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Predicting relapse in Crohn’s disease: a biopsychosocial model
Abstract
Background: Crohn’s disease (CD) is a chronic relapsing inflammatory bowel disorder. Both biological and psychosocial factors may modulate the illness experience. Aim: The aim of this study was to identify clinical, biological and psychosocial parameters as predictors of clinical relapse in quiescent CD. Methods: Patients in medically induced remission were followed prospectively for 1 year, or less if they relapsed. Disease characteristics were determined at baseline. Serum cytokines, anti- Saccharomyces cerevisiae antibodies, C-reactive protein (CRP), erythrocyte sedimentation rate and intestinal permeability were measured every 3 months. Psychological distress, perceived stress, minor life stressors and coping strategies were measured monthly. A time-dependent multivariate Cox regression model determined predictors of time to relapse. Results: 101 patients (60 females, 41 males) were recruited. Fourteen withdrew and 37 relapsed. CRP (HR = 1.5 per 10 mg/l, 95% CI 1.1 to 1.9, p = 0.007), fistulising disease (HR = 3.2, 95% CI, 1.1 to 9.4, p = 0.04), colitis (HR = 3.5 95% CI 1.2 to 9.9, p = 0.02) and the interaction between perceived stress and avoidance coping (HR = 7.0 per 5 unit increase for both scales, 95% CI 2.3 to 21.8, p = 0.003) were predictors of earlier relapse. Conclusions: In quiescent CD, a higher CRP, fistulising disease behaviour and disease confined to the colon were independent predictors of relapse. Moreover, patients under conditions of low stress and who scored low on avoidance coping (ie, did not engage in social diversion or distraction) were least likely to relapse. This study supports a biopsychosocial model of CD exacerbation.
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“When we restricted the analysis to include only the two studies that recruited patients in clinical remission,[20, 26] the risk of flare among those with symptoms of anxiety at baseline was significantly higher (RR = 1.80; 95% CI 1.242.61).”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [20]
In the citing paper
“The 13 eligible articles reported on 12 separate study populations,[11, 20-30, 33] containing 9192 patients.”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [20]
In the citing paper
“Study quality is provided in Supplementary Tables 1 and 2; five studies scored 7 or more on the NewcastleOttawa scale.[11, 20, 23, 24, 26]”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [20]
In the citing paper
“When data were pooled from five studies,[20, 26, 27, 29, 30] containing 1244 patients, the risk of developing a flare of disease activity was no higher among those with symptoms of anxiety at baseline (RR = 1.20; 95% CI 0.93-1.55), with moderate heterogeneity between studies ( I 2 =53.7%).”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [20]
In the citing paper
“When data were pooled from eight studies,[20-23, 26, 27, 29, 30] which included 7606 patients, symptoms of depression at baseline were associated with a significantly increased risk of flare of disease activity during longitudinal follow-up (RR = 1.60; 95% CI 1.212.12), with high heterogeneity between studies ( I 2 =73.5%)”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [20]
In the citing paper
“However, when the analysis was restricted to include only three studies that recruited only patients in clinical remission,[20, 23, 26] there was no longer a significant increase in risk (RR = 1.36; 95% CI 0.88-2.09).”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [20]
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Metadata
- Authors
- Bitton, A., Dobkin, P. L., Edwardes, M. D., Sewitch, M. J., Meddings, J. B., Rawal, S., Cohen, A., Vermeire, S., Dufresne, L., Franchimont, D., & Wild, G. E.
- Affiliations
- McGill University Health Centre (CA)
- University of Alberta (CA)
- Jewish General Hospital (CA)
- Universitair Ziekenhuis Leuven (BE)
- Douglas Mental Health University Institute (CA)
- Corresponding author
- Bitton, A
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2008-04-07
- Volume
- 57
- Issue
- 10
- Pages
- 1386-1392
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W2028756447
- Cited by
- 254
- References
- 63
- Citations by year
- 2026: 4 · 2025: 14 · 2024: 13 · 2023: 6 · 2022: 18 · 2021: 15 · 2020: 10 · 2019: 14 · 2018: 11 · 2017: 20 · 2016: 17 · 2015: 14 · 2014: 15 · 2013: 21 · 2012: 12
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Rheumatology › Spondyloarthritis Studies and Treatments
- Keywords
- Crohn's disease, recurrence prediction, biopsychosocial model, C-reactive protein, perceived stress, avoidance coping, colitis, serum cytokines, ASCA, intestinal permeability, psychosocial factors
- MeSH terms
- Adult, Blood Sedimentation, C-Reactive Protein, Crohn Disease, Female, Humans, Male, Models, Psychological, Permeability, Predictive Value of Tests, Prospective Studies, Recurrence, Stress, Psychological, Disease Progression
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