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Hypothalamic-pituitary-adrenal dysregulation and psychological distress in Crohn's disease: Insights from acute and chronic stress responses
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DOI：10.5498/wjp.v16.i3.111523.png)
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Abstract
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BACKGROUND Crohn's disease (CD) is a chronic inflammatory bowel disease associated with both physical and psychological stressors. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in various autoimmune diseases; however, its role in CD remains insufficiently explored. AIM To evaluate HPA axis responses to acute/chronic stress in patients with CD and assess perceived stress, anxiety, and depression. METHODS This study involved two groups: (1) Surgical group: 22 patients with CD and 28 surgery-controls without inflammatory bowel disease; and (2) Outpatient group: 101 patients with CD and 52 positive-control patients with cancer. In the surgical group, acute stress was measured using six postoperative salivary cortisol samples and chronic stress was assessed by hair cortisol measurements. In the outpatient group, emotional distress was evaluated using the Depression Anxiety Stress Scale 21 questionnaire. Demographic and clinical data were analyzed for associations with stress, anxiety, and depression. RESULTS Hair cortisol levels were significantly lower in patients with CD compared to controls (median 6.375 pgF/mg vs 9.643 pgF/mg, P = 0.038), suggesting impaired HPA axis function in response to chronic stress. No significant differences in postoperative salivary cortisol levels were found between patients with CD and controls. According to Depression Anxiety Stress Scale 21 responses, 58% of patients with CD experienced elevated stress levels, while 27% and 24% experienced severe or extremely severe anxiety and depression, respectively. Higher Harvey-Bradshaw Index scores, smoking, and lower hemoglobin levels were independently associated with higher perceived stress and anxiety. Among the controls, 53% exhibited elevated stress levels, while 37% and 13% experienced severe or extremely severe anxiety and depression, respectively. CONCLUSION Patients with CD exhibit a blunted HPA axis response to chronic stress and high psychological distress - comparable to patients with cancer - highlighting the need for a multidisciplinary, holistic approach to disease management.
Keywords:
Crohn's disease
Chronic stress
Acute stress
Hypothalamic-pituitary-adrenal axis dysregulation
Hair cortisol
Salivary cortisol
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