Scientific Abstract

Proposal No.   IBD-0031R
Principal Investigator:  David S. Rampton, BM, DPhil
Applicant Organization:  Queen Mary, University of London (United Kingdom)
Project Title: Stress and hypnosis in ulcerative colitis
Period of Award:  August 1, 2003 - July 31, 2005

Conventional treatment of inflammatory bowel disease (IBD) is not always effective and is commonly associated with side effects. Hypnotherapy is an alternative form of therapy, associated with relaxation and intended to relieve stress. Psychological stress, in contrast, is thought to exacerbate IBD through as yet incompletely defined neuroimmunomodulatory pathways

This study aims to investigate the hypothesis that stress levels can modify inflammation in IBD.  We propose that increased psychological stress worsens inflammation, and that relaxation achieved by hypnosis reduces inflammation.  In patients with high chronic perceived stress levels identified by psychometric testing and quantified further by measurement of 24 hour urinary cortisol excretion, we will investigate the contrasting anti- and pro-inflammatory effects of hypnosis and psychological stress, administered as a dichotomous listening test, on systemic and rectal mucosal components of the inflammatory response in patients with UC and healthy controls.  Before and after these procedures, the level of systemic inflammation will be assessed in the peripheral blood by measurement of cytokine production by lymphocytes, neutrophil function, platelet activation and plasma antioxidant capacity (AOC).  Rectal mucosal function will be evaluated by measurement of release of cytokines and eicosanoids, using an in vivo filter paper technique of production of reactive oxygen metabolites from biopsies in vitro, and by recording of blood flow in vivo using laser doppler flowmetry.  The physiological response to hypnosis and stress will also be quantified by measurement of pulse, blood pressure and skin conductance.

Although psychological stress is thought to exacerbate IBD, to date there have been no specific studies of how this might occur in man, or of the potential therapeutic value of antagonising the effects of mental stress in patients with IBD.  Furthermore, there have been no studies reported of the possible anti-inflammatory effects of hypnotherapy in IBD.

These studies may improve our understanding of the pathophysiology of IBD and lead ultimately to new therapeutic approaches.  Indeed, in the longer term, if promising results from the present work are obtained, we aim to undertake clinical trials of the efficacy and safety of hypnotherapy in patients with UC and Crohn’s disease. The present investigations should clarify some of the interactions between the central nervous system, enteric nervous system and intestinal function and immunoregulation, and shed light on the physiological and immunomodulatory effects of hypnotherapy and psychological stress.  Lastly, it is hoped that data obtained in patients with IBD may be of use in other chronic inflammatory disorders such as rheumatoid arthritis, psoriasis and asthma.