Psychological stress in IBD: new insights into pathogenic and therapeutic implications
- Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Correspondence to:
Professor D S Rampton
Endoscopy Unit, Royal London Hospital, London E1 1BB, UK;
Psychological stress has long been reported anecdotally to increase disease activity in inflammatory bowel disease (IBD), and recent well designed studies have confirmed that adverse life events, chronic stress, and depression increase the likelihood of relapse in patients with quiescent IBD. This evidence is increasingly supported by studies of experimental stress in animal models of colitis. With the evolving concept of psychoneuroimmunology, the mechanisms by which the nervous system can affect immune function at both systemic and gut mucosal levels are gradually becoming apparent. Recent data suggest that stress induced alterations in gastrointestinal inflammation may be mediated through changes in hypothalamic-pituitary-adrenal (HPA) axis function and alterations in bacterial-mucosal interactions, and via mucosal mast cells and mediators such as corticotrophin releasing factor (CRF). To date, the therapeutic opportunities offered by stress reduction therapy remain largely unexplored, in part because of methodological difficulties of such studies. This paper reviews recent advances in our understanding of the pathogenic role of psychological stress in IBD and emphasises the need for controlled studies of the therapeutic potential of stress reduction.
Both ulcerative colitis (UC) and Crohn’s disease are chronic, relapsing, and remitting diseases. There is marked temporal variation in mucosal inflammation, from near normal in remission to severe ulceration during relapse. The aetiology of both diseases involves a complex interaction between genes and environment.1,2 There has been substantial progress in identification of the genes responsible for predisposition to IBD3 but the environmental factors which trigger initial presentation and subsequent relapses, and the mechanisms by which they act, are less clearly understood. Psychological stress is one environmental factor which has long been anecdotally reported as having a relationship with activity in IBD,4 and there have been substantial recent advances in both proving this relationship and in elucidating the mechanisms by which it …