Is the Psychological Pattern of IBD Patients Underestimated by Colorectal Surgeons

When Grace et al. [33], in 1951, found that emotional influences can produce changes in the colon mucosa up to frank ulcerations, both intrinsic nerves and neurotransmitters in the bowel were either poorly known or fully ignored. In the 1970, Paulley [34] claimed dramatic improvement of colitic patients by means of psychotherapy, but Latimer [35], reviewing 20 studies, found that only three of them had used consecutive cases and therefore criticized Paulley's and others' conclusions that psyche played key role in IBD. More recently, Kiss and Ferenci [36] reported that psychotherapy - regardless of how intensive it might be - has not been proven to cure the underlying biologic disturbance. Therefore, the hope of complete cure by psychotherapy is not warranted. While improvement and even freedom of all symptoms may take place, psychotherapy cannot prevent stress-related response. With increased skepticism regarding the psychological component, Goligher, in his book, the Bible of colorectal surgery, reported that only 14% of his patients considered the relapses of colitis due to emotional distresses or attended a psychiatrist, the immunologic theory being the more accredited to explain the etiology of IBD [37]. Keigh-ley's and Williams' "Surgery of the Anus, Rectum and Colon" dedicate just a few lines to the topic of "psyche and colitis" in their extensive chapter on ulcerative colitis, even admitting that psychological factors play a role in the mechanism of relapse. Moreover, there is no mention of psychological involvement or psychosomatic aetiology in the modern Beck's Handbook of Colorectal Surgery [38].

Finally, the topic "psyche and colitis" does not appear in any issues of Diseases of the Colon and Rectum - the journal with the highest impact on the col-orectal community - between 1985 and 2005. Therefore, it is not surprising at all that the role of psychological and emotional disorders may be either neglected or underestimated by surgeons when dealing with colitic patients.

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