PREdiCCT: Role of psychosocial factors in IBD flares unravelled

The prospective observational PREdiCCT study identified various psychosocial factors that were associated with an increased risk of flare in patients with inflammatory bowel disease (IBD). Anxiety, sleep, depression, and somatisation were all linked to an increased risk of flare. According to the authors, these findings support using a holistic approach in IBD.

The PREdiCCT trial aimed to establish to what extent baseline habitual diet, environmental factors, genetic variation, and gut microbiota are associated with the occurrence of flare in patients with Crohn’s disease (CD) or ulcerative colitis (UC).

“We included participants with CD [n=1,370] or UC [n=1,259] who were in self-reported remission and collected DNA, stool samples, and detailed information about lifestyle and diet,” said Dr Lauranne Derikx (Erasmus MC, the Netherlands) [1]. “We compared the data of participants who had a disease flare and those who did not have a disease flare.” After 2 years of follow-up, 36% of the participants had experienced a ‘clinical flare,’ which was a self-reported flare, and 13% had had a ‘hard flare’, which was defined as an increase in symptoms plus an elevation in CRP and/or calprotectin, as well as a change in IBD therapy. “No variables were associated with baseline calprotectin,” stressed Dr Derikx.

Severe anxiety was associated with an increased risk for flare in CD (HR 1.86; 95% CI 1.38–2.52; P=0.001) and in UC (HR 1.46; 95% CI 1.08–1.99; P=0.01). Sleep disturbances were linked to an elevated risk of clinical flare in CD (HR 1.58; 95% CI 1.22–2.04; P<0.001) but not in UC. Also, somatisation was related to an increased risk for clinical flare in both CD and UC. “Perhaps even more important, depression and lack of exercise were both associated with a heightened risk for a hard flare in patients with UC,” stated Dr Derikx (see Figure).

Figure: Several psychological factors are associated with clinical and hard flare [1]



In summary, anxiety, sleep disturbances, somatisation, depression, and lack of exercise were all related to an increased risk of flare in patients with IBD. “More clinical, dietary, genomic, and microbiome data is coming soon from PREdiCCT,” promised Dr Derikx.

1. Derikx LAAP, et al. Psychosocial factors are associated with risk of flare in IBD; results from the PREdiCCT study. OP07, 20th Congress of ECCO, 19–22 February 2025, Berlin, Germany.

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Posted on 8 April 20258 April 2025