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P230. Influence of stress in the clinical course of inflammatory bowel disease patients

M. Iglesias-Rey1, M. Barreiro-de Acosta1, R. Ferreiro1, F. Caamaño2, I. Vazquez3, A. Lorenzo1, J.E. Dominguez-Munoz1, 1University Hospital, Gastroenterology, Santiago, Spain, 2University Hospital, Epidemiology, Santiago, Spain, 3Univesity of Santiago, Psychology, Santiago, Spain

Background

Psychological stress has been defined as a process in which environmental equal or exceeds the adaptative capacity of an organism. There is a long but inconsistent history of studies about the relationship between stress and Inflammatory Bowel Disease (IBD). The aim of this study was to assess the influence of stress on the clinical course of IBD patients.

Methods

A prospective study was designed. Crohn's Disease (CD) and Ulcerative Colitis (UC) patients older than 18 years of age were included. Stress was assessed with the Spanish version of Perceived Stress scale (PSS). This scale is a self-report instrument that assesses the level of perceived stress during the last month, consisting of 14 items with a response format of a five-point scale (0 = never, 1 = hardly ever, 2 = once in a while, 3 = often, 4 = very often). The sum score obtained indicates that a higher score corresponds with a higher level of perceived stress (range 0–56). In order to assess the clinical course of IBD, during a follow-up period of 18 months all emergency visits and hospitalisations related with IBD were recorded. The influence of stress on clinical course was analyzed by Multiple Regression analysis.

Results

716 patients were included; 343 (47.9%) male, mean age 44.5 years, ages ranging from 18 to 86 years, 297 (41.8%) patients with CD and 413 (58.2%) with UC. The mean in the PSS was 23.67, with an SD of 9.59. The mean of emergency visits was 1.05 (SD: 1.68, range 0–14) and for hospitalizations it was 0.35 (SD: 0.94, range 0–9). At month 18 higher stress at baseline was related with more emergency visits in the follow up (B = 0.11; 95% CI: 0.01–0.03; p = 0.005) but not with more hospitalizations (B = −0.02; 95% CI: −0.01–0.01; p = 0.685). Only the type of disease (CD) (B = −0.13; 95% CI: −0.39–0.11; p < 0.0001) and presence of relapse at baseline (B = 0.22; 95% CI: 0.29–0.57; p < 0.0001) were related with more hospitalizations after 18 months.

Conclusion

A higher perception of stress in IBD patients is related with an increased number of emergency visits related with the disease in the following months. These patients could probably benefit from a psychological intervention that would improve their psychological status.