Effect of Psychological Comorbidity on Inflammatory Bowel Disease Activity

Pavankumar Kamat


June 22, 2021


  • Patients with inflammatory bowel disease (IBD) in biochemical remission had a worse disease course with increasing psychological comorbidity at baseline.

Why this matters

  • Findings emphasise the importance of recognising not only the effect of psychological comorbidity on IBD progression but also the increased risk of multiple psychological comorbidities on adverse clinical outcomes.

Study design

  • A longitudinal follow-up study of 218 patients with IBD and confirmed biochemical remission (faecal calprotectin, ≤250 μg/g).

  • Effect of multiple psychological comorbidities on IBD activity outcomes (glucocorticosteroid prescription or flare of disease activity, escalation of therapy, hospitalisation or intestinal resection) was evaluated over ≥2 years of follow-up.

  • Funding: Leeds Hospital Charitable Foundation.

Key results

  • Of 218 patients with IBD, 48 (22.0%) had 1, 13 (6.0%) had 2 and 9 (4.1%) had 3 psychological comorbidities at baseline.

  • Following multivariate Cox regression analysis:

    • rates of glucocorticosteroid prescription or flare were significantly higher in patients with IBD with:

      • 2 psychological comorbidities (HR, 3.18; 95% CI, 1.44-7.02); and

      • 3 psychological comorbidities (HR, 3.53; 95% CI, 1.26-9.92).

    • requirement for escalation of medical therapy due to disease activity was significantly higher in those with:

      • 2 psychological comorbidities (HR, 2.48; 95% CI, 1.03-5.93); and

      • 3 psychological comorbidities (HR, 8.19; 95% CI, 2.88-23.23).

  • Incidence of ≥1 outcome of IBD activity was significantly higher in those with:

    • 1 psychological comorbidity (HR, 1.74; 95% CI, 1.07-2.82);

    • 2 psychological comorbidities (HR, 2.47; 95% CI, 1.12-5.46); and

    • 3 psychological comorbidities (HR, 4.93; 95% CI, 1.84-13.17).


  • Small sample size.


Fairbrass KM, Gracie DJ, Ford AC. Longitudinal follow-up study: effect of psychological co-morbidity on the prognosis of inflammatory bowel disease. Aliment Pharmacol Ther. 2021 Jun 11 [Epub ahead of print]. doi: 10.1111/apt.16454. PMID: 34114664.  View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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