Although perceived stress (PS) is known to cause symptomatic flares in inflammatory bowel disease, clinical and physiological measures associated with perceived stress and flare are not known. 

A recent study identified physiological factors associated with perceived stress in ulcerative colitis (UC) subjects and their relationship with flare.

The study subjected the enrolled UC patients in clinical remission (Simple Colitis Clinical Activity Index (SCCAI) score< 5) to undergo clinical and behavioral assessments, morning salivary cortisol measurements, autonomic nervous system activity testing [heart rate variability(HRV), electrodermal activity(EDA)] at baseline with patient-reported SCCAI every two weeks over 1-2 years and fecal calprotectin at time of the flare. It evaluated Clinical flares (SCCAI >5) and biochemical flares (SCCAI >5 with fecal calprotectin >250 μg/g).

The findings were as follows-

• The study enrolled 110 U.C. subjects with a mean follow-up of 65.6 weeks.
• It determined the U.C. subjects with higher and lower P.S.
• Although the high P.S. group showed 3.6 times higher odds of a clinical flare than the low P.S. group, they showed no significant differences in biochemical flares.
• Both the groups differed in tonic sympathetic arousal as indexed by significantly greater baseline EDA in the high P.S. group, but not in terms of HRV and morning cortisol levels.
• Increased fecal calprotectin was associated with cardioautonomic measures indicating lower parasympathetic activity.

Thus, this study explained that an increased P.S. evaluated at baseline is associated with tonic sympathetic arousal and greater odds of clinical flares in U.C. subjects.

Source: Sauk JS, Ryu HJ, Labus JS, et al. Clin Gastroenterol Hepatol. 2022 Aug 8;S1542-3565(22)00721-2. doi: 10.1016/j.cgh.2022.07.025.