动有益。通讯：Siddharth Singh，医学博士，硕士。电子邮件：sis040@ucsd.edu。2019年8月31日收到，2020年3月3日接受©2020美国胃肠病学院。保留所有权利。