The challenge of inflammatory bowel disease (IBD) is formidable. For the patient, there are the symptoms of the disease, causing personal suffering and interference with physical and social activities. For the clinician, the problems are just as challenging: the patho-genesis is yet obscure, and the diagnosis, especially for Crohn's disease, can prove frustrating, as the disease may be diffuse and latent in parts of the bowel that appears normal. The surgeon can be particularly frustrated by the knowledge that he or she can never claim to be able to cure the patient's problem.
The crude recurrence rate of Crohn's disease was 72% 1 year after surgery and 77% after more than 3 years in a large series of 114 patients reported by Rut-geerts et al. . Unfortunately, there was a progressively more severe nature of the lesion at the longer follow-up intervals. Optimal therapy has been reported to embrace many possibilities: drugs, nutrition, psychology and surgery , but surgeons, due both to their heavy schedule and their "organic" approach, usually concentrate their efforts on the selection and execution of the best operative procedure rather than on the psychological and emotional patterns of patients. For example, restorative proctocolectomy is considered the gold standard in the surgical treatment of ulcerative colitis, but, surprisingly, having an ileostomy does not seem to affect patients' quality of life while having an ileoanal anastomosis may lead to more anxiety and depression .
Can a psychological approach be of any help to the surgeon in the management of patients with IBD? To find it out, the surgeon should know whether or not emotional distress plays a causative role in the onset of the disease and whether a stressful event may facilitate an acute attack. Moreover, the surgeon should be aware of the role of psychological support, if any, in the recovery of patients after surgery, especially considering the high recurrence rate of Crohn's disease.
The aim of the present chapter is to clarify these aspects and stimulate surgeons' interest to consider and improve the emotional state and psychological patterns of their patients.
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