There is a long but inconsistent history of observations suggesting that psychologic stress contributes to the course of ulcerative colitis and Crohn's disease.
Dr Robert Maunder evaluated the strength of evidence for a causal link between stress, depression, and inflammatory bowel disease course.
Dr Maunder conducted a literature review and unstructured qualitative analysis, including all reported prospective studies of stress or depression and disease outcomes.
| Ulcerative colitis has not been studied with adequately designed randomized control trials|
|Inflammatory Bowel Diseases|
The researcher also included all randomized controlled studies of stress reduction interventions.
Dr Maunder noted that results remained inconsistent.
However, prospective studies support a role for psychologic stress in the course of ulcerative colitis and for depressive symptoms in the course of Crohn's.
The investigator found that randomized control trials do not support the benefit of stress reduction for unselected patients with Crohn's disease.
Dr Maunder observed that ulcerative colitis has not been studied with adequately designed randomized control trials.
Animal models suggest mechanisms whereby stress can exacerbate preexisting inflammatory disease, especially through increased epithelial permeability.
Dr Maunder concludes, “A synthesis of the literature is presented suggesting approaches to reconcile apparently contradictory findings.”
“Recommendations for further research emphasize refinements to avoid type II error and to identify subgroups of patients who are most likely to experience stress-related effects on illness or to benefit from stress reduction intervention.”