Ulcerative colitis is a potentially serious disease of the digestive tract that involves inflammation of the inner lining of the colon and rectum (unlike irritable bowel syndrome, a much more common but non-inflammatory and benign functional condition with which it is often confused). Individuals with ulcerative colitis alternate between periods of activity and periods of remission throughout their lives.
Although ulcerative colitis patients and their physicians often blame stress for flare-ups, scientific studies have been unable to demonstrate such a link. "Despite the tenacity of the stress-exacerbation hypothesis, there is little evidence in its favor," said lead author Susan Levenstein, MD, of the San Camillo-Forlanini Hospital in Rome, Italy, who conducted this research while at the Nuovo Regina Margherita Hospital in Rome.
The approach taken in this study differed from previous studies in several ways. First, Levenstein and colleagues looked at the overall levels of stress that respondents perceived themselves to be under, rather than such partial measures as specific negative life events, depressive symptoms, etc. The researchers developed a new questionnaire to measure perceived stress, made up of questions such as how often respondents felt they were in situations of conflict or felt they were in a hurry.
Second, Levenstein and colleagues evaluated the experience and the impact of stress over long periods of time. "Previous researchers assessed stress over days to weeks, and looked for an effect within a month or two. Our study instead asked patients to report stress levels both for the previous month and over the previous two years and examined impact over months to years," said Levenstein.
The study participants were 62 ulcerative colitis patients, none of whom had any intestinal symptoms at the time they entered the study. The researchers compared the 27 patients whose symptoms flared up during a period of up to six years with those who remained in remission.
Respondents with high scores on the two-year perceived stress test were significantly more likely to develop attacks of active disease. Brief spurts in stress levels, on the other hand, did not appear to trigger flare-ups. The study results appear in the May issue of the American Journal of Gastroenterology.
The researchers are hesitant to make therapeutic recommendations based on their study findings, since previous studies testing the effects of stress-reduction techniques and psychotherapy found these therapies had little impact on ulcerative colitis. Levenstein does suggest that better results might be found if psychologically oriented therapies are offered to a select group of patients particularly likely to benefit rather than being given indiscriminately.
Though prolonged stress may indeed play a role in symptom flare-ups, it isn't solely to blame. "In fact, neither stress nor previously described risk factors went far toward explaining the disease patterns we observed -- a reminder that the determinants of ulcerative colitis fluctuations are still largely unknown," said Levenstein. She warns against overestimating the importance of stress, saying that due to excess psychologizing many patients feel themselves stigmatized and the severity of their disease undervalued.
"Interactions between mind and body are the rule rather than the exception in disease processes, and recognition of these interactions should not lead to subtle forms of victim blaming," she added.
The American Journal of Gastroenterology, published by Elsevier Science, presents the latest clinically oriented information in the field of gastroenterology, including original research, case reports, and papers presented before the annual convention and postgraduate course of the American College of Gastroenterology. For information about the journal, contact Paula Gantz at p.gantz@elsevier.com.
Posted by the Center for the Advancement of Health www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.