Psychological stress and hypnosis in ulcerative colitis.

PhDPrevious studies suggest that life events and chronic stress increase the risk of relapse in inflammatory bowel disease. Furthermore, experimental stress has been shown to worsen inflammation in animal models of colitis. Hypnotherapy is effective for functional gastrointestinal (GI) disorders and claimed by some patients to improve ulcerative colitis (UC). Two major hypotheses are tested in this thesis: i) Psychological stress can worsen inflammation via its effects on various systemic and rectal mucosal inflammatory variables in quiescent UC. ii) Relaxation achieved through hypnosis can reduce inflammation via its effects on various systemic and mucosal inflammatory variables in active UC. Patients with UC and healthy controls underwent an experimental stress test, hypnotherapy session or control procedure. Various systemic and, in patients with UC, rectal mucosal inflammatory measures were assessed before and after each procedure. The major findings are as follows: i) In patients with inactive UC, acute experimental stress increased LPS stimulated TNF-a and IL-6 production by whole blood. Stress also increased leukocyte count, Natural Killer (NK) cell count, platelet activation and platelet-leukocyte aggregate (PLA) formation. At the mucosal level, stress increased TNF-a in perimucosal fluid, and mucosal ROM production; it reduced rectal mucosal blood flow (RMBF). ii) In patients with active UC, one session of hypnotherapy reduced serum IL-6 concentration and caused a transient reduction in NK cell numbers. At the mucosal level, hypnotherapy caused a reduction in the concentration in peri-mucosal fluid of Substance P, histamine and IL-13 and reduced RMBF. iii) Chronic stress, as assessed by psychometric questionnaires,d id not affect the response to acute experimental stress. iv) There was no difference between the responses of patients with UC and healthy volunteers to any protocol. In conclusion, stress increased, whilst hypnotherapy reduced various inflammatory measures at both the systemic and mucosal level in patients with UC. These effects might contribute to the reported adverse effects of stress and therapeutic efficacy of hypnotherapy in UC

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text

Psychological stress and hypnosis in ulcerative colitis

Previous studies suggest that life events and chronic stress increase the risk of relapse in inflammatory bowel disease. Furthermore, experimental stress has been shown to worsen inflammation in animal models of colitis. Hypnotherapy is effective for functional gastrointestinal (GI) disorders and claimed by some patients to improve ulcerative colitis (UC). Two major hypotheses are tested in this thesis: i) Psychological stress can worsen inflammation via its effects on various systemic and rectal mucosal inflammatory variables in quiescent UC. ii) Relaxation achieved through hypnosis can reduce inflammation via its effects on various systemic and mucosal inflammatory variables in active UC. Patients with UC and healthy controls underwent an experimental stress test, hypnotherapy session or control procedure. Various systemic and, in patients with UC, rectal mucosal inflammatory measures were assessed before and after each procedure. The major findings are as follows: i) In patients with inactive UC, acute experimental stress increased LPS stimulated TNF-a and IL-6 production by whole blood. Stress also increased leukocyte count, Natural Killer (NK) cell count, platelet activation and platelet-leukocyte aggregate (PLA) formation. At the mucosal level, stress increased TNF-a in perimucosal fluid, and mucosal ROM production; it reduced rectal mucosal blood flow (RMBF). ii) In patients with active UC, one session of hypnotherapy reduced serum IL-6 concentration and caused a transient reduction in NK cell numbers. At the mucosal level, hypnotherapy caused a reduction in the concentration in peri-mucosal fluid of Substance P, histamine and IL-13 and reduced RMBF. iii) Chronic stress, as assessed by psychometric questionnaires,d id not affect the response to acute experimental stress. iv) There was no difference between the responses of patients with UC and healthy volunteers to any protocol. In conclusion, stress increased, whilst hypnotherapy reduced various inflammatory measures at both the systemic and mucosal level in patients with UC. These effects might contribute to the reported adverse effects of stress and therapeutic efficacy of hypnotherapy in UC.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Depression, anxiety, and stress among inflammatory bowel disease patients during COVID-19:A UK cohort study

Background and Aim: Patients with chronic diseases are believed to be at increased risk of mental health conditions during the COVID-19 pandemic. We aimed to assess the incidence of psychological morbidity in inflammatory bowel disease (IBD) patients during the COVID-19 pandemic, explore for association with risk of severe COVID-19 and other factors, and establish patients' interest in psychological support. Methods: A survey including the Patient Health Questionnaire-9, General Anxiety Disorder-7, and Perceived Stress Scale tools for depression, anxiety, and stress was administered to IBD patients from a tertiary center in London, United Kingdom, in June 2020. Results: Two hundred seventy-four patients responded to the survey (57% response rate), with 271 (99%) completing it. Moderate–severe depression was observed in 61 (22.5%), while 49 (18%) had moderate–severe anxiety; 39 (14%) had both diagnoses. Mean (SD) stress score was 16.2 (7.4). There was no association between degree of severe COVID-19 risk and psychological morbidity. Flare symptoms and fatigue were associated with worse psychological morbidity, while accessibility of information regarding COVID-19 risk and reducing that risk was protective for depression (odds ratio [OR] 0.56 [0.33–0.94], P = 0.03), anxiety (OR 0.62 [0.4–0.96], P = 0.03), and stress (standardized β-coefficient −0.15 [−0.28 to −0.03], P = 0.02). Seventy-nine (30%) respondents were interested in receiving psychological support during the pandemic, while 200 (76%) expressed interest beyond the pandemic. Conclusions: Although depression, anxiety, and stress among IBD patients during the pandemic were common, their frequency was similar to pre-pandemic rates and recent general population levels. Ensuring easy access to personalized risk information with targeted psychological support may mitigate psychological burden as patients reintegrate into society and deal with future COVID-19 waves.</p