Comprehensive Lifestyle-Modification in Patients with Ulcerative Colitis–A Randomized Controlled Trial

Abstract

Patients with ulcerative colitis suffer from impaired health-related quality of life (HrQoL). Comprehensive lifestyle-modification might increase HrQoL and decrease disease activity. Ninety-seven patients in clinical remission with impaired HrQoL were randomly assigned to a 10 week comprehensive lifestyle-modification program (LSM; n = 47; 50.28 ± 11.90 years) or control (n = 50; 45.54 ± 12.49 years) that received a single workshop of intense training in naturopathic self-help strategies. Primary outcome was HrQoL (Inflammatory Bowel Disease Questionnaire; IBDQ) at week 12. Secondary outcomes included IBDQ subscales; generic HrQoL; disease activity and microbiome. Both groups showed improvement in HrQoL from baseline to post-treatment at week 12. The IBDQ sum score showed no significant group difference (p = 0.251). If patients attended more than 50% of the training sessions, a significant group effect (p = 0.034) was evident in favor of LSM. In addition, the SF-36 mental component summary (p = 0.002) was significantly different between the groups in favor of LSM. Disease activity microbiome and adverse events did not differ. Both a single workshop and a 10-week comprehensive lifestyle-modification program can improve HrQoL in patients with ulcerative colitis in remission with no apparent effects on clinical disease activity. A treatment difference was observed when examining a subsample of patients who attended ≥ 50% of sessions.

Altered Brain Structure in Chronic Visceral Pain: Specific Differences in Gray Matter Volume and Associations With Visceral Symptoms and Chronic Stress

“…However, this negative result is difficult to interpret given the absence of group differences in chronic stress levels in our UC cohort, indicating essentially normal perceived chronic stress in this sample despite elevated clinical symptoms of anxiety as quantified with the HADS. While sample characteristics of UC were in this respect similar to an earlier study in a different sample of UC that used a comparable recruitment strategy ( 75 ), other studies from our own group ( 76 ) and other groups [e.g., ( 63 )] reported more psychological impairment in patients, including elevated chronic stress levels. The lack of elevated chronic stress in this UC sample obviously limits the interpretation of these results, although owing to our approach to test the interaction this does not per se exclude an impact but rather a disease-specific differential association compared to controls.…”

“…The lack of elevated chronic stress in this UC sample obviously limits the interpretation of these results, although owing to our approach to test the interaction this does not per se exclude an impact but rather a disease-specific differential association compared to controls. Clearly, our data do not provide conclusive answers, and hopefully inspire further study, possibly in selected patient groups presenting with higher stress levels or other impairment in psychological health, as recently accomplished by our group in a treatment trial ( 75 ), or in concert with biological measures relevant to neuroendocrine stress mediators and inflammation ( 76 ), both accomplished without concurrent brain imaging. Longitudinal studies already elucidated the relation between stress and disease course ( 37 , 38 ).…”

Comprehensive Lifestyle Modification Influences Medium-Term and Artificially Induced Stress in Ulcerative Colitis—A Sub-Study within a Randomized Controlled Trial Using the Trier Social Stress Test

“…The present study presents long-term results of stress-related outcomes of a prospective RCT [ 25 ]. In addition, exploratory results of a sub-study applying a laboratory stress protocol conducted within the RCT are reported.…”

“…Patients were randomized using computer generated stratified block randomization (Strata: sex and azathioprine) to either the lifestyle-modification group or the control group using the Random Allocation Software. For further information see Langhorst, Schöls [ 25 ].…”

“…Patients in the comprehensive lifestyle-modification program including mind–body techniques participated in ten 6-hour group sessions within ten weeks. For further information on the intervention, see Langhorst, Schöls, Cinar, Eilert, Kofink, Paul, Zempel, Elsenbruch, Lauche, Ahmed, Haller, Cramer, Dobos and Koch [ 25 ].…”