Does stress influence inflammatory bowel disease? The clinical data.

There is increasing evidence that psychological stress and associated mood disorders are linked with, and can adversely affect the course of inflammatory bowel disease (IBD). Of 11 longitudinal studies of the effects of stress or depression on the course of IBD, most suggested that stress worsened IBD, the rest giving either negative or inconclusive results. If stress does have an adverse effect on the natural history of IBD, then measures which reduce stress should help symptoms and activity of IBD. Unfortunately, because of methodological difficulties inherent in undertaking appropriately targeted and blinded trials, good data about the effects on IBD of interventions aimed to ameliorate stress and mood disorders are limited. Emerging trial evidence supports the suggestion that psychologically orientated therapy may ameliorate IBD-associated mood disorders, but there is no strong data yet to indicate that stress management has a beneficial effect on the activity or course of IBD. More rigorous assessments are needed of the relation between psychological state and activity of IBD, and of the potential benefits of stress-reducing measures in IBD.