Hanyang Med Rev.  2014 May;34(2):66-71. 10.7599/hmr.2014.34.2.66.

Psychological Stress in Chronic Intestinal Diseases

• Byun YJ
• Eun CS

• KMID: 2284407
• DOI: http://doi.org/10.7599/hmr.2014.34.2.66

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.

Keyword

Stress, Psychological; Brain-gut Axis; Inflammatory Bowel Disease; Irritable Bowel Syndrome

MeSH Terms

Adrenal Glands
Antidepressive Agents
Autonomic Nervous System
Clinical Protocols
Cytokines
Enteric Nervous System
Humans
Hydrocortisone
Inflammatory Bowel Diseases
Intestinal Diseases*
Irritable Bowel Syndrome
Mast Cells
Permeability
Placebo Effect
Stress, Psychological*
Axis, Cervical Vertebra
Antidepressive Agents
Cytokines
Hydrocortisone

Reference

1. Selye H. A syndrome produced by diverse nocuous agents. 1936. J Neuropsychiatry Clin Neurosci. 1998; 10:230–231.

2. Nakade Y, Fukuda H, Iwa M, Tsukamoto K, Yanagi H, Yamamura T, et al. Restraint stress stimulates colonic motility via central corticotropin-releasing factor and peripheral 5-HT3 receptors in conscious rats. Am J Physiol Gastrointest Liver Physiol. 2007; 292:G1037–G1044.

3. Keefer L, Keshavarzian A, Mutlu E. Reconsidering the methodology of "stress" research in inflammatory bowel disease. J Crohns Colitis. 2008; 2:193–201.

4. Drossman DA. Presidential address: gastrointestinal illness and the biopsychosocial model. Psychosom Med. 1998; 60:258–267.

5. Goyal RK, Hirano I. The enteric nervous system. N Engl J Med. 1996; 334:1106–1115.

6. Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000; 47:861–869.

7. Sondergaard SR, Ostrowski K, Ullum H, Pedersen BK. Changes in plasma concentrations of interleukin-6 and interleukin-1 receptor antagonists in response to adrenaline infusion in humans. Eur J Appl Physiol. 2000; 83:95–98.

8. Van der Poll T, Lowry SF. Lipopolysaccharide-induced interleukin 8 production by human whole blood is enhanced by epinephrine and inhibited by hydrocortisone. Infect Immun. 1997; 65:2378–2381.

9. Siegmund B, Eigler A, Hartmann G, Hacker U, Endres S. Adrenaline enhances LPS-induced IL-10 synthesis: evidence for protein kinase A-mediated pathway. Int J Immunopharmacol. 1998; 20:57–69.

10. Van der Poll T, Lowry SF. Epinephrine inhibits endotoxin-induced IL-1 beta production: roles of tumor necrosis factor-alpha and IL-10. Am J Physiol. 1997; 273:R1885–R1890.

11. Amsterdam A, Tajima K, Sasson R. Cell-specific regulation of apoptosis by glucocorticoids: implication to their anti-inflammatory action. Biochem Pharmacol. 2002; 64:843–850.

12. Frank MG, Wieseler Frank JL, Hendricks SE, Burke WJ, Johnson DR. Age at onset of major depressive disorder predicts reductions in NK cell number and activity. J Affect Disord. 2002; 71:159–167.

13. Straub RH, Dhabhar FS, Bijlsma JW, Cutolo M. How psychological stress via hormones and nerve fibers may exacerbate rheumatoid arthritis. Arthritis Rheum. 2005; 52:16–26.

14. Mawdsley JE, Macey MG, Feakins RM, Langmead L, Rampton DS. The effect of acute psychologic stress on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Gastroenterology. 2006; 131:410–419.

15. Straub RH, Herfarth H, Falk W, Andus T, Scholmerich J. Uncoupling of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis in inflammatory bowel disease? J Neuroimmunol. 2002; 126:116–125.

16. Santos J, Saperas E, Nogueiras C, Mourelle M, Antolin M, Cadahia A, et al. Release of mast cell mediators into the jejunum by cold pain stress in humans. Gastroenterology. 1998; 114:640–648.

17. Barclay GR, Turnberg LA. Effect of psychological stress on salt and water transport in the human jejunum. Gastroenterology. 1987; 93:91–97.

18. Soderholm JD, Perdue MH. Stress and the gastrointestinal tract II. Stress and intestinal barrier function. Am J Physiol Gastrointest Liver Physiol. 2001; 280:G7–G13.

19. Theoharides TC, Cochrane DE. Critical role of mast cells in inflammatory diseases and the effect of acute stress. J Neuroimmunol. 2004; 146:1–12.

20. Moreno-Jimenez B, Lopez Blanco B, Rodriguez-Munoz A, Garrosa Hernandez E. The influence of personality factors on health-related quality of life of patients with inflammatory bowel disease. J Psychosom Res. 2007; 62:39–46.

