Subjective and Objective Stress in Inflammatory Bowel Disease

Background: Stress may have an impact on the course of inflammatory bowel disease (IBD), but evidence is still lacking regarding a potential association between perceived (subjective) stress and objectively measured stress and whether patients’ levels of stress in relapse differ from those in remission. The aim of this study was to investigate patients’ level of stress in relapse and in remission. Methods: Twenty-three patients with active IBD participated in the study. Cortisol was assessed in saliva and in blood to obtain objective measurements. For subjective measurements, the patients completed the Short Health Scale (SHS) and Perceived Stress Scale (PSS) questionnaires. Physiological measurements were taken, and questionnaires were completed at the beginning of relapse and when the patient was classified as being in remission. Relapses and remissions were determined by endoscopic examination and faecal calprotectin. Results: Cortisol levels did not differ between measurements in active disease and in remission (7.50 ± 5.52 vs. 5.55 ± 2.65). PSS showed no differences between the two measurements (13 vs. 16, p-value 0.83). Inflammatory cytokines IL-6 (1.97 ± 2.47 vs. 0.72 ± 0.43, p < 0.05) and IL-8 (6.84 ± 3.57 vs. 2.94 ± 2.79, p < 0.001) were significantly lower during remission compared with active disease. Conclusions: This study demonstrated low to moderate levels of perceived stress in patients with IBD during active disease and remission. The results also showed significantly elevated levels of the pro-inflammatory cytokines IL-6 and IL-8 in serum during relapse compared with remission. However, no evidence of elevated objective stress was found when levels of cortisol in saliva were measured. Further research is needed to establish the possible association between stress and IBD and how it affects patients.