Jedel S, Hoffman A, Merriman P, Swanson B, Voigt R, Rajan K B, Shaikh M, Li H, Keshavarzian A
Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill., USA.
Digestion. 2014;89(2):142-55. doi: 10.1159/000356316. Epub 2014 Feb 14.
BACKGROUND/AIMS: The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL.
Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments.
55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01).
MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.
背景/目的：溃疡性结肠炎（UC）的主要治疗目标是通过在发作时进行治疗以及预防发作来维持卓越的生活质量（QOL）。由于压力可引发UC发作，我们研究了基于正念减压疗法（MBSR）减少发作及改善生活质量的疗效。
将处于缓解期的中度至重度UC患者随机分为MBSR组或时间/注意力控制组。主要结局为疾病状态。次要结局为炎症和疾病活动标志物、压力标志物及心理评估的变化。
55名受试者被随机分组。两组在1年期间的无发作情况、发作时间及发作严重程度相似。然而，事后分析显示，在尿皮质醇处于最高三分位数且有基线感知压力的参与者中，MBSR降低了至少发作一次的参与者比例（30%对70%；p<0.001）。与对照组中发作的患者相比，发作的MBSR组患者在最后一次就诊时的压力显著更低（p=0.04）。此外，MBSR可防止发作期间炎症性肠病生活质量问卷评分下降（p<0.01）。
MBSR对缓解期UC患者的发作率或严重程度无影响。然而，MBSR可能对缓解期具有高应激反应性（高感知压力和尿皮质醇）的患者有效。MBSR似乎通过将发作对生活质量的负面影响降至最低来改善UC患者的生活质量。需要进一步研究以确定MBSR可改变疾病进程的患者亚组。
