title: Impact of psychological stress on irritable bowel syndrome.
abstract: Psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidence showed that IBS is a combination of irritable bowel and irritable brain. In the present review we discuss the potential role of psychological stress in the pathogenesis of IBS and provide comprehensive approaches in clinical treatment. Evidence from clinical and experimental studies showed that psychological stresses have marked impact on intestinal sensitivity, motility, secretion and permeability, and the underlying mechanism has a close correlation with mucosal immune activation, alterations in central nervous system, peripheral neurons and gastrointestinal microbiota. Stress-induced alterations in neuro-endocrine-immune pathways acts on the gut-brain axis and microbiota-gut-brain axis, and cause symptom flare-ups or exaggeration in IBS. IBS is a stress-sensitive disorder, therefore, the treatment of IBS should focus on managing stress and stress-induced responses. Now, non-pharmacological approaches and pharmacological strategies that target on stress-related alterations, such as antidepressants, antipsychotics, miscellaneous agents, 5-HT synthesis inhibitors, selective 5-HT reuptake inhibitors, and specific 5-HT receptor antagonists or agonists have shown a critical role in IBS management. A integrative approach for IBS management is a necessary.
authors.affiliation: Hong-Yan Qin, Department of Pharmacy, First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Hong-Yan
authors.initials: HY
authors.lastname: Qin
authors.affiliation: Hong-Yan Qin, Department of Pharmacy, First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Chung-Wah
authors.initials: CW
authors.lastname: Cheng
authors.affiliation: Hong-Yan Qin, Department of Pharmacy, First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Tang
authors.affiliation: Hong-Yan Qin, Department of Pharmacy, First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Zhao-Xiang
authors.initials: ZX
authors.lastname: Bian
mesh_terms: D000818:Animals; D001921:Brain / Q000503:physiopathology*; D006801:Humans; D007422:Intestines / Q000294:innervation*; D043183:Irritable Bowel Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy
keywords: Immune activation; Irritable bowel syndrome; Microbiota-gut-brain axis; Psychological stress