Modifiable Factors Influencing Disease Flares in Inflammatory Bowel Disease: A Literature Overview of Lifestyle, Psychological, and Environmental Risk Factors

Abstract

Background: A significant concern for patients with Inflammatory Bowel Disease (IBD) is predicting and managing disease flares. While healthcare providers rely on biomarkers, providing conclusive patient advice remains challenging. This review explores the role of lifestyle, psychological health, and environmental exposures in the prediction and management of IBD flares. Methods: This review followed PRISMA guidelines (2020). A structured search was conducted in PubMed for articles published between 2012 and 2024, using free and Medical Subject Heading (MeSH) terms for predicting factors in IBD. Inclusion criteria included studies reporting primary data on modifiable clinical or environmental predictors of IBD relapse, excluding studies on post-operative investigations, treatment cessation, and pediatric or pregnant populations. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies. Results: Out of 2287 identified citations, 58 articles were included. Several modifiable factors influencing disease flares were identified, including psychological stress, sleep disturbances, smoking, and nutrition. Poor sleep quality and mental health were linked to increased flare risks, while smoking was associated with higher relapse rates in Crohn's disease. Environmental exposures, such as heat waves and high-altitude regions, also contributed. Predictive models integrating clinical, lifestyle, and psychological factors showed promising accuracy but require further refinement. Limitations of this review include the potential for publication bias, variability in flare definitions, and limited sample sizes Conclusions: Key predictors of IBD flares include dietary factors, psychological stress, poor sleep quality, and pharmacological influences. Personalized approaches integrating these predictors can optimize disease control and improve patient outcomes.

Keywords: disease flares; inflammatory bowel disease; lifestyle factors; nutrition; personalized treatment; predictive models; psychological health; risk factors; sleep quality.

Figure 1

PRISMA 2020 flow diagram.

Figure 2

Summary of identified risk factors for disease flares in inflammatory bowel disease. Abbreviations: VAT:SAT, Visceral Adipose Tissue–Subcutaneous Adipose Tissue; CD, Crohn’s Disease; UC, Ulcerative Colitis; NSAIDs, Non-steroidal Anti-inflammatory Drugs; COVID-19, Coronavirus Disease 2019; ECCI, Endoscopic Clinical Correlation Index; SCCAI, Simple Clinical Colitis Activity Index; SEO, Seo’s Activity Index.