Autonomic response to a visceral stressor is dysregulated in irritable bowel syndrome and correlates with duration of disease

Abstract

Background Previous studies reported altered autonomic nervous system (ANS) responses in IBS at baseline and to colonic balloon distension. This study examined heart rate variability (HRV) and plasma catecholamines as an index of ANS responsiveness in IBS during flexible sigmoidoscopy (FS) and explored associations of HRV with clinical measures. Methods Rome III positive IBS patients and healthy controls completed questionnaires measuring GI and psychological symptoms. HRV measures were calculated using electrocardiogram (ECG) data at rest and during FS. Plasma catecholamines were measured before and after the FS. Linear mixed effects models were used to compare HRV with IBS status and IBS duration across six time points. Significance was assessed at the 0.05 level. Results 36 IBS patients (53% F, mean age 37.89) and 31 controls (58% F, mean age 37.26) participated. After adjusting for age, sex, BMI, and HAD anxiety, IBS patients had a non-significant lower cardiovagal tone (p=0.436) and higher cardiosympathetic balance (p=0.316) at rest. During FS, controls showed a transient increase in cardiosympathetic balance and decrease in cardiovagal tone. However, IBS patients had significantly less cardiosympathetic and cardiovagal responsiveness both leading up to (p=0.003, p=0.005) and following (p=0.001, p=0.001) this stimulus. Those with longer duration of disease had less cardiosympathetic (p=0.014) and cardiovagal (p=0.009) responsiveness than those with shorter duration. No differences in catecholamines between IBS and controls were found. Conclusion IBS demonstrated dysregulated ANS responses to a visceral stressor which could be related to disease duration. Therefore, autonomic dysregulation is an objective physiologic correlate of IBS.

Stress and visceral pain: Focusing on irritable bowel syndrome

“…In normal healthy subjects, rectal distention induces an increase in heart rate, and the low frequency/high frequency ratio of heart rate variability is used as a marker of cardiac sympathetic activity with a concomitant increase in rCBF in the right anterior insula [74]. On the other hand, IBS patients exhibit an impaired cardiac sympathetic and vagal response to colonic stimulation in response to flexible sigmoidoscopy [11]. These findings suggest that robust sympathetic arousal is a normal feature of the cardiac autonomic response to colorectal distention and that IBS patients have an abnormal autonomic response to painful stimuli to the colorectum.…”

Increased Postprandial Colonic Motility and Autonomic Nervous System Activity in Patients With Irritable Bowel Syndrome: A Prospective Study

“…It has been reported that IBS patients had significantly less cardiosympathetic and cardiovagal responsiveness after controlling age effect during flexible sigmoidoscopy which may cause visceral nociception. 28 The altered responses in the emotional-arousal network during visceral stimulation were shown in IBS patients by means of brain imaging techniques. [37][38][39] These brain regions are closely related to stress responses which often induce cardiovascular activation.…”

“…27,28 The variables were analyzed by the non-parametric Mann-Whitney U statistic and the Spearman rank correlation coefficient to account for non-normal distributions of some variables. Categorical data were analyzed with the c 2 test.…”

肠易激综合征亚型患者具有肠道和躯体高敏感, 自主心血管功能紊乱以及肠道低浓度炎症

“…Most previous investigations of somatic hypersensitivity involved only a single stimulus method, and the conclusions were contradictory (Whitehead et al, 1990;Zighelboim et al, 1995). Whether autonomic cardiovascular dysfunction is involved in the pathological process of IBS is controversial (Elsenbruch and Orr, 2001;Tousignant-Laflamme et al, 2006;Cheng et al, 2013). Finally, a growing body of research evidence suggests that damage to the intestinal mucosal barrier and low-grade inflammation of the gut wall are related to the pathogenesis of IBS (Peuhkuri et al, 2010;Snoek et al, 2010;Liu et al, 2012).…”