Level of chronic life stress predicts clinical outcome in irritable bowel syndrome

Abstract

Background-Life stress contributes to symptom onset and exacerbation in the majority of patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD); research evidence is conflicting, however, as to the strength of these effects. Aims-To test prospectively the relation of chronic life stress threat to subsequent symptom intensity over time. Patients-One hundred and seventeen consecutive outpatients satisfying the modified Rome criteria for IBS (66% with one or more concurrent FD syndromes) participated. Methods-The life stress and symptom intensity measures were determined from interview data collected independently at entry, and at six and 16 months; these measures assessed the potency of chronic life stress threat during the prior six months or more, and the severity and frequency of IBS and FD symptoms during the following two weeks. Results-Chronic life stress threat was a powerful predictor of subsequent symptom intensity, explaining 97% of the variance on this measure over 16 months. No patient exposed to even one chronic highly threatening stressor improved clinically (by 50%) over the 16 months; all patients who improved did so in the absence of such a stressor. Conclusion-The level of chronic life stress threat predicts the clinical outcome in most patients with IBS/FD. (Gut 1998;43:256-261) Keywords: irritable bowel syndrome; chronic life stress threat; symptom intensityIn irritable bowel (IBS) and functional dyspepsia (FD) syndromes, major life stress situations precede onset and/or exacerbation of symptoms, 1-3 and early observations suggest that symptoms either disappear or improve following resolution of major life stress problems. 4 Furthermore, an impressive and sustained improvement in symptoms occurs following the acquisition of more eVective stress management skills.5-7 In a recent study of patients with functional gastrointestinal disorders (FGID), 8 we showed a significant correspondence between the intensity of chronic life stress threat and the severity and extent of aVective, gastrointestinal, and extraintestinal symptomatology, particularly in patients with IBS-FD syndromes. Despite these observations, the extent to which life stress contributes to the course of IBS and/or FD symptoms remains uncertain. 10To extend our previous cross sectional findings, our aim was to examine, in patients with IBS, group and individual patterns of change in life stress and symptom intensity over time. Specifically we aimed to determine within subject: (1) covariance of life stress and subsequent symptom intensity over three time frames; (2) time lag relations (with and without relevant covariates); (3) the role of personality, age, sex, and emotional distress in the above; (4) the life stress predictors of any improvement or lack of improvement in symptom intensity over time; and (5) the life stress predictors of clinical (50% or more) improvement or no clinical improvement in symptom intensity over time. We hypothesised that: (1) life stress and subsequent symptom intensity will...

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“…Interestingly, there is a growing evidence that both stress and anxiety are associated with the release of neuropeptides as secretagogues of various effector cells which, in turn, secrete pruritogenic and proinflammatory mediators (Giannetti and Girolomoni, 1989). In the field of gastrointestinal research, stress induces irritable bowel syndrome, gastric ulcers, or gastric hemorrhages (Bennett et al, 1998). It has been established that physical and psychological stressors can induce marked alterations in water and electrolyte transport across the epithelium in the small intestines of rats (Santos et al, 2001;Bonaz and Tache, 1994).…”

“…There have been significant advances on the understanding of intestinal responses to stress (van de Langerijt et al, 1994). For example, psychological stress reactivates inflammatory bowel disease in humans and rats Levenstein et al, 2000;Bennett et al, 1998). Castagliuolo et al (1996) reported that immobilization stress caused colonic mucin release and mast cell degranulation in rats.…”

Mechanisms of Stress-induced Visceral Pain

“…[1][2][3][4][5][6] Risk factors for IBS include being female and exposure to chronic stress. [7][8][9][10][11] A common feature of IBS is that for many patients, their symptoms are worsened by stress and overlap with other stress disorders, including anxiety, depression, and post-traumatic stress disorder. [12][13][14][15] In support of IBS being a stress-sensitive disorder, there is experimental evidence showing abnormal hypothalamicpituitary-adrenal (HPA) axis reactivity in IBS patients as shown by a heightened HPA response to a corticotropin-releasing hormone (CRH) challenge, and an overall increase in hourly cortisol secretion in IBS compared to controls.…”

Significant psychological morbidity occurs in irritable bowel syndrome: a case‐control study using a pharmacy reimbursement database

“…10,11 Psychological distress severely impairs response to IBS treatment. 12 A number of studies have examined the prevalence of depression and anxiety in IBS. [13][14][15][16][17][18][19][20][21][22] Limitations of these studies include selection bias, disparate diagnostic criteria for IBS, depression and anxiety and assessing psychological traits as opposed to psychiatric diagnosis.…”