Do life events and stress influence inflammatory bowel disease course?

The influence of stress on the clinical course of inflammatory bowel disease (IBD) is increasingly recognised. However, the role of particular life events in causing relapses remains controversial. Prospective studies have shown contradictory results for life events, but have found a significant relation between perceived stress (daily hassles) and symptom exacerbation and rectal inflammation in asymptomatic patients with ulcerative colitis. Long-term stress and depression increase the risk of exacerbation of the disease. Stress may function through a feedback regulatory loop between the central nervous system, the endocrine system and the immune system. There are also potential indications of a stress-induced intestinal barrier dysfunction. In terms of clinical management, it should be taken into consideration that social support and psychological intervention have a favourable impact on psychological distress and therefore may improve health outcomes in IBD patients.