The role of stress in symptom exacerbation among IBS patients

Blanchard, Edward B.; Lackner, Jeffrey M.; Jaccard, James; Rowell, Dianna; Carosella, Ann Marie; Powell, Catherine; Sanders, Kathryn A.; Krasner, Susan S.; Kuhn, Eric

doi:10.1016/j.jpsychores.2007.10.010

Cited by 126 publications

(106 citation statements)

References 29 publications

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“…Given that psychosocial stress is considered a key factor in both the onset and exacerbation of symptoms in IBS (Blanchard et al 2008), the results of the current study suggest that interventional studies aimed at modulating the HPA axis and GI response to the TSST may help to identify novel therapeutic approaches in IBS. The impact of an overactive HPA axis in daily life is clearly problematic and can impact negatively on numerous physiological processes and possibly on cognition, as has recently been reported in IBS (Kennedy et al 2013).…”

Section: Discussionmentioning

confidence: 96%

A sustained hypothalamic–pituitary–adrenal axis response to acute psychosocial stress in irritable bowel syndrome

et al. 2014

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Background. Despite stress being considered a key factor in the pathophysiology of the functional gastrointestinal (GI) disorder irritable bowel syndrome (IBS), there is a paucity of information regarding the ability of IBS patients to respond to acute experimental stress. Insights into the stress response in IBS could open the way to novel therapeutic interventions. To this end, we assessed the response of a range of physiological and psychological parameters to the Trier Social Stress Test (TSST) in IBS.Method. Thirteen female patients with IBS and 15 healthy female age-matched control participants underwent a single exposure to the TSST. Salivary cortisol, salivary C-reactive protein (CRP), skin conductance level (SCL), GI symptoms, mood and self-reported stress were measured pre-and post-exposure to the TSST.Results. The hypothalamic-pituitary-adrenal (HPA) axis response to the TSST was sustained in IBS, as shown by a greater total cortisol output throughout (p = 0.035) and higher cortisol levels measured by an area under the curve with respect to ground (AUC G ) analysis (p = 0.044). In IBS patients, GI symptoms increased significantly during the recovery period following exposure to the TSST (p = 0.045). Salivary CRP and SCL activity showed significant changes in relation to stress but with no differential effect between experimental groups.Conclusions. Patients with IBS exhibit sustained HPA axis activity, and an increase in problematic GI symptoms in response to acute experimental psychosocial stress. These data pave the way for future interventional studies aimed at identifying novel therapeutic approaches to modulate the HPA axis and GI symptom response to acute psychosocial stress in IBS.

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Section: Discussionmentioning

confidence: 96%

A sustained hypothalamic–pituitary–adrenal axis response to acute psychosocial stress in irritable bowel syndrome

et al. 2014

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“…Our study is not, however, directly comparable with theirs in three important respects. One is that Blanchard et al 29 studied the effect of stress on GI symptoms over an acute period of 3 weeks in comparison with our much longer time course of 18 months. The second is that our study was not concerned with stress as such but rather psychiatrically diagnosed anxiety and depression and while these constructs are likely to be positively correlated they are also quite different.…”

Section: Discussionmentioning

confidence: 99%

“…The second is that our study was not concerned with stress as such but rather psychiatrically diagnosed anxiety and depression and while these constructs are likely to be positively correlated they are also quite different. The third is that Blanchard et al 29 assessed their data for the best-fitting model whereas our aim was to test specific and a priori specified hypotheses.…”

Section: Discussionmentioning

confidence: 99%

“…Given the requirement for correct temporal order, concurrent pathways are not informative and, hence, not all mathematically possible paths were included in the analysis despite being demonstrated in previous studies. 29 The hypothesized paths have been reported empirically via pairwise Pearson correlation coefficients to describe the paths as observed (i.e. ignoring other elements of the model).…”

Section: Methodsmentioning

confidence: 99%

“…When the model fits the observed variance-covariance structure well, both the TLI and CFI are close to 1.0 with values >0.95 generally considered to be adequate. 30 Statistical power was assessed for the final outcome variable in each model using the method described in Blanchard et al 29 The power for multiple regression when the model-explained variance was 10% was >0.95 at the 0.05 level of statistical significance (two-tailed).…”

Section: Methodsmentioning

confidence: 99%

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Early life factors initiate a ‘vicious circle’ of affective and gastrointestinal symptoms: A longitudinal study

Jones

Oudenhove

Koloski³

et al. 2013

UEG Journal

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Objective: Functional gastrointestinal disorders (FGID) have been shown to be associated with both comorbid mood disorders and traumatic events such as abuse earlier in life. In a longitudinal study, we tested a model that hypothesized: (i) childhood abuse was associated with subsequent mood disorder and pain or interference in life by bowel symptoms both directly and indirectly via neurotic personality; and (ii) an ongoing cycle of mood disorder impacts on bowel symptoms. Design: Subjects from the general population classified as irritable bowel syndrome and/or functional dyspepsia (IBS/FD, n ¼ 207) or free of FGID (n ¼ 100) were