Gut—brain interactions in IBD: a clinician’s perspective
While most physicians, and some patients, consider psychosocial factors as important in aggravating the symptoms of already existing IBD, most of the information is based on varied anecdotal observations and bolstered by a few recent scientific studies. However, a belief in an association between the mind and IBD is tempered by a tendency for patients and some physicians to view psychosocial and stress-related issues with speculation, bias and some stigmatization. On the positive side, patients with proctitis who have experienced recrudescence of mucosal friability and rectal bleeding within a day of a severe life stress provide a dramatic example of such ‘hard-to-dismiss’ anecdotes. While psychosocial factors may not initiate inflammation in IBD, it is possible that they lead to alterations in the immune response and thereby alter disease activity. Thus, impulses started in the brain may act as aggravating factors for already-established bowel inflammation, rather than as primary causative factors.
KeywordsInflammatory Bowel Disease Ulcerative Colitis Irritable Bowel Syndrome Psychosocial Factor Enteric Nervous System
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