ENVIRONMENTAL FACTORS EFFECTING INFLAMMATORY BOWEL DISEASE ACTIVITY

Purpose: Inflammatory bowel disease (IBD) is a waxing and waning illness with many modulating environmental factors effecting disease activity. Many of these environmental factors are not well established and studies evaluating the effects of seasonal variation, menstrual cycle, NSAID ingestion, stress and dietary intake have yielded controversial results. The purpose of this study was to further examine the relationship of several of these factors, thought to influence disease activity, to patient's perceived disease activity. Methods: This was a retrospective study involving 30 patients with IBD within the greater Chicago area (mean age = 51, 17 women, 13 men). Sixteen patients with Crohn's disease and 14 patients with Ulcerative Colitis were administered a telephone questionnaire designed to assess patient's perceived disease activity in correlation with variables such as season, stress, menstrual cycle, NSAID use, OCP use, and several dietary factors. Results were analyzed using one way chi-squared analysis. Results: 73% of all patients reported increased symptoms with increased life stress (p = .01). 53% of all patients reported a perceived seasonal variation in their symptoms, with 50% of these reporting worse symptoms in winter, 25% in summer, 12.5% in spring and 12.5% in fall (p = 0.72). 36% of patients reported increased symptoms post dairy intake (p = 0.14). Among menstruating women, 40% reported increased symptoms during menstruation (p = 0.43). Of the patients who drank alcohol, 43% reported increased symptoms post EtOH ingestion (p = 0.51). Only 23% of patients reported worsening of symptoms with sugar intake and 27% of patients reported increased symptoms post NSAID use (p = .003 and p = 0.01 respectively, significant for not effecting perceived symptoms). Conclusions: Our study found a significant association between life stress and perceived inflammatory bowel disease activity. Although trends were noted, our study reveals no significant association between perceived disease activity and season, dairy intake, menstruation, EtOH intake, sugar ingestion or NSAID use. Larger prospective studies focused on the influence of environmental factors and more specifically the role of stress and the therapeutic benefits of stress management on disease activity are warranted.