21. Flett GL, Baricza C, Gupta A, Hewitt PL, Endler NS. Perfectionism, psychosocial impact and coping with irritable bowel disease: a study of patients with Crohn's disease and ulcerative colitis. J Health Psychol. 2011; 16:561–571.

22. Mols F, Denollet J. Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems. Health Qual Life Outcomes. 2010; 8:9.

23. Temoshok LR, Waldstein SR, Wald RL, Garzino-Demo A, Synowski SJ, Sun L, et al. Type C coping, alexithymia, and heart rate reactivity are associated independently and differentially with specific immune mechanisms linked to HIV progression. Brain Behav Immun. 2008; 22:781–792.

24. Kiebles JL, Doerfler B, Keefer L. Preliminary evidence supporting a framework of psychological adjustment to inflammatory bowel disease. Inflamm Bowel Dis. 2010; 16:1685–1695.

25. Helzer JE, Chammas S, Norland CC, Stillings WA, Alpers DH. A study of the association between Crohn's disease and psychiatric illness. Gastroenterology. 1984; 86:324–330.

26. Mittermaier C, Dejaco C, Waldhoer T, Oefferlbauer-Ernst A, Miehsler W, Beier M, et al. Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med. 2004; 66:79–84.

27. Addolorato G, Capristo E, Stefanini GF, Gasbarrini G. Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol. 1997; 32:1013–1021.

28. Tache Y, Bernstein CN. Evidence for the role of the brain-gut axis in inflammatory bowel disease: depression as cause and effect? Gastroenterology. 2009; 136:2058–2061.

29. Mawdsley JE, Rampton DS. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005; 54:1481–1491.

30. Schwarz SP, Blanchard EB. Evaluation of a psychological treatment for inflammatory bowel disease. Behav Res Ther. 1991; 29:167–177.

31. Mikocka-Walus AA, Gordon AL, Stewart BJ, Andrews JM. A magic pill? A qualitative analysis of patients' views on the role of antidepressant therapy in inflammatory bowel disease (IBD). BMC Gastroenterol. 2012; 12:93.

32. Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. Gender-related differences in IBS symptoms. Am J Gastroenterol. 2001; 96:2184–2193.

33. Tache Y, Martinez V, Wang L, Million M. CRF1 receptor signaling pathways are involved in stress-related alterations of colonic function and viscerosensitivity: implications for irritable bowel syndrome. Br J Pharmacol. 2004; 141:1321–1330.

34. Sagami Y, Shimada Y, Tayama J, Nomura T, Satake M, Endo Y, et al. Effect of a corticotropin releasing hormone receptor antagonist on colonic sensory and motor function in patients with irritable bowel syndrome. Gut. 2004; 53:958–964.

35. Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M. Comorbid psychiatric disorders in irritable bowel and inflammatory bowel disease. Am J Gastroenterol. 2007; 102:2767–2776.

36. Miller AR, North CS, Clouse RE, Wetzel RD, Spitznagel EL, Alpers DH. The association of irritable bowel syndrome and somatization disorder. Ann Clin Psychiatry. 2001; 13:25–30.

37. Creed F, Ratcliffe J, Fernandes L, Palmer S, Rigby C, Tomenson B, et al. Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. Br J Psychiatry. 2005; 186:507–515.

38. Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002; 122:1140–1156.

39. Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002; 123:2108–2131.

40. Tkalcic M, Hauser G, Stimac D. Differences in the health-related quality of life, affective status, and personality between irritable bowel syndrome and inflammatory bowel disease patients. Eur J Gastroenterol Hepatol. 2010; 22:862–867.

41. Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, et al. Alexithymia and somatization in general population. Psychosom Med. 2008; 70:716–722.

42. Gomborone J, Dewsnap P, Libby G, Farthing M. Abnormal illness attitudes in patients with irritable bowel syndrome. J Psychosom Res. 1995; 39:227–230.

43. Lackner JM, Quigley BM, Blanchard EB. Depression and abdominal pain in IBS patients: the mediating role of catastrophizing. Psychosom Med. 2004; 66:435–441.

44. Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009; 58:367–378.

45. Hutton J. Cognitive behaviour therapy for irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2005; 17:11–14.

46. Boyce PM, Talley NJ, Balaam B, Koloski NA, Truman G. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol. 2003; 98:2209–2218.

47. Kearney DJ, Brown-Chang J. Complementary and alternative medicine for IBS in adults: mind-body interventions. Nat Clin Pract Gastroenterol Hepatol. 2008; 5:624–636.

48. Heymann-Monnikes I, Arnold R, Florin I, Herda C, Melfsen S, Monnikes H. The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol. 2000; 95:981–994.