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Life-event stress induced by the Great East Japan Earthquake was associated with relapse in ulcerative colitis but not Crohn's disease: a retrospective cohort study
  1. Hisashi Shiga1,
  2. Teruko Miyazawa1,
  3. Yoshitaka Kinouchi1,
  4. Seiichi Takahashi1,
  5. Gen Tominaga2,
  6. Hiroki Takahashi3,
  7. Sho Takagi4,
  8. Nobuya Obana5,
  9. Tatsuya Kikuchi6,
  10. Shinya Oomori7,
  11. Eiki Nomura8,
  12. Manabu Shiraki9,
  13. Yuichirou Sato5,
  14. Shuichiro Takahashi10,
  15. Ken Umemura11,
  16. Hiroshi Yokoyama12,
  17. Katsuya Endo1,
  18. Yoichi Kakuta1,
  19. Hiroki Aizawa13,
  20. Masaki Matsuura2,
  21. Tomoya Kimura9,
  22. Masatake Kuroha9,
  23. Tooru Shimosegawa1
  1. 1Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
  2. 2Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
  3. 3Department of Gastroenterology, Sendai Medical Center, Sendai, Japan
  4. 4Takagi Clinic, Sendai, Japan
  5. 5Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan
  6. 6Department of Gastroenterology, Sendai City Hospital, Sendai, Japan
  7. 7Department of Gastroenterology, Japanese Red Cross Sendai Hospital, Sendai, Japan
  8. 8Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan
  9. 9Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
  10. 10Department of Gastroenterology, Iwate Prefectural Chubu Hospital, Kitakami, Japan
  11. 11Department of Gastroenterology, South Miyagi Medical Center, Ogawara, Japan
  12. 12Department of Gastroenterology, Iwate Prefectural Iwai Hospital, Ichinoseki, Japan
  13. 13Department of Internal Medicine, Kesennuma City Hospital, Kesennuma, Japan
  1. Correspondence to Dr Hisashi Shiga; shiga{at}


Objective Stress is thought to be one of the triggers of relapses in patients with inflammatory bowel disease (IBD). We examined the rate of relapse in IBD patients before and after the Great East Japan Earthquake.

Design A retrospective cohort study.

Settings 13 hospitals in Japan.

Participants 546 ulcerative colitis (UC) and 357 Crohn's disease (CD) patients who received outpatient and inpatient care at 13 hospitals located in the area that were seriously damaged by the earthquake. Data on patient's clinical characteristics, disease activity and deleterious effects of the earthquake were obtained from questionnaires and hospital records.

Primary outcome We evaluated the relapse rate (from inactive to active) across two consecutive months before and two consecutive months after the earthquake. In this study, we defined ‘active’ as conditions with a partial Mayo score=2 or more (UC) or a Harvey-Bradshaw index=6 or more (CD).

Results Among the UC patients, disease was active in 167 patients and inactive in 379 patients before the earthquake. After the earthquake, the activity scores increased significantly (p<0.0001). A total of 86 patients relapsed (relapse rate=15.8%). The relapse rate was about twice that of the corresponding period in the previous year. Among the CD patients, 86 patients had active disease and 271 had inactive disease before the earthquake. After the earthquake, the activity indices changed little. A total of 25 patients experienced a relapse (relapse rate=7%). The relapse rate did not differ from that of the corresponding period in the previous year. Multivariate analyses revealed that UC, changes in dietary oral intake and anxiety about family finances were associated with the relapse.

Conclusions Life-event stress induced by the Great East Japan Earthquake was associated with relapse in UC but not CD.

  • earthquake
  • ulcerative colitis
  • Crohn's disease
  • relapse

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