Psychological Stress in Chronic Intestinal Diseases

Abstract

Psychological stress induces alterations in the function of the hypothalamic-pituitary-adrenal axis via corticotorphin releasing factor and alterations in the enteric nervous system via actions of the autonomic nervous system. Mucosal mast cells and adrenal glands release several inflammatory cytokines and cortisol, causing increased intestinal permeability. Increased intestinal permeability as well as increased inflammatory cytokines and hormones cause changes in bacterial-mucosal interactions, leading to the aggravation of disease activity and gastrointestinal symptoms in inflammatory bowel syndrome (IBD) and irritable bowel syndrome (IBS). Several studies have demonstrated that stress has an important roles in the pathogenesis of IBD and IBS. Personal traits, health beliefs and personal stress-coping mechanisms can also have adverse effects on the disease course of IBD and IBS. Stress reduction therapies have been adapted for treatment of IBD and IBS. Antidepressants and psychological therapies such as cognitive-behavior therapy, hypnotherapy, and multi-component psychological therapy have been used for control of disease activity and symptoms in IBD and IBS patients. The efficacy of such treatments is controversial, because there has not been an adequate standardization in treatment protocol, and studies suffer from the difficulties involved in selection of appropriate control groups, questions related to a high placebo effect, as well as differences in interpretation. Well-designed prospective controlled studies evaluating the role of stress in the pathogenesis of IBD and IBS and the role of stress reduction therapies are warranted for improvement of clinical treatments and outcomes.