Evidence of Bidirectional Associations Between Perceived Stress and Symptom Activity

Abstract

The analysis revealed prospective bidirectional relationships between perceived stress and IBD symptoms but no relationship between perceived stress and change in intestinal inflammation as assessed by fecal calprotectin.

Bi-directionality of Brain–Gut Interactions in Patients With Inflammatory Bowel Disease

“…31,32 Our data set comprising almost 800 patients with complete clinical data at baseline, more than 400 of whom provided longitudinal follow-up questionnaire data, is larger than the only other study that has sought to describe these relationships in IBD. 33 Recruitment took place as part of routine clinical practice, in a secondary care setting, meaning our findings are likely to be generalizable to the wider IBD population. Performing Cox regression analysis allowed us to determine independent baseline predictors of subsequent new-onset psychological comorbidity, and new-onset disease activity, after adjusting for other variables, including total duration of follow-up in all patients.…”

“…Although our use of FC as an objective marker of intestinal inflammation in assessing for biochemical evidence of disease activity at baseline is a strength, the cut-off value of 250 mg/g of stool that we used is contentious, although it is advocated by expert opinion, 34 and has been used in other studies in this field. 21,33,[35][36][37] We were only able to measure 2 points over time, using data analyzed at a group level. We acknowledge that the relationship between disease activity and psychological distress is likely to be more complex and individualistic.…”

The influence of the brain–gut axis in inflammatory bowel disease and possible implications for treatment

“…72 Only two prospective observational studies have sought to examine bi-directional brain-gut interactions in IBD. 23,73 In the first of these, Sexton et al conducted a longitudinal 6-month follow-up study of 369 patients with IBD. 73 Following multivariate regression, their results supported the existence of a bi-directional relationship between clinical disease activity, but not inflammation, and perceived stress in CD.…”

“…23,73 In the first of these, Sexton et al conducted a longitudinal 6-month follow-up study of 369 patients with IBD. 73 Following multivariate regression, their results supported the existence of a bi-directional relationship between clinical disease activity, but not inflammation, and perceived stress in CD. In a similar study of 405 patients with IBD, conducted over a minimum follow-up period of 2 years, the hazard ratio for both flare of disease activity and escalation of medical therapy in patients with anxiety and quiescent disease at baseline, confirmed by FC, was more than twice that of patients with quiescent disease who did not report symptoms of anxiety.…”

Systematic review with meta‐analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease

“…In animal studies, chemical induction of depression in a rodent model for IBD was associated with colitis reactivation . In humans, the influence of a variety psychological state on disease course in IBD, including anxiety, acute experimental stress, life‐event stress and perceived stress have been previously reported . The results from these studies are conflicting, perhaps as a consequence of the marked heterogeneity in study design, varied definition of psychological exposure and wide‐ranging quantification of disease outcomes.…”