From the Guidelines
Stress is not considered the root cause of inflammatory bowel disease (IBD), but it can trigger flare-ups or worsen symptoms in people who already have the disease. The development of IBD is believed to result from a complex interaction of genetic predisposition, environmental factors, immune system dysfunction, and gut microbiome imbalances 1. Stress affects IBD through the gut-brain axis, where stress hormones like cortisol can increase inflammation, alter gut permeability, and disrupt the balance of gut bacteria.
According to the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults, stress can promote a flare of IBD 1. The guidelines also highlight the importance of treating anxiety and depression in IBD patients, as these conditions are common and associated with poorer outcomes, including the need for hospitalization.
Some key points to consider in managing stress in IBD patients include:
- Stress management techniques such as cognitive behavioral therapy, mindfulness meditation, regular exercise, and adequate sleep can help reduce symptom severity
- Psychological intervention, including psychotherapy, patient education, and relaxation techniques, can reduce anxiety, pain, and stress levels while improving quality of life and mood 1
- Anti-anxiety medications or antidepressants like SSRIs may be beneficial for some patients, but these should be prescribed by a healthcare provider familiar with IBD
- Managing stress should complement rather than replace conventional medical therapies like anti-inflammatory medications, immunomodulators, or biologics that address the underlying inflammation.
It is essential to note that high-quality studies on the pharmacological intervention for anxiety or depression in IBD are limited, and this is an area of research need 1. However, the available evidence suggests that addressing stress and psychological symptoms is crucial in improving outcomes and quality of life for IBD patients.
From the Research
Association between Stress and IBD
- Stress can affect the pathogenesis of inflammatory bowel disease (IBD), but the precise contribution of psychologic stress to IBD remains unclear 2.
- Psychological stress appears to precede IBD exacerbation, although what role it plays in psychosocial outcomes and how it is best managed is unclear 3.
- There is a need to conduct studies that can further confirm the association between psychological stressors, mental health conditions, and IBD 4.
Mechanisms of Stress in IBD
- The effect of stress on IBD might be mediated by autonomic nervous system and hypothalamic pituitary adrenal axis, which are part of the "brain-gut axis" 5.
- Stress can increase intestinal permeability, bacterial translocation, and cytokines network, leading to worsening of IBD symptoms 5.
Impact of Stress on IBD Patients
- The incidence of emotional disorders is higher in Crohn's Disease and Ulcerative Colitis compared to the general population 5.
- Depression and anxiety influence the course and the severity of the underlying intestinal disease, making it important to consider appropriate psychological therapy in IBD patients 5.
- Patients with insomnia had higher disease activity than those without insomnia, especially in the group that believed their disease was exacerbated by psychologic stress 2.
Management of Stress in IBD
- Cognitive behavioural interventions may reduce stress and other interventions with disease-specific stress, but more studies are needed to confirm this 3.
- Emerging trial evidence supports the suggestion that psychologically orientated therapy may ameliorate IBD-associated mood disorders, but there is no strong data yet to indicate that stress management has a beneficial effect on the activity or course of IBD 6.