Research Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 21, 2014; 20(15): 4329-4334
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4329
Case-control study of factors that trigger inflammatory bowel disease flares
Linda A Feagins, Ramiz Iqbal, Stuart J Spechler
Linda A Feagins, Ramiz Iqbal, Stuart J Spechler, VA North Texas Healthcare System, Dallas, TX 75216, United States
Linda A Feagins, Stuart J Spechler, Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX 75216, United States
Author contributions: Feagins LA designed the study, enrolled study patients, analyzed and interpreted the data, and drafted and approved the article; Iqbal R played a critical role in patient recruitment and data acquisition; Spechler SJ played a critical role in data interpretation and revising the manuscript for important intellectual content.
Supported by The Office of Medical Research, Department of Veteran’s Affairs, and in part, by Janssen, Inc.
Correspondence to: Linda A Feagins, MD, Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas VA Medical Center, 4500 S Lancaster Road, Dallas, TX 75216, United States. linda.feagins@va.gov
Telephone: +1-214-8571820 Fax: +1-214-8571571
Received: August 1, 2013
Revised: September 24, 2013
Accepted: October 19, 2013
Published online: April 21, 2014
Processing time: 259 Days and 10.3 Hours
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: Inflammatory bowel diseases; Flare; Non-adherence; Crohn’s disease; Ulcerative colitis

Core tip: Flares of Crohn’s disease and colitis are often unpredictable and physicians and patients alike search for triggers for these flares in an attempt to prevent future flares. In this study, we prospectively enrolled and queried patients with flares of inflammatory bowel diseases (IBD) and compared their responses to IBD patients in remission. We found that medication non-adherence was the only significant trigger for flares of IBD, while nonsteroidal anti-inflammatory drug use, antibiotic use, infections, smoking, travel and emotional stress were not associated with flares. Clinicians should be aware the significant role that non-adherence plays in flare-ups of IBD in order to counsel their patients appropriately.