by Antonella Sparvoli
Recent studies confirm the impact of psychological conditions on chronic intestinal inflammatory diseases. And they suggest new therapeutic approaches
Psychological stress worsens intestinal inflammation caused by inflammatory bowel diseases, favoring flare-ups. Now, an American study, published in the journal Cell, has shed new light on the mechanism by which this happens, further paving the way for intervention strategies that also act on this front.
Different hypotheses
American scholars from the University of Pennsylvania in Philadelphia, in laboratory simulations, have discovered that after stressful events the brain sends signals to the adrenal glands to release glucocorticoids, substances including the well-known stress hormone, cortisol, which act directly on the intestinal nerve cells and on the glial cells that connect them to each other and not, as previously hypothesized, on the immune cells. Instead, it would be precisely the cells of our intestinal brain that activate the immune cells, causing them to release inflammatory substances responsible for the symptoms associated with chronic inflammatory intestinal diseases.
The origin of inflammatory intestinal diseases, such as ulcerative colitis and Crohn’s disease (the most well-known and widespread), is multifactorial – stated Alessandro Armuzzi, head of the IBD operational unit for chronic inflammatory bowel diseases of the Humanitas clinical institute in Milan and professor at Humanitas University —. Beyond genetic predisposition, alterations in the microbiota associated with changes in diet over the last half century and other factors, stress could actually also play a role and understanding the mechanisms could help us better treat these often disabling conditions.
The brain-gut link confirmed by the analysis of 13 studies
The presence of a possible bidirectional link between brain and intestine also emerged from a recent review of the scientific literature conducted in Humanitas and published in the journal Inflammatory Bowel Diseases. The analysis of 13 studies on the topic highlighted that there is a significant association between pre-existing depressive symptoms and subsequent development of chronic intestinal inflammatory diseases – Armuzzi points out -. Precisely because of this link between psychological problems and intestinal inflammation, a psychologist should always be present in the reference centers for the treatment of inflammatory intestinal diseases. One of the main requests from patients is precisely that of having this type of support.
New evidence suggests that treatments for ulcerative colitis and Crohn’s disease, in combination with stress management techniques or psychological support, may be more effective than drugs alone.
Symptoms
It is not easy to live with these conditions which have a major impact on everyday life. Intestinal symptoms are insidious and are often associated with other extraintestinal manifestations that complicate the picture. In over 90 percent of cases, ulcerative colitis manifests itself with blood from the rectum and diarrhea – explains Armuzzi -. In the presence of these “red flags”, it is essential to have a specialist visit to confirm the suspicions and at the same time exclude other conditions that can give similar symptoms, from infections to colorectal cancer.
Crohn’s disease, on the other hand, is more subtle, with symptoms that vary depending on the area affected. Abdominal pain, diarrhea and weight loss, not necessarily present at the same time, are the most typical symptoms. Also in this case a differential diagnosis must be made with other conditions, starting from irritable bowel syndrome. In one in three patients with ulcerative colitis and Crohn’s disease, concomitant non-intestinal manifestations may also be present. These include arthritis, which most often arises after diagnosis, but in 20-25 percent of cases even before or concurrently, and autoimmune manifestations on the skin such as erythema nodosum and psoriasis – reports the expert -. Sometimes inflammatory eye diseases may be present and more rarely, in 5-6 percent of cases, liver diseases.
Diagnosis
In recent years, the recognition of chronic inflammatory intestinal diseases has improved greatly, also because the time factor is crucial: recognizing the pathology promptly allows you to set up a personalized therapy, offering greater possibilities of keeping it under control. Non-invasive tests have also been introduced to evaluate the level of intestinal inflammation, such as calprotectin dosage. Furthermore, initially you can count on ultrasound of the intestine, which is useful before proceeding with colonoscopy, biopsy and sometimes magnetic resonance imaging, concludes Armuzzi.
What can you eat
What can I eat?. one of the first requests of those with chronic inflammatory bowel disease. There is no advice that is valid for everyone – clarifies Armuzzi -. A Mediterranean-style diet is usually suggested because it can help, along with treatment. In hyperacute situations, the intake of fiber should be reduced, but in everyday life we suggest not eliminating them completely, especially the soluble ones, which stimulate the growth of intestinal “good bacteria”. However, studies on diets are underway. For example, from Israel comes the Crohn’s disease exclusion diet (Cded), which excludes or limits exposure to foods that can negatively influence the microbiome or alter the intestinal barrier function. During the first phase you essentially have to eat eggs, bananas, apples, chicken and boiled potatoes. Although there are benefits, diets of this kind are not easily applicable, which is why work is being done to make them more palatable.
October 22, 2023 (modified October 22, 2023 | 08:11)
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