Ulcerative Colitis Resource Center
Ulcerative Colitis Resource Center
July 08, 2015
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Perceived stress linked to symptoms, not inflammation in IBD

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A recent study showed a strong link between perceived stress and gastrointestinal symptoms but not intestinal inflammation in patients with inflammatory bowel disease.

“The primary purpose behind the study was to delineate the relationship between a patients’ perceived level of stress, the burden of gastrointestinal symptoms, and the presence of underlying inflammation among persons with IBD,” Laura E. Targownik, MD, MSHS, from University of Manitoba, Canada, told Healio Gastroenterology. “The reasoning behind this that while it is understood that persons who perceive higher amount of stress in their life are more likely to report a higher burden of gastrointestinal symptoms, we were less certain as to the relationship between these symptoms and inflammation.”

Laura E. Targownik

Aiming to better understand the relationships between inflammation, symptoms and perceived stress in IBD, Targownik and colleagues examined a population-based sample of IBD patients using a cross-sectional design. They used validated questionnaires to assess clinical history, symptom severity, disease severity and perceived stress, and collected stool samples to evaluate fecal calprotectin levels.

In total, 261 patients with Crohn’s disease and 217 with ulcerative colitis were included. Perceived stress was associated with symptomatic activity in both Crohn’s disease (1.07 per point increased on perceived stress scale; 95% CI, 1.03-1.1) and ulcerative colitis (1.07; 95% CI, 1.03-1.11). However, perceived stress and intestinal inflammation were not significantly associated, and active symptoms were associated with inflammation in ulcerative colitis (OR = 3.94; 95% CI, 1.65-9.43), but not in Crohn’s disease.

“While persons who experience stress are more likely to also experience symptoms, it does not appear that this relationship is mediated by the presence of inflammation, and raises the question whether interventions aimed at stress reduction may have benefits for symptomatic patients, irrespective of the presence of underlying inflammation,” Targownik said.

“Further study is required to determine whether perceived stress influences the development of future inflammatory activity, and to explore whether a structured psychological intervention would promote improved outcomes in symptomatic individuals with IBD with high levels of perceived stress,” the authors wrote. – by Adam Leitenberger

Disclosure: Targownik reports being on the speaker’s panel for Janssen Canada, Takeda Canada and Pfizer Canada, and on advisory boards for Takeda Canada, AbbVie Canada and Janssen Canada. Please see the full study for a list of all other authors’ relevant financial disclosures.