Perceived stress, not inflammation, key factor in IBD symptoms

Last Updated: 2015-06-25

By Anne Harding

NEW YORK (Reuters Health) - Gastrointestinal symptoms of inflammatory bowel disease (IBD) may have more to do with a patient's level of perceived stress than with their level of intestinal inflammation, according to new findings.

"While there was a strong correlation between how patients said they were feeling and their level of stress, this didn't appear to correlate with the level of intestinal inflammation," lead author Dr. Laura Targownik of the University of Manitoba in Winnipeg, Canada, told Reuters Health.

Medical management of IBD is intended to ease symptoms and prevent complications by reducing inflammation, Dr. Targownik and her team write in the American Journal of Gastroenterology, online June 16.

But there is evidence that some patients may have gastrointestinal (GI) symptoms that are independent of inflammation, they add. IBD patients who are having symptoms are also known to have higher levels of perceived stress.

To investigate the relationship among perceived stress, GI symptoms and inflammation in IBD, Dr. Targownik and her colleagues looked at 478 IBD patients who completed surveys about their stress levels and symptoms. Patients also provided stool samples, which allowed the researchers to gauge inflammation by measuring fecal calprotectin.

There was a significant relationship between perceived stress measured with Cohen's Perceived Stress Scale and symptomatic activity based on the Manitoba IBD Index.

However, there was no relationship between perceived stress and intestinal inflammation (defined as a fecal calprotectin level above 250 mcg/g) for Crohn's disease (CD) or ulcerative colitis (UC) patients. UC patients with active symptoms were about four times as likely to have intestinal inflammation, but there was no link between symptoms and inflammation among the CD patients.

Based on the findings, Dr. Targownik said, trying to treat patients' GI symptoms by boosting anti-inflammatory therapy may not always be effective. "If you were simply relying on symptoms to decide on how to alter your anti-inflammatory therapy, you'd probably be doing a poor job."

Instead, it makes more sense for physicians to assess patients for objective evidence of inflammation before augmenting therapy, according to Dr. Targownik. "The trouble is that often assessments of inflammatory activity are difficult to come by," she added.

For example, colonoscopy is invasive and expensive, while imaging tests expose patients to radiation and have other drawbacks. While the fecal calprotectin test is a good measurement of intestinal inflammation, she noted, it is not yet widely available, and it also requires patients to collect stool samples and deliver them to their physician.

The findings suggest, according to Dr. Targownik, that helping IBD patients to cope with stress effectively could reduce symptom burden, although she added that there have not been many definitive studies on the best approach to helping people with UC and CD to manage stress.

"On one hand it's nice to be able to point out to patients that there is a relationship between stress and symptoms," she added. "Sometimes even the awareness can help patients put it into perspective and build it into their understanding of the disease process."

Dr. Targownik concluded: "Stress does relate to symptoms, but it probably does not do so by causing an increase in inflammation. That being said, it's still an important factor in patients' experience."

SOURCE: http://bit.ly/1fEOYMG

Am J Gastroenterol 2015.