The Role of Psychological Stress in Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is an idiopathic inflammatory condition of the gastrointestinal tract whose natural history is one of periods of remission and relapse. The aetiology is complex and reflects an interaction between genes and environment. Psychological stress has long been reported by both doctors and patients as worsening disease activity in IBD. Prospective studies of the relationship between disease relapse and adverse life events have produced conflicting results, in part due to the inherent difficulties of such studies. However, several more recent analyses have suggested that both adverse life events and chronic perceived stress can contribute to disease relapse. There is also an increasing body of evidence to suggest that experimental stress can increase mucosal inflammation both in patients with IBD and in animal models of colitis. Despite this increase in understanding the pro-inflammatory effects of stress in IBD, thus far only a few limited studies have examined stress reduction as a therapeutic modality.

INSPIRE study: Does stress management improve the course of inflammatory bowel disease and disease-specific quality of life in distressed patients with ulcerative colitis or crohnʼs disease? A randomized controlled trial

“…Models of disease course as well as disease-specific quality of life were different in the two diseases, suggesting that UC and CD should be treated separately and not as one common IBD group in psychotherapeutic intervention studies. Previous studies evaluating the relationship of stress to relapse in IBD reported mixed results, 6,41,42 but prospective studies have linked UC more strongly than CD to perceived stress 21,23 ; our results indirectly support this. Moreover, our findings are in agreement with results from the largest psychotherapeutic intervention study in CD patients, 10 and from studies of psychological intervention studies in studies of mixed samples of IBD 11,12 or IBD patients with psychiatric problems such as high anxiety.…”

Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease

“…In terms of the association between variables experienced in one 3-mo period and a symptomatic flare in the next 3-mo period, only psychological factors, including the occurrence of a major life event, high perceived stress, and high negative mood during a previous 3-mo period, were significantly associated with the subsequent occurrence of a flare. This study complements the growing evidence from experimental as well as clinical studies that stress exposure, including stressful events and perceived stress (the individual's view of his or her own level of demand relative to resources), may contribute to relapse risk in IBD [14][15][16][17][18] . In fact, using multivariate logistic regression analyses of these variables, only high perceived stress (adjusted OR = 2.40; 95%CI: 1.35-4.26) was associated with an increased risk of flare.…”

Facteurs psychosociaux et risque de rechute au cours de la maladie de Crohn

“…Il apparaît que les patients atteints de la MC utilisent davantage de straté gies é motionnelles de coping comme, par exemple, des straté gies centré es sur l'é vitement ou la fuite [11]. Ainsi, l'utilisation privilé gié e de straté gies de coping centré es sur l'é motion paraît augmenter la vulné rabilité des patients à rechuter [23,24] alors que la mise en place par le patient d'autres straté gies de coping n'engendrant pas de dé tresse psychologique ré duirait ce risque de ré cidive [17,18]. La dé tresse é motionnelle comme facteur de rechute fait l'objet de nombreux travaux, au dé triment de la qualité de vie.…”