Inflammatory bowel disease (IBD) refers to two disorders: Crohn's disease and ulcerative colitis. Both are remitting diseases, with alternating periods of exacerbation and remission with symptoms of pain, diarrhoea and anorexia. Ulcerative colitis usually affects the large colon and results from inflammation of its inner lining. Crohn's disease results from an inflammation of the entire thickness of the intestinal wall, and may occur anywhere in the gastrointestinal tract, although it most frequently occurs in the small intestine. Complications of both disorders include the development of fistulas and scarring which may lead to obstruction and distension and, potentially fatal, rupture of the bowel. Both are thought to result from immune dysfunction and carry a high risk for the development of cancer (see ‘Cancer: digestive tract’).

Aetiology and impact

Initial aetiological theories suggested both ulcerative colitis and Crohn's disease to be psychosomatic in origin (see ‘Psychosomatics’). Early analytical work by Alexander provided clinical evidence of this relationship, while a number of uncontrolled studies found a high percentage of IBD patients to report adverse life events prior to symptom exacerbation. However, controlled studies have shown little consistent evidence that IBD patients experience more stress preceding exacerbation than is typically encountered by healthy controls. Indeed, Von Wietersheim et al. (1992) found the number of life events reported in the previous six months by ulcerative colitis patients to be lower than those reported by patients undergoing surgery for minor injuries. However, they listed more feelings of being under pressure.