The Psychosomatic Theory

Among the several hypothesised aetiologies of IBD (autoimmune, infective, etc.), there is also a psychosomatic theory. I report several cases that seem to support this theory.

I saw patients who started to suffer from ulcerative colitis after the death of the mother, or a divorce or a car accident as well as patients whose colitis disappeared after retirement from a stressful job. It may seem anecdotical, but it is well known that there are very close connections between the central nervous system (CNS), the autonomic nerves and the so-called "gut brain", represented by the intrinsic nervous system of the bowel devoted to motility, absorption, secretion, hormonal and immunological response to endogenous and external stimuli. The psycho-neuro-endocrine-immune system (PNEI) is an interactive cybernetic network that regulates activity of abdominopelvic viscera in health and disease [11]. As an example, the role of enterochromaf-fin cells in determining mucosal inflammation has been recently investigated in the large bowel; they may be involved in determining both appendicitis and ulcerative colitis [12].

The rationale of the psychosomatic theory is that, primarily due to incapacity to express their emotions, patients concentrate negative stressful energies towards a target organ. Therefore, a holistic (body and mind, the whole individual) approach is strongly suggested when dealing with patients with IBD. Should the surgeon just remove the segment of diseased intestine without considering the underlying disorders of the whole "brain-body" system [13], another target organ (e.g. the terminal small bowel that replaced the rectum as a reservoir after restorative proctocolectomy) might well become involved by the diseased PNEI and would cause further distress and illness to the patient due to infective, metabolic or immune disorders.

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