Psychological stress in IBD: new insights into pathogenic and therapeutic implications

Gut. 2005 Oct;54(10):1481-91. doi: 10.1136/gut.2005.064261.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Animals
  • Chronic Disease
  • Colitis, Ulcerative / immunology
  • Colitis, Ulcerative / physiopathology
  • Colitis, Ulcerative / psychology
  • Crohn Disease / immunology
  • Crohn Disease / physiopathology
  • Crohn Disease / psychology
  • Disease Models, Animal
  • Gastrointestinal Motility / physiology
  • Gastrointestinal Tract / immunology
  • Humans
  • Hypothalamo-Hypophyseal System / immunology
  • Hypothalamo-Hypophyseal System / physiopathology
  • Inflammatory Bowel Diseases / immunology
  • Inflammatory Bowel Diseases / physiopathology
  • Inflammatory Bowel Diseases / psychology*
  • Intestinal Mucosa / physiopathology
  • Life Change Events
  • Pituitary-Adrenal System / immunology
  • Pituitary-Adrenal System / physiopathology
  • Stress, Psychological / immunology
  • Stress, Psychological / physiopathology*