Adverse childhood experiences are associated with irritable bowel syndrome and gastrointestinal symptom severity

Abstract

BACKGROUND & AIMS Early adverse life events (EALs) are associated with irritable bowel syndrome (IBS). Exposure to EALs as assessed by the Adverse Childhood Experiences (ACE) questionnaire is associated with greater disease prevalence, but ACE has not been studied in gastrointestinal disorders. Study aims were to: 1) Estimate the prevalence of EALs in the IBS patients using the ACE questionnaire; 2) Determine correlations between ACE and Early Trauma Inventory Self Report-Short Form (ETI-SR) scores to confirm its validity in IBS; and 3) Correlate ACE scores with IBS symptom severity. METHODS 148 IBS (73% women, mean age=31 years) and 154 HCs (59% women, mean age=30 years) completed the ACE and ETI-SR between June 2010 and April 2015. These surveys measured EALs before age 18 in the domains of physical, sexual, emotional abuse, and general trauma. IBS and abdominal pain severity was measured by a 20-point scale (0=none, 20=worst symptoms). RESULTS The ACE score increased the odds of having IBS (odds ratio (OR)=2.05 [95% confidence interval (CI): 1.21-3.48], p=0.008). Household mental illness (p<0.001), emotional abuse (p=0.004), and incarcerated household member (p=0.019) were significant predictors of IBS. ACE and ETI-SR scores were strongly correlated (r=0.59, p<0.001). ACE, but not ETI-SR, modestly correlated with IBS severity (r=0.17, p=0.036) and abdominal pain (r=0.20, p=0.015). CONCLUSION The ACE questionnaire is a useful instrument to measure EALs in IBS based on its use in large studies, its ability to measure prevalence across different EAL domains, and its correlation with symptom severity.

Resilience is decreased in irritable bowel syndrome and associated with symptoms and cortisol response

“…Each of the 27 items is scored as ‘Yes’=1 or ‘No’=0 (score range 0‐27) . The ETI‐SR has previously been used in studies of EALs in IBS …”

“…3 Early adverse life events (EALs) have been found to increase the risk of developing IBS and can be associated with alterations in the central stress response systems, including the hypothalamic-pituitary-adrenal (HPA) axis. [16][17][18] In addition, studies have supported a dysregulated HPA axis in IBS even in the absence of EALs. 19,20 There are some data in the current literature suggesting that resilience can affect the response to stress, and that resilience scores are associated with changes in brain regions involved in stress responsiveness; 9,11-13 however, to our knowledge, this has not been examined in IBS in regards to symptom severity, quality of life, and physiologic markers of stress.…”

“…Predisposing factors that can affect resilience include early life experience, genetic factors, and developmental environment . Early adverse life events (EALs) have been found to increase the risk of developing IBS and can be associated with alterations in the central stress response systems, including the hypothalamic‐pituitary‐adrenal (HPA) axis . In addition, studies have supported a dysregulated HPA axis in IBS even in the absence of EALs .…”

Beyond Complex Trauma: An Existential View of Adverse Childhood Experiences

“…The second pathway identified by Felitti () is that an adult health issue may occur as a result of chronic stress experienced during childhood. Some potential adult health issues that have been linked to ACEs include obesity (Isohookana, Marttunen, Hakko, Riipinen, & Riala, ; Rehkopf et al, ), poor heart health (Klassen, Chirico, O’Leary, Cairney, & Wade, ; Monnat & Chandler, ; Su et al, ), Type 2 diabetes (Huang et al, ; Monnat & Chandler, ), and digestive disorders (Park et al, ).…”

The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma

“…Studies have also identified associations between childhood adversity and trauma and specific adult diagnoses including fibromyalgia [35], migraine [36], irritable bowel syndrome [37], insomnia and insufficient sleep [38], cancer [39], cognitive function in mental health disorders [40], as well as learning and behavior problems and obesity in youth [41] and adolescent pregnancy and fetal death [42]. Collectively, this research suggests the significant and pervasive negative impact of childhood ACEs and trauma on short- and long-term health outcomes, and therefore, the necessity and opportunity to prevent and intervene on ACEs, and to provide trauma-informed services broadly to offset the negative consequences in children, the adults they will become, and possibly even future generations.…”