Many people wonder about the link between IBD and stress. Many have noticed that their symptoms are ‘worse’ when they are anxious or depressed. Indeed this connection has been such that some eminent physicians have suggested that IBD is entirely psychosomatic! We now know of course that this is not true. IBD is caused by an immune reaction between bacteria living in the intestine and the hosts immune system which leads to inflammation.
Nevertheless, it is undeniable that symptoms are worse under stress. A bold attempt to unravel this tangle has recently been made by a team from Winnipeg, Manitoba. They examined 478 participants with known IBD. They studied symptoms, the amount of stress which the volunteers felt they were suffering and they checked against the level of intestinal inflammation by measuring the level of calprotectin in the faeces.
Many patients with quite marked symptoms showed no evidence of increased intestinal inflammation. There was however, a strong relationship between perceived stress and gastrointestinal symptoms. These symptoms were not arising from intestinal inflammation, because there was no connection at all with the level of calprotectin.
We all know that when we are worried about exams, work, family issues etc this may lead to wind, bloating, pain, and even diarrhoea. This mechanism is quite unrelated to inflammation in the gut and is not a sign of the impending development or flare up of existing IBD! These symptoms can occur in patients suffering with IBD even when the underlying condition is adequately controlled by diet or medication. This is important for treatment as it is crucial to separate stress symptoms from those caused by IBD. It is always a mistake to treat symptoms of IBD without careful reference to their cause and the availability of faecal calprotectin level is an invaluable pointer in this situation. If symptoms are due to IBD the calprotectin will almost always be raised and if it is not, the link between symptoms and stress must be explored.
Ref: Targownik LE et al American Journal of Gastroenterology 2015 110 1001-12.
This article was first published on the original crohns.org.uk blog. Research has moved on since, so please check current advice with your IBD team.