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World J Gastroenterol. Oct 21, 2014; 20(39): 14126-14131
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14126
Impact of psychological stress on irritable bowel syndrome
Hong-Yan Qin, Chung-Wah Cheng, Xu-Dong Tang, Zhao-Xiang Bian
Hong-Yan Qin, Department of Pharmacy, First Hospital of Lanzhou University, Lanzhou 730000, China
Hong-Yan Qin, Chung-Wah Cheng, Zhao-Xiang Bian, Lab of Brain and Gut Research, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
Xu-Dong Tang, China Academy of Chinese Medical Sciences, Beijing 100700, China
Author contributions: Qin HY wrote the manuscript about experimental evidence; Cheng CW contributed to the manuscript writing on clinical evidence; Tang XD contributed to the structure design of the manuscript; Bian ZX designed the aim of the editorial and finalized the manuscript.
Correspondence to: Zhao-Xiang Bian, MD, PhD, Professor, Lab of Brain and Gut Research, School of Chinese Medicine, Hong Kong Baptist University, No 7 of Baptist Road, Kowloon Tong, Hong Kong. bzxiang@hkbu.edu.hk
Telephone: +852-34112905 Fax: +852-34112929
Received: January 27, 2014
Revised: June 3, 2014
Accepted: July 22, 2014
Published online: October 21, 2014
Processing time: 267 Days and 23.7 Hours
Abstract

Psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidence showed that IBS is a combination of irritable bowel and irritable brain. In the present review we discuss the potential role of psychological stress in the pathogenesis of IBS and provide comprehensive approaches in clinical treatment. Evidence from clinical and experimental studies showed that psychological stresses have marked impact on intestinal sensitivity, motility, secretion and permeability, and the underlying mechanism has a close correlation with mucosal immune activation, alterations in central nervous system, peripheral neurons and gastrointestinal microbiota. Stress-induced alterations in neuro-endocrine-immune pathways acts on the gut-brain axis and microbiota-gut-brain axis, and cause symptom flare-ups or exaggeration in IBS. IBS is a stress-sensitive disorder, therefore, the treatment of IBS should focus on managing stress and stress-induced responses. Now, non-pharmacological approaches and pharmacological strategies that target on stress-related alterations, such as antidepressants, antipsychotics, miscellaneous agents, 5-HT synthesis inhibitors, selective 5-HT reuptake inhibitors, and specific 5-HT receptor antagonists or agonists have shown a critical role in IBS management. A integrative approach for IBS management is a necessary.

Keywords: Psychological stress; Irritable bowel syndrome; Microbiota-gut-brain axis; Immune activation

Core tip: Evidence from both clinical and experimental studies showed that psychological stress, acute or chronic, occurring in early life or adulthood, has marked impact on intestinal sensitivity, motility, secretion and permeability, and the underlying mechanism has a close correlation with mucosal immune activation, alteration in central nervous system, peripheral neurons and gastrointestinal microbiota. This review provides an overview about how psychological stress contributes to the development of irritable bowel syndrome (IBS) and aggravation of IBS symptoms, and informs a more comprehensive approach to the management of IBS.