We read with interest the article by Mawdsley and Rampton on the relationship between psychological stress, increased disease activity in inflammatory bowel diseases (IBD), and the role of alterations in the hypothalamic-pituitary-adrenal (HPA) axis function (Gut 2005;54:1481–91). In IBD patients, chronic colonic inflammation induces downregulation of HPA axis responses, and animal studies have shown that altered function of the HPA axis renders rodents susceptible to stress induced increases in gastrointestinal inflammation. Central receptors located in the medial prefrontal cortex and hippocampus play a crucial role in glucocorticoid (GC) mediated counterregulation of stress induced HPA axis activation.¹

Polymorphisms of the GC receptor (GR) gene may contribute to the large interindividual variations in sensitivity to GCs and HPA axis activity that are frequently observed in …