Impact of mind/body medicine on quality of life and on neuroendocrine and cellular immune functions in patients with ulcerative colitis

Objective

The role of psychosocial factors in the development and modulation of inflammatory bowel disease remains controversial. The aim of our trial was to determine whether comprehensive lifestyle changes affect psycho-neuro-immunologic interactions, quality of life and disease activity in patients with ulcerative colitis (UC).

Materials and methods

In this prospective controlled randomised trial 15 patients were assigned to an experimental group and 15 to a usual-care control group. Intervention contained a structured 60-hour training programme over a 10-week period, including stress management training, moderate exercise, Mediterranean diet, behavioural techniques and self-care strategies. Disease-related quality of life and psychopathology was assessed with standardised questionnaires (IBDQ, SF-36, SCL-90 and HADS).

Results

Compared with healthy controls, UC patients demonstrated a decreased TNF-α production. No effect of therapy was evident after the intervention. Bowel symptoms (difference d = 0.6 score points, 95% CI = 0.1–1.0, P = 0.0091) of IBDQ and mental component summary score of improvement after therapy SF-36 (d = 0.9 normalised score points, 95% CI 0.13–1.66, P = 0.0218) showed significant improvement after therapy (SF-36 dimensions: role-physical, P = 0.0840; role-emotional, P = 0.0660; mental health, P = 0.0083).

Plasma cortisol, urine catecholamines, the distribution of circulating lymphocyte subsets and monocytes showed no significant change after therapy.

The PNM-elastase and calprotectin levels were measured in feces showing changes from pathological to normal.

Conclusion

Comprehensive lifestyle modification improves quality of life in IBD patients. The results might enable us to design more definitive studies in the clinic and useful therapies on the role of stress and lifestyle modification in UC.