Psychological stress in inflammatory bowel disease: Psychoneuroimmunological insights into bidirectional gut–brain communications
Open accessAbstract
Inflammatory bowel disease (IBD), mainly including ulcerative colitis (UC) and Crohn’s disease (CD), is an autoimmune gastrointestinal disease characterized by chronic inflammation and frequent recurrence. Accumulating evidence has confirmed that chronic psychological stress is considered to trigger IBD deterioration and relapse. Moreover, studies have demonstrated that patients with IBD have a higher risk of developing symptoms of anxiety and depression than healthy individuals. However, the underlying mechanism of the link between psychological stress and IBD remains poorly understood. This review used a psychoneuroimmunology perspective to assess possible neuro-visceral integration, immune modulation, and crucial intestinal microbiome changes in IBD. Furthermore, the bidirectionality of the brain–gut axis was emphasized in the context, indicating that IBD pathophysiology increases the inflammatory response in the central nervous system and further contributes to anxiety- and depression-like behavioral comorbidities. This information will help accurately characterize the link between psychological stress and IBD disease activity. Additionally, the clinical application of functional brain imaging, microbiota-targeted treatment, psychotherapy and antidepressants should be considered during the treatment and diagnosis of IBD with behavioral comorbidities. This review elucidates the significance of more high-quality research combined with large clinical sample sizes and multiple diagnostic methods and psychotherapy, which may help to achieve personalized therapeutic strategies for IBD patients based on stress relief.
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Stress is considered a trigger in patients with functional gastrointestinal disorders such as IBS and functional dyspepsia, and in IBDs such as ulcerative colitis and Crohn's disease.
“Stress is considered a trigger in patients with functional gastrointestinal disorders, such as IBS and functional dyspepsia, as well as IBDs like ulcerative colitis and Crohn’s disease (493).”
From Signalling cognition: The gut microbiota and hypothalamic-pituitary-adrenal axis (2023) · cites this paper as [493]
The gut-brain axis is a complex bidirectional communication system driven by neural, hormonal, metabolic, immunological, and microbial signals.
“The gut–brain axis is a complex bidirectional communication system driven by neural, hormonal, metabolic, immunological, and microbial signals [77,78].”
From Association between Childhood Onset Inflammatory Bowel Disease and Psychiatric Comorbidities in Adulthood (2023) · cites this paper as [77]
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- Authors
- Ge, L., Liu, S., Li, S., Yang, J., Hu, G., Xu, C., & Song, W.
- Affiliations
- Shandong Provincial QianFoShan Hospital (CN)
- Shandong First Medical University (CN)
- Corresponding author
- Song, Wengang
- Venue
- Frontiers in Immunology
- Publisher
- Frontiers Media SA
- Published
- 2022-10-06
- Volume
- 13
- Pages
- 1016578-1016578
- ISSN
- 1664-3224 (ISSN-L)
- PMC
- PMC9583867
- OpenAlex
- W4303184202
- Cited by
- 187
- References
- 225
- Citations by year
- 2026: 58 · 2025: 74 · 2024: 42 · 2023: 12 · 2022: 1
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Immunology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China
- Natural Science Foundation of Shandong Province
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- inflammatory bowel disease, psychological stress, psychoneuroimmunology, gut-brain axis, ulcerative colitis, Crohn's disease, anxiety, depression, immunomodulation, gut microbiota, neuroinflammation, psychotherapy, antidepressants, recurrence
- MeSH terms
- Antidepressive Agents, Brain, Chronic Disease, Humans, Psychoneuroimmunology, Stress, Psychological, Inflammatory Bowel Diseases
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