Effects of occupational stress on the gastrointestinal tract

Abstract

The aim of this review is to provide a general overview of the relationship between occupational stress and gastrointestinal alterations. The International Labour Organization suggests occupational health includes psychological aspects to achieve mental well-being. However, the definition of health risks for an occupation includes biological, chemical, physical and ergonomic factors but does not address psychological stress or other affective disorders. Nevertheless, multiple investigations have studied occupational stress and its physiological consequences, focusing on specific risk groups and occupations considered stressful. Among the physiological effects of stress, gastrointestinal tract (GIT) alterations are highly prevalent. The relationship between occupational stress and GIT diseases is evident in everyday clinical practice; however, the usual strategy is to attack the effects but not the root of the problem. That is, in clinics, occupational stress is recognized as a source of GIT problems, but employers do not ascribe it enough importance as a risk factor, in general, and for gastrointestinal health, in particular. The identification, stratification, measurement and evaluation of stress and its associated corrective strategies, particularly for occupational stress, are important topics to address in the near future to establish the basis for considering stress as an important risk factor in occupational health.

Keywords: Gastric alterations; Gastrointestinal tract diseases; Health risks; Occupation; Stress.

Figure 1

Representation of the hypothetical mechanism by which occupational stress produces gastrointestinal tract alterations in workers. Stress during job development (see occupational stress) generates a response of the network integrated by the hypothalamus (paraventricular nucleus), amygdala and periaqueductal grey. These brain regions receive input from visceral and somatic afferents and from the medial prefrontal cortex (PFC) and the anterior cingulated (ACC) and insular cortices (Insular C). In turn, output from this integrated network to the pituitary and ponto-medullary nuclei (PMN) mediates the neuroendocrine and autonomic responses in the body. The final output of this central stress circuitry is called the emotional motor system and includes the autonomic neurotransmitters norepinephrine and epinephrine and neuroendocrine (hypothalamus-pituitary-adrenal axis, HPA) and pain modulatory systems. PVN: Paraventricular nucleus; PAG: Periaqueductal grey; GIT: Gastrointestinal tract; ACTH: Adrenocorticotropic hormone; CRH: Corticotrophin-releasing hormone; ANS: Autonomic nervous system.