Recent studies suggest that life events and chronic stress increase the risk of relapse in inflammatory bowel disease.
Dr Joel Mawdsley and colleagues studied the effects of psychologic stress on systemic and rectal mucosal inflammatory responses with inactive ulcerative colitis.
The research team assessed 25 patients with inactive ulcerative colitis and 11 healthy volunteers who underwent an experimental stress test.
A further 10 patients with ulcerative colitis and 11 healthy volunteers underwent a control procedure.
Before and after each procedure, systemic inflammatory response was assessed by serum interleukin-6 and -13 concentrations, and tumor necrosis factor-alpha.
The researchers evaluated the inflammatory response by interleukin-6 production by lipopolysaccharide-stimulated whole blood.
|Stress increased mucosal tumor necrosis factor-alpha by 102%|
In addition, leukocyte count, natural killer cell numbers, platelet activation, and platelet-leukocyte aggregate formation was assessed.
In patients with ulcerative colitis, rectal mucosal inflammation was assessed by tumor necrosis factor-alpha, interleukin-13, histamine and substance P release.
The team measured reactive oxygen metabolite production, mucosal blood flow and histology in these patients.
The researchers found that stress increased pulse and systolic blood pressure.
In ulcerative colitis, stress increased lipopolysaccharide-stimulated tumor necrosis factor-alpha and interleukin-6 production by 54% and 11%, respectively.
The team observed that leukocyte count was increased by 16% due to stress.
Stress increased natural killer cell count by 18%, platelet activation by 65%, platelet-leukocyte aggregate formation by 25%.
The researchers noted that stress also increased mucosal tumor necrosis factor-alpha release by 102%, and reactive oxygen metabolite production by 475%.
Rectal mucosal blood flow was reduced by 22%.
The control protocol did not change any of the variables measured.
The team identified no differences between the responses of the patients with ulcerative colitis and healthy volunteers.
Dr Mawdsley's team concludes, “Acute psychologic stress induces systemic and mucosal proinflammatory responses, which could contribute to exacerbations of ulcerative colitis in ordinary life.”