Posted: 03.27.2014 | by AMRA

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Ulcerative colitis is an inflammatory bowel disease that is a chronic autoimmune disorder of the colon. Despite the best medical management, ulcerative colitis patients often experience episodic flare-ups with symptoms that include abdominal pain, diarrhea, and rectal bleeding. Flare-ups are sometimes triggered by stress, and there is a great deal of interest in stress-reduction interventions that might improve quality of life and reduce flare-ups, and defining those ulcerative colitis subpopulations that might benefit most from such techniques.

Jedel et al. [Digestion] studied MBSR’s effectiveness in preventing ulcerative colitis flare-ups in a randomized, double-blind study. Fifty-five moderately severe ulcerative colitis patients in remission were assigned to either MBSR or a placebo (lectures and videos on mind/body medicine). Moderate severity of disease status was defined by a Mayo Ulcerative Colitis Disease Activity Index of 6–12. Measures taken at baseline, post-treatment, and 6 and 12-month follow-up included inflammation markers (calprotectin, C-reactive protein, and cytokines), stress markers (ACTH, cortisol), measures of perceived stress and IBD quality of life, and measures of mood and mindfulness (MAAS).

There was no difference in the number or severity of flare-ups or the length of the inflammation-free interval prior to flare-ups between groups, but MBSR participants who flared had significantly better quality of life and lower perceived stress than control subjects who flared (quality of life was also higher for MBSR participants regardless of whether or not they flared). There were no group differences on measures of mood or mindfulness, possibly due to a ceiling effect in this mentally healthy cohort.

MBSR participants with the highest number of gastrointestinal symptoms at baseline benefited the most. MBSR participants with the highest perceived stress and/or cortisol levels at baseline had significantly fewer flare-ups than controls with the highest perceived stress and/or cortisol levels. MBSR positively impacted ACTH and cytokine levels, but not enough to prevent flare-ups.

This study shows that MBSR improves the quality of life of ulcerative colitis patients generally and may also prevent flare-ups in patients experiencing high levels of perceived stress.

Reference:

Jedel, S., Hoffman, A., Merriman, P., Swanson, B., Voigt, R., Rajan, K. B., . . . Keshavarzian, A. (2014). A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. Digestion, 89(2):142-155. [PMID: 24557009]

[Link to abstract]