Imbalance in the stress-adaptation system in patients with inflammatory bowel disease.

ABSTRACT

AIM: Though inflammatory bowel disease (IBD) is known as a stress-related disorder, basic evidence for this claim is lacking. The current study was performed to investigate the function of the neuroendocrine-immune system as a main pathway in stress response and stress-coping ability and the associations among stress response, stress-coping ability, and disease activity in IBD patients. METHOD: A questionnaire was administered to obtain information concerning stress state and stress-coping ability (self-efficacy and sense of coherence [SOC]) in 78 IBD patients and 21 healthy volunteers. Blood samples were taken for determining the serum levels of various stress-related hormones and cytokines before and after a calculation stress test. RESULTS: Self-efficacy was significantly decreased in patients, though the degree of perceived stress and SOC did not differ between patients and controls. Basal levels of cortisol did not differ, but levels of adrenocorticotropic hormone, ß-endorphin and interleukin (IL)-6 were significantly higher in patients than in controls. In addition, the control group, but not the patient group, demonstrated significant differences in the basal cortisol levels between low and high SOC subgroups and between low and high perceived stress subgroups. Furthermore, IL-6 levels were significantly increased following the calculation stress test in patients only. CONCLUSION: Results indicate that IBD patients may have skewed neuroendocrine-immune systems and that emotional stress may aggravate the disease. Stress-management interventions might be useful, not only for patients' quality of life (QOL) but also for disease control.