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