Gastrointestinal Disorders

Studies of patients with inflammatory bowel disease suggest that they may be more vulnerable than healthy comparison adolescents to developing psychiatric disorders, including symptoms of anxiety and depression (Hommel 2008; Mackner and Cran-dall 2006; Mackner et al. 2006). Anxiety symptoms can occur in the context of any treatment with a cor-ticosteroid. Evidence is mixed regarding whether patients' inflammatory bowel disease relapses are related to times of increased stress in adults (Creed and Olden 2005), and less is known about the role of stress in inflammatory bowel disease symptom exacerbation in pediatric patients (Mackner et al. 2006).

Pediatric patients with functional gastrointestinal disorders (i.e., those not clearly associated with a structural, infectious, inflammatory, or biochemical etiology) have been found to have elevated levels of anxiety that, although similar to anxiety levels reported by children with organic gastrointestinal diagnoses, are significantly higher than those of healthy children (Banez and Cunningham 2003; Scharff 1997; Walker et al. 1993). Patients with a history of functional abdominal pain are at increased risk of having irritable bowel syndrome and higher levels of psychosocial distress, disability, and health service use over time (Walker et al. 1998). Considerable clinical and scientific progress has been made in understanding the etiologies of, diagnosing, and treating functional gastrointestinal disorders in children (Li 2009).

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