Effects of occupational stress on the gastrointestinal tract

Table 1 Summary of the international literature on the gastrointestinal tract disorders most frequently reported by workers experiencing job-related psychological stress and other alterations in their affective states

GIT alteration	Ref.	Study/procedure	Conclusions
Generalized GIT disturbances/IBS	Konturek et al[4]	Impact of stress on the GIT. The study addresses the role of stress in the pathophysiology of the most common GIT diseases.	The exposure to stress is the major risk factor in the pathogenesis of various GIT diseases.
	Bhatia et al[5]	Association between stress and various GIT pathologies.	The mind directly influences the gut. The enteric nervous system is connected bidirectionally to the brain by the parasympathetic and sympathetic pathways, forming the brain-gut axis.
	Karling et al[18]	Pre- and post-dexamethasone morning serum cortisol levels were analyzed in 124 subjects with symptoms of IBS.	There is a relationship between mood alterations (anxiety/depression) and IBS-like symptoms in patients with unipolar depression, in patients with IBS and in a sample of the normal population.
	Karling et al[19]	In total, 867 subjects representative of the general population and 70 patients with IBS were genotyped for the val158met polymorphism. The IBS patients completed the Hospital Anxiety and Depression Scale questionnaire.	There is an association between the val/val genotype of the val158met COMT gene and IBS and with the specific IBS-related bowel pattern in IBS patients.
	Belcastro et al[41]	Estimation of the relationship between teachers’ somatic complaints and illnesses and their self-reported job-related stresses. Stress group: teachers	Several somatic complaints have been suggested to be associated with burnout.
	Hui et al[45]	Perception of life events and the role of daily "hassles" (stressful events) in 33 dyspeptic patients vs 33 controls of comparable sex, age and social class.	Patients with non-ulcer dyspepsia have a higher negative perception of major life events than controls. Psychological factors may play a role in the pathogenesis of non-ulcer dyspepsia.
	Angolla et al[46]	Empirical study of police-work stress, symptoms and coping strategies among police service workers in Botswana measured by a questionnaire. Sample size n = 229 (163 males and 66 females). Stress group: the Botswana Police Service.	Police duties are highly stressful. The highest rated symptoms were as follows: feeling a lack of energy, loss of personal enjoyment, increased appetite, feeling depressed, trouble concentrating, feeling restless, nervousness and indigestion.
Ulcers	Alp et al[11]	Comparative study using a neuroticism-scale questionnaire administered to 181 patients with previously diagnosed gastric ulcers and 181 controls without any previous history of gastric ulcers.	People with a past history of chronic gastric ulcers have an increased incidence of domestic and financial stress compared with age- and sex-matched individuals with no previous history of gastric ulcers.
	Cobb et al[44]	Review of aeromedical certification examinations of 4325 traffic controllers and 8435 second-class aviators. Stress group: air traffic controllers.	Air traffic controllers were almost twice as likely to have stomach ulcers as civilian copilots .
	Shigemi et al[48]	Two-year study to examine the role of perceived job stress on the relationship between smoking and peptic ulcers.	These results suggest that specific and perceived job stress is an effect modifier in the relationship between the history of peptic ulcers and smoking.
	Nakadaira et al[50]	Effects of working far from family on the health of 129 married male workers (40-50 yr of age) compared with the control group.	The tanshin funin workers had higher rates of missing breakfast, stress due to daily chores and stress-related health problems (e.g., headache, gastric/duodenal ulcers and common colds/bronchitis).
	Westerling et al[51]	1985 study of the Swedish population (21-64 yr of age). Analyses of standardized mortality ratios (avoidable mortality) of blue-collar workers, white-collar workers, self-employed workers, and individuals outside the labor market. Stress group: Unemployed individuals	The death rates for the non-workers were higher than for the workers. The largest differences were found for stomach and duodenal ulcers.
	Lin et al[53]	289 call center workers in Taiwan, 19 to 54 yr of age. Health complaints, perceived level of job stress and major job stressors were considered. Stress group: call center workers.	Workers who perceived higher job stress had significantly increased risks of multiple health problems, including hoarse or sore throat, irritable stomach and peptic ulcers.
Gastric motility alterations	Mawdsley et al[2]	Review of recent advances in the understanding of the pathogenic role of psychological stress in IBD, with an emphasis on the necessity of investigating the therapeutic potential of stress reduction.	The living-organism (human or animal) responds to emotional or physical threats. Psychological stress contributes to the risk of IBD relapse.
	Huerta-Franco et al[3]	Bioimpedance technique. In this study, 57 healthy women (40-60 yr of age) were analyzed.	Assessment of the changes in gastric motility induced by acute psychological stress.
	Mai et al[7]	Description or tracking of 238 experiments conducted over more than 10 yr on a young man (Beaumont) with digestive disorders.	Emotions can cause bile reflux into the stomach and may delay gastric emptying.
	Wolf et al[8]	Description of the work of the French physiologist Cabanis.	Inhibitory and excitatory effects of gastric secretory and motor function were described.
	Muth et al[9]	Electrogastrograms were recorded, and the inter-beat intervals were obtained from electrocardiographic recordings from 20 subjects during baseline and in response to a shock avoidance task (shock stimulus) and forehead cooling (dive stimulus).	Acute stress can evoke arousal and dysrhythmic gastric myoelectrical activity. These acute changes, which occur in healthy individuals, may provide insight into functional gastrointestinal disorders.

GIT: Gastrointestinal tract; IBD: Inflammatory bowel disease; IBS: Irritable bowel syndrome; COMT: catechol-O-methyltransferase.