Autonomic nervous system dysregulation in irritable bowel syndrome

Salvioli, Beatrice; Pellegatta, Gaia; Malacarne, Mara; Pace, F.; Malesci, Alberto; Pagani, Massimo; Lucini, Daniela

doi:10.1111/nmo.12512

Cited by 68 publications

(57 citation statements)

References 55 publications

(63 reference statements)

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“…These results are consistent with the current pathophysiological knowledge of these functional disorders, although most of the research in this area focuses predominantly on IBS [5,6,8,10,28,29]. …”

Section: Discussionsupporting

confidence: 89%

Psychometry and Pescatori projective test in coloproctological patients

Caetano

Oliveira

Gomes³

et al. 2017

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BackgroundPsychological assessment is not commonly performed nor easily accepted by coloproctological patients. Our aim was to evaluate the psychological component of coloproctological disorders using uncommon tools.MethodsThe 21-Item Depression Anxiety and Stress Scale and the Pescatori projective test were applied to coloproctological outpatients of the Gastroenterology Department of our hospital as well as to healthy volunteers.ResultsSeventy patients (median age 47 years, 22 male) divided in 4 groups (functional constipation, constipated irritable bowel syndrome, benign anorectal disease and perianal Crohn’s disease) and 52 healthy volunteers (age 45 years, 18 male) completed the tests. Proctological patients showed higher scores of depression (P<0.001), anxiety (P<0.001), and stress (P<0.001) compared to healthy participants. Compared to the control group, patients with functional constipation, irritable bowel syndrome and perianal Crohn’s disease maintained the highest scores in all subscales (P<0.05), while patients with benign anorectal disease only had higher anxiety and stress (P<0.001) scores. The patients’ also showed lower scores in the Pescatori projective test (P=0.012). A weak association between the projective test and the depression subscale was found (P=0.05).ConclusionProctological patients had higher scores of depression, anxiety and stress and lower scores in the Pescatori projective test compared to healthy controls.

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Section: Discussionsupporting

confidence: 89%

Psychometry and Pescatori projective test in coloproctological patients

Caetano

Oliveira

Gomes³

et al. 2017

aog

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“…21 Some studies have demonstrated an altered autonomic function in IBS patients and suggest that IBS patients have increased sympathetic nervous system and cardiovascular activation. 22,23 The endothelin system seems to exert an increased vasoconstrictive and sympathoexcitatory role in conditions characterized cardiovascular risk such as hypertension. 15 Moreover, some studies demonstrated that ET-1 mediates smooth muscle contraction in GI tract.…”

Section: Discussionmentioning

confidence: 99%

Neuroendocrine Dysregulation in Irritable Bowel Syndrome Patients: A Pilot Study

Stasi

Bellini

Gambaccini

et al. 2017

J Neurogastroenterol Motil

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Background/AimsIrritable bowel syndrome (IBS) is a multifactorial disorder, involving dysregulation of brain-gut axis. Our aim was to evaluate the neuroendocrine activity in IBS. MethodsThirty IBS and 30 healthy volunteers were enrolled. Psychological symptoms were evaluated by questionnaires. Urinary 5-hydroxyindoleacetic acid, plasma serotonin (5-hydroxytryptamine, 5-HT), endothelin, and neuropeptide Y (NPY), and plasma and urinary cortisol levels were evaluated. Fourteen IBS subjects underwent microneurography to obtain multiunit recordings of efferent postganglionic muscle sympathetic nerve activity (MSNA). ResultsPrevalent psychological symptoms in IBS were maladjustment (60%), trait (40%) and state (17%) anxiety, obsessive compulsivedisorders (23%), and depressive symptoms (23%). IBS showed increased NPY (31.9 [43.7] 1] pg/mL, P = 0.054], compared to healthy volunteers. Moreover, plasma NPY, endothelin, cortisol and 5-HT, and urinary 5-hydroxyindoleacetic acid were associated with some psychological disorders (P ≤ 0.05). Despite a similar resting MSNA, after cold pressor test, IBS showed a blunted increase in MSNA burst frequency (+4.1 vs +7.8 bursts/min, P = 0.048; +30.1% vs +78.1%, P = 0.023). Baseline MSNA tended to be associated with urinary cortisol (ρ = 0.557, P = 0.059). Moreover, changes in heart rate after mental stress were associated with urinary cortisol (ρ = 0.682, P = 0.021) and changes in MSNA after mental stress were associated with plasma cortisol (ρ = 0.671, P = 0.024)." ConclusionHigher concentrations of endothelin, NPY, and 5-HT were found to be associated with some psychological disorders in IBS patients together with an altered cardiovascular autonomic reactivity to acute stressors compared to healthy volunteers.

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“…3,[11][12][13] Recent evidence suggests that alterations in the brain-gut axis play an important role in IBS, 14,15 including altered sympathetic and parasympathetic activities of the autonomic nervous system (ANS). 16 Similarly, patients with IBS are known to have a higher occurrence of mood disturbances, anxiety, depression, somatization disorders, and psychological distress, 15,17 and the central nervous system (CNS) is believed to be involved in the concomitance of these conditions. 15,18,19 Heart rate variability (HRV) is a noninvasive measure of ANS activities.…”

Section: Introductionmentioning

confidence: 99%

Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

Jang

Hwang

Padhye

et al. 2017

J Neurogastroenterol Motil

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Background/AimsThe relation between heart rate variability (HRV) as non-invasive biomarkers of autonomic function and cognitive behavior therapy (CBT) as non-pharmacological treatments has rarely been examined in patients with constipation-predominant irritable bowel syndrome (IBS-C). The purpose of this study is to evaluate the efficacy of an 8-week CBT intervention on HRV and IBS symptoms, and the correlation of changes in HRV with changes in IBS symptoms among young female nursing students with IBS-C. MethodsThis study consisted of an exploratory subgroup analysis of 43 participants with IBS-C who had been randomly assigned to receive either 8 weeks of CBT (n = 23) or general medical information (control, n = 20). At baseline and 8, 16, and 24 weeks, participants completed a questionnaire assessing their gastrointestinal (GI) symptoms, anxiety, depression, and stress, and their HRV was measured via electrocardiography. ResultsAt the 8-week follow-up, the high-frequency (HF) power was significantly higher, and the low-frequency (LF)/HF ratio was lower in the CBT group than in the control group (P < 0.001 for both), and the severity of GI symptoms (P = 0.003), anxiety (P < 0.001), depression (P < 0.001), and stress (P < 0.001) was significantly lower in the CBT group than in the control group. Changes in the HF power were significantly and inversely associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from -0.37 to -0.68). Changes in the LF/HF ratio were also significantly and positively associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from 0.38 to 0.60). ConclusionsCBT was effective in managing symptoms in young IBS-C patients and the improvement of symptoms was sustained at 24 weeks following the completion of CBT. Furthermore, indirect measurement of autonomic function using HRV may be a useful objective parameter for assessing response to CBT in young IBS-C patients.

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Autonomic nervous system dysregulation in irritable bowel syndrome

Abstract: IBS subjects display a significant reduction in α index, an established marker of cardiac baroreflex. ANS dysfunction appears to be involved in the pathophysiology of IBS and its assessment may open new perspectives for clinical management of patients suffering from IBS.

Cited by 68 publications

References 55 publications

Psychometry and Pescatori projective test in coloproctological patients

Psychometry and Pescatori projective test in coloproctological patients

Neuroendocrine Dysregulation in Irritable Bowel Syndrome Patients: A Pilot Study

Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

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