Stress may be an IBD trigger

April 16, 2010

Note from CCFA's Patient Education Committee: "Major stressful events, not just everyday stress, correlate with flares of IBD."

By Amy Norton

NEW YORK (Reuters Health) - People with inflammatory bowel disease (IBD) commonly believe that stress can trigger their symptoms, and a new study suggests they may be right.

Canadian researchers found that among 552 patients with Crohn's disease or ulcerative colitis followed for a year, the risk of a symptom flare-up increased when patients were feeling particularly stressed.

The findings, reported online April 6th in the American Journal of Gastroenterology, lend support to what many people with IBD have believed to be true. Studies show that many people with IBD feel that stress worsens their symptoms, but there has been relatively little scientific evidence of that.

"This is among the first evidence to show that the perception of stress had a direct association with disease course," lead author Dr. Charles N. Bernstein told Reuters Health in by email.

"We are proposing that, based on this study and other emerging data, that clinicians make more of an effort to identify and manage psychological problems and stress that patients may have," said Dr. Bernstein, who directs the IBD Clinical and Research Center at the University of Manitoba in Winnipeg.

Patients in the study completed surveys every three months for one year, reporting on symptom flare-ups, stressful events, perceived stress, and other factors.

Overall, 174 patients reported a symptom flare-up during the study period.

The researchers found that patients' risk of a symptom flare-up increased more than two-fold when they had reported high levels of perceived stress in the preceding three-month period.

High stress in the previous 3 months was reported by 52% of patients who had flares, compared to 29% of those who remained symptom-free.

On the other hand, certain other factors suspected of triggering IBD symptoms showed no relationship to flare-ups, including use of antibiotics or non-steroidal anti-inflammatory drugs as well as colds, pneumonia and urinary tract infections.

There are biological reasons to believe that a person's response to stress would trigger or worsen IBD symptoms, Dr. Bernstein and his colleagues note.

The sympathetic nervous system acts on the lining of the colon and might exacerbate existing inflammation. There is also evidence that stress hormones may help harmful bacteria take up residence in the intestines, which might, in turn, affect symptoms.

If stress does trigger IBD symptoms in some people, then it's possible that learning better ways of managing stress would help stave off flare-ups, the researchers said.

Am J Gastroenterol 2010.

Crohn's & Colitis Foundation

The Crohn's & Colitis Foundation's mission is to cure Crohn's disease and ulcerative colitis, and to improve the quality of life of children and adults affected by these diseases. The Foundation ranks third among leading health non-profits in the percentage of expense devoted to research toward a cure, with more than 80 cents of every dollar the Foundation spends going to mission-critical programs. The Foundation consistently meets the standards of organizations that monitor charities, including the Better Business Bureau's Wise Giving Alliance ( and the American Institute of Philanthropy (

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