Stress as a Trigger for Relapses in IBD: A Case-Crossover Study

Background: It is important to identify factors that influence the risk of relapses in inflammatory bowel disease. Few studies have been conducted and with limited methodology. This prospective case-crossover study, aims to examine whether perceived stress has a short-term acute effect, namely whether it acts as a trigger, on the risk of relapse in inflammatory bowel disease. Methods: Sixty patients with inflammatory bowel disease and in remission were included. The case-crossover design was employed, which is an epidemiological design developed to study triggers for acute events and diseases. To collect information regarding symptoms and potential trigger factors, such as perceived stress, a structured diary was constructed. The participants were instructed to fill in the diary daily during six months. Fifty patients completed the study. Results: The analysis showed an effect for high level of perceived stress. Being exposed to "quite a lot" of stress, yield an increase in risk for relapse during the forthcoming day (OR = 4.8, 95% CI 1.09 -21.10). No statistically increased risk for lower levels of perceived stress was found, although elevated effect estimates were found for "some" stress. Conclusion: This study supports earlier findings regarding perceived stress as an important factor in triggering relapses in IBD. However, this is the first case-crossover study performed to explore the trigger risk of stress in this population. Further investigations with larger patient samples are needed to confirm the findings.