Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Apr 21;20(15):4329-34.
doi: 10.3748/wjg.v20.i15.4329.

Case-control study of factors that trigger inflammatory bowel disease flares

Linda A Feagins  1 , Ramiz Iqbal  1 , Stuart J Spechler  1
Affiliations

Case-control study of factors that trigger inflammatory bowel disease flares

Linda A Feagins et al. World J Gastroenterol. .

Abstract

Aim: To explore the association between inflammatory bowel diseases (IBD) flares and potential triggers.

Methods: Patients evaluated for an acute flare of IBD by a gastroenterologist at the Dallas VA Medical Center were invited to participate, as were a control group of patients with IBD in remission. Patients were systematically queried about nonsteroidal anti-inflammatory drug use, antibiotic use, stressful life events, cigarette smoking, medication adherence, infections, and travel in the preceding 3 mo. Disease activity scores were calculated for each patient at the time of enrollment and each patient's chart was reviewed. Multivariate regression analysis was performed.

Results: A total of 134 patients with IBD (63 with Crohn's disease, 70 with ulcerative colitis, and 1 with indeterminate colitis) were enrolled; 66 patients had flares of their IBD and 68 were controls with IBD in remission (for Crohn's patients, average Crohn's disease activity index was 350 for flares vs 69 in the controls; for UC patients, Mayo score was 7.6 for flares vs 1 for controls in those with full Mayo available and 5.4p for flares vs 0.1p for controls in those with partial Mayo score). Only medication non-adherence was significantly more frequent in the flare group than in the control group (48.5% vs 29.4%, P = 0.03) and remained significant on multivariate analysis (OR = 2.86, 95%CI: 1.33-6.18). On multivariate regression analysis, immunomodulator use was found to be associated with significantly lower rates of flare (OR = 0.40, 95%CI: 0.19-0.86).

Conclusion: In a study of potential triggers for IBD flares, medication non-adherence was significantly associated with flares. These findings are incentive to improve medication adherence.

Keywords: Crohn’s disease; Flare; Inflammatory bowel diseases; Non-adherence; Ulcerative colitis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Frequency of potential triggers in patients with a flare of inflammatory bowel disease and in control patients in remission for at least 6 mo. NSAID: Nonsteroidal anti-inflammatory drug.
Figure 2
Figure 2
Frequencies of missing a dose of medication to treat inflammatory bowel disease.
Figure 3
Figure 3
Reasons for medication non-adherence.
See this image and copyright information in PMC

References

    1. Feagins LA, Cryer BL. Do non-steroidal anti-inflammatory drugs cause exacerbations of inflammatory bowel disease? Dig Dis Sci. 2010;55:226–232. - PubMed
    1. Aberra FN, Brensinger CM, Bilker WB, Lichtenstein GR, Lewis JD. Antibiotic use and the risk of flare of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2005;3:459–465. - PubMed
    1. Issa M, Ananthakrishnan AN, Binion DG. Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis. 2008;14:1432–1442. - PubMed
    1. Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Cattan S, Gendre J. Effects of current and former cigarette smoking on the clinical course of Crohn’s disease. Aliment Pharmacol Ther. 1999;13:1403–1411. - PubMed
    1. Beaugerie L, Massot N, Carbonnel F, Cattan S, Gendre JP, Cosnes J. Impact of cessation of smoking on the course of ulcerative colitis. Am J Gastroenterol. 2001;96:2113–2116. - PubMed

Publication types

MeSH terms

Substances