title: A prospective population-based study of triggers of symptomatic flares in IBD.
abstract: OBJECTIVE
  We aimed to determine whether any of the nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, infections, and stress trigger symptomatic flares of inflammatory bowel diseases (IBDs).
  
  
  METHODS
  Participants drawn from a population-based IBD research registry were surveyed every 3 months for 1 year. They simultaneously tracked the use of NSAIDs, antibiotics, infections, major life events, mood, and perceived stress. Social networks, childhood socioeconomic status, and smoking were assessed at baseline. Disease flare was identified using the Manitoba Inflammatory Bowel Disease Index, a validated disease activity index. Across any two consecutive survey periods, participants were categorized as having a flare (inactive/active), having no flare (inactive/inactive), or remaining active (active/active). Potential triggers were evaluated for the first 3-month period to determine predictive rather than concurrent relationships. Data from only one pair of 3-month periods from an individual were analyzed.
  
  
  RESULTS
  A total of 704 participants completed the baseline survey; 552 (78.3%) returned all 5 surveys. In all, 174 participants who had a flare were compared with 209 who had no flare. Perceived stress, negative affect (mood), and major life events were the only trigger variables significantly associated with flares. There were no differences between those who flared and those who did not, in the use of NSAIDs, antibiotics, or in the presence of infections. Multivariate logistic regression analyses indicated that only high-perceived stress (adjusted odds ratio=2.40 (1.35, 4.26)) was associated with an increased risk of flare.
  
  
  CONCLUSIONS
  This study adds to the growing evidence that psychological factors contribute to IBD symptom flares. There was no support for differential rates of use of NSAIDS, antibiotics, or for the occurrence of (non-enteric) infections related to IBD flares.
authors.affiliation: IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada. cbernst@cc.umanitoba.ca
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.forename: Sunny
authors.initials: S
authors.lastname: Singh
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Graff
authors.forename: John R
authors.initials: JR
authors.lastname: Walker
authors.forename: Norine
authors.initials: N
authors.lastname: Miller
authors.forename: Mary
authors.initials: M
authors.lastname: Cheang
mesh_terms: D000328:Adult; D000339:Affect; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D005260:Female; D006306:Health Surveys; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D008016:Life Change Events; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal