High Perceived Stress is Associated With Increased Risk of Ulcerative Colitis Clinical Flares,Clinical Gastroenterology and Hepatology

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High Perceived Stress is Associated With Increased Risk of Ulcerative Colitis Clinical Flares
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2022-08-08 , DOI: 10.1016/j.cgh.2022.07.025
Jenny S Sauk ₁ , Hyo Jin Ryu ₂ , Jennifer S Labus ₂ , Ariela Khandadash ₂ , Aaron I Ahdoot ₃ , Venu Lagishetty ₃ , William Katzka ₃ , Hao Wang ₂ , Bruce Naliboff ₂ , Jonathan P Jacobs ₄ , Emeran A Mayer ₁

Affiliation

Background & Aims

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.

Methods

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.

Results

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.

Conclusions

Increased PS assessed at baseline is associated with tonic sympathetic arousal and greater odds of clinical flares in patients with UC.

中文翻译：

高感知压力与溃疡性结肠炎临床发作风险增加有关

背景与目标

尽管感知压力 (PS) 与炎症性肠病的症状发作有关，但与感知压力和发作相关的临床和生理指标尚不清楚。本研究的目的是确定与溃疡性结肠炎 (UC) 受试者的感知压力相关的生理因素，以及它们与发作的关系。

方法

临床缓解的 UC 患者（单纯性结肠炎临床活动指数 [SCCAI] 评分 <5）在基线时接受了临床和行为评估、早晨唾液皮质醇测量、自主神经系统活动测试（心率变异性、皮肤电活动）以及患者报告的 SCCAI在 1 至 2 年内每 2 周一次，并在发作时粪便钙卫蛋白。评估了临床耀斑（SCCAI ≥5）和生化耀斑（SCCAI ≥5，粪便钙卫蛋白≥250 μg/g）。

结果

110 名 UC 患者入组，平均随访 65.6 周。确定具有较高和较低 PS 的 UC 患者。尽管高 PS 组的临床发作几率比低 PS 组高 3.6 倍，但在低 PS 组和高 PS 组之间未观察到生化发作的显着差异。高 PS 组与低 PS 组在紧张性交感神经唤醒方面存在差异，高 PS 组的基线皮肤电活动显着增加（4.3 对 3.4 微西门子；P = .026），但在心率变异性和早晨皮质醇水平方面没有差异。粪便钙卫蛋白增加与心脏自主神经功能相关，表明副交感神经活动较低。