Feeding and colonic distension provoke altered autonomic responses in irritable bowel syndrome

Ng, Clinton; Malcolm, Allison; Hansen, Ross; Kellow, John

doi:10.1080/00365520600965749

Cited by 27 publications

(34 citation statements)

References 17 publications

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“…The lack of difference in ANS measures between IBS and controls at baseline differs from most previous HRV analysis findings which show IBS patients having higher cardiosympathetic tone and/or lower cardiovagal tone compared with healthy controls . Our main finding of ANS blunting in IBS in response to visceral stressor differs from the literature which generally shows greater cardiosympathetic activity in IBS patients during and after both rectal/colonic distensions and meals compared with controls.…”

Section: Discussioncontrasting

confidence: 99%

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

Cheng

Shih

Alberto

et al. 2013

Neurogastroenterology Motil

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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.

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Section: Discussioncontrasting

confidence: 99%

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

Cheng

Shih

Alberto

et al. 2013

Neurogastroenterology Motil

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“…Several studies have previously reported that IBS patients show various alterations in their autonomic, immunologic and visceral response to food intake. 11,[15][16][17][18][19][20][21][22]29,30 However, to the best of our knowledge this is one of the first studies to propose a meal as a way to induce GI symptoms in IBS patients and compare their symptom responses to healthy controls, with the intention to create a tool for disease evaluation.…”

Section: Discussionmentioning

confidence: 99%

Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

et al. 2013

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Background: Patients with irritable bowel syndrome (IBS) often complain of worsening of symptoms after meal intake. Meal challenge tests have previously been used to study symptoms and pathophysiology in functional dyspepsia. Objective: The objective of this article is to evaluate differences in gastrointestinal (GI) symptom response to a standardized meal test in IBS compared to healthy controls. Methods: We included 67 patients with IBS and 16 healthy controls. After an overnight fast the subjects were served breakfast (540 kcal; 36% fat, 15% proteins, 49% carbohydrates; 8.9 g fiber). They completed visual analog scales assessing severity of six GI symptoms (abdominal pain, bloating, discomfort, nausea, gas, fullness) before breakfast and every 30 minutes up to 240 minutes after breakfast. The patients also completed a questionnaire (IBS-SSS) to assess IBS symptom severity during the preceding week. The course of symptom scores over time was analyzed using mixed models. Results: The meal was well tolerated and all subjects completed the test period. In patients, significant effects of time (initial increase to a maximum, followed by a return to baseline) were found for fullness, bloating, nausea and discomfort (all p values < 0.01 for linear, quadratic and third-order effect of time). In IBS patients, an independent significant association between IBS-SSS scores and all postprandial symptoms, except for nausea, was found (all p < 0.01). In controls, a significant linear, quadratic and third-order effect of time (all p < 0.0001) was found for fullness only. The difference in time course for bloating and discomfort between IBS patients and controls was confirmed when comparing the groups directly (significant time-by-group interaction effects, all p < 0.05), but not for nausea. On average, IBS patients scored significantly higher than controls on all symptoms, except for nausea (significant main effects of group, all p < 0.05). Conclusions: A standardized meal test seems to be a promising tool to study the symptom pattern in IBS and potentially to follow the effect of interventions.

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“…One study demonstrated that postprandial GI disorders in IBS patients might be associated with cellular immune function along the neuroendocrine-immune axis [152] . Furthermore, altered autonomic responses after a meal might cause exacerbated postprandial symptoms in IBS patients [153] .…”

Section: Dietary Factorsmentioning

confidence: 99%

Irritable bowel syndrome: Emerging paradigm in pathophysiology

Lee

Park

2014

WJG

132

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Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, characterized by abdominal pain, bloating, and changes in bowel habits. These symptoms cannot be explained by structural abnormalities and there is no specific laboratory test or biomarker for IBS. Therefore, IBS is classified as a functional disorder with diagnosis dependent on the history taking about manifested symptoms and careful physical examination. Although a great deal of research has been carried out in this area, the pathophysiology of IBS is complex and not completely understood. Multiple factors are thought to contribute to the symptoms in IBS patients; altered gastrointestinal motility, visceral hypersensitivity, and the brain-gut interaction are important classical concepts in IBS pathophysiology. New areas of research in this arena include inflammation, postinfectious low-grade inflammation, genetic and immunologic factors, an altered microbiota, dietary factors, and enteroendocrine cells. These emerging studies have not shown consistent results, provoking controversy in the IBS field. However, certain lines of evidence suggest that these mechanisms are important at least a subset of IBS patients, confirming that IBS symptoms cannot be explained by a single etiological mechanism. Therefore, it is important to keep in mind that IBS requires a more holistic approach to determining effective treatment and understanding the underlying mechanisms.

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Feeding and colonic distension provoke altered autonomic responses in irritable bowel syndrome

Abstract: IBS patients demonstrated altered autonomic responses to feeding and colonic distension. Further studies should determine whether these alterations could explain the postprandial exacerbation of symptoms in IBS.

Cited by 27 publications

References 17 publications

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

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

Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

Irritable bowel syndrome: Emerging paradigm in pathophysiology

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