Psychological therapies in inflammatory bowel disease

Crohn's disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal tract arising from dysregulated immunity in people who are genetically susceptible. Pathophysiological mechanisms that contribute to inflammatory bowel disease (IBD) onset and progression involve key drivers, such as genetics, diet, lifestyle, and other factors (eg, the intestinal microbiome, epithelial barrier function, and mucosal immunity). 1 Chang JT Pathophysiology of inflammatory bowel diseases. N Engl J Med. 2020; 383: 2652-2664 Crossref PubMed Scopus (312) Google Scholar However, evidence suggests that the natural history of IBD might be influenced by gut–brain interactions related to the direct effects of inflammatory signalling, 2 Agirman G Yu KB Hsiao EY Signaling inflammation across the gut–brain axis. Science. 2021; 374: 1087-1092 Crossref PubMed Google Scholar associations between psychological health and clinical disease activity, 3 Fairbrass KM Gracie DJ Ford AC Relative contribution of disease activity and psychological health to prognosis of inflammatory bowel disease during 6.5 years of longitudinal follow-up. Gastroenterology. 2022; 163: 190-203 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar and the presence of coexisting disorders of gut–brain interaction, such as irritable bowel syndrome (IBS). 4 Fairbrass KM Costantino SJ Gracie DJ Ford AC Prevalence of irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5: 1053-1062 Summary Full Text Full Text PDF PubMed Scopus (65) Google Scholar Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysisPsychological therapies have beneficial, short-term effects on anxiety, depression, stress, and quality-of-life scores, but not on disease activity. Further RCTs in selected groups are needed to establish the place for such therapies in IBD care. Full-Text PDF Open Access