Wednesday, May 31, 2017

Stress and Its Impact on the Common Stomach and Intestinal Conditions GERD (Gastroesophageal Reflux Disease), IBS (Irritable Bowel Syndrome), and IBD (Inflammatory Bowel Disease - Colitis and Crohn's Disease)

My recent lead author publication was just published in the March/April issue of Explore: The Journal of Science and Healing, entitled, “Perceived Stress in Patients with Common Gastrointestinal Disorders:  Associations with quality of life (QOL), symptoms and disease management.”  Explore 2017;13:124-8.

Here are the Important Study Findings:

1.     Perceived stress in people with GERD, IBS and IBD is higher than 84 % of the general population.

2.     The quality of life, both mental and physical, is at least one half to a full standard deviation below general population normative values.

3.     Perceived stress significantly correlated with average and worst pain in people with GERD and IBD – since these are indicators of disease management, stress may be an important marker of disease management in these conditions.  Note – there was not a correlation between perceived stress and pain in IBS, but I believe that this is due to the ability of stress to contribute to worse diarrhea in some people and worse constipation in others.

4.     While stress management should be included in the care of people with GERD, IBS and IBD, an integrative medicine or holistic approach, which also includes effective dietary guidelines and exercise, would be more important to study and include in GI care in order to get the best health outcomes.

Here is the Abstract:

Objective and Methods:  Research supports relationships between stress and gastrointestinal (GI) symptoms and disorders. This pilot study assesses relationships between perceived stress, quality of life (QOL) and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Results:  In the full sample (n=402) perceived stress positively correlated with depression (r=0.76, p<0.0001), fatigue (r=0.38, p< 0.0001), sleep disturbance (r=0.40, p<0.0001), average pain (r=0.26, p <0.0001) and worst pain (r=0.25, p< 0.0001).  Higher perceived stress also correlated with lower mental health-related QOL.  Similar correlations were found for the participants with GERD (n=188), IBS (n=132) and IBD (n=82).  Finally, there were significant correlations in the GERD cohort between perceived stress, and average pain (r=0.34, p<0.0001) and worst pain (r=0.29, p<0.0001), and in the IBD cohort between perceived stress, and average pain (r=0.32, p<0.0001) and worst pain (r=0.35, p<0.01).
Conclusions:  Perceived stress broadly correlated with QOL characteristics in patients with GERD, IBS, and IBD.  Perceived stress also appeared to be an indicator of symptom management (self-reported pain ratings) in GERD and IBD, but not IBS.  While future research using objective measures of stress and symptom/disease management is needed to confirm these associations, as well as to evaluate the ability of stress reduction interventions to improve perceived stress, QOL and disease management in these GI disorders, integrative medicine treatment programs may be most beneficial to study.


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