The role of stress in the development and clinical course of inflammatory bowel disease: Epidemiological evidence

被引:134
作者
Maunder, Robert G. [1 ]
Levenstein, Susan [2 ]
机构
[1] Mt Sinai Hosp, Dept Psychiat, Toronto, ON M5G 1X5, Canada
[2] Aventino Med Grp, Rome, Italy
关键词
stress; depression; Crohn's disease; ulcerative colitis; inflammatory bowel disease; inflammation; psychology;
D O I
10.2174/156652408784533832
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background: It is unclear whether psychological stress contributes to the inflammatory process in the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD). This review assesses the epidemiological evidence regarding a causal link between stress and gut inflammation in IBD. Methods: A Medline search identified prospective studies of the effects of stress on subsequent disease activity and randomized controlled studies of the effects of psychological interventions on disease course in IBD. Controlled retrospective studies were included in the review of aspects of the stress-inflammatory relationship for which few prospective studies are available (e. g. the link between stress and disease onset). Studies were assessed qualitatively. Results: Among 9 longitudinal studies of stress or depression and disease course, a significant stress-inflammation relationship has been found when UC and CD are studied independently (4 of 4 studies positive) but studies of mixed samples of CD and UC have mostly had negative results (1 of 5 studies positive). Evidence of a contribution of stress to disease onset is very weak. The results of 5 studies of psychological interventions in IBD have been negative or modestly supportive of benefit. Confidence in therapeutic benefits of psychological interventions results is limited by methodological weaknesses in these studies. Discussion: There is consistent evidence for a contribution of psychological factors to IBD disease course, especially stress in UC and depressive symptoms in CD. More rigorous tests of psychological interventions in IBD are needed.
引用
收藏
页码:247 / 252
页数:6
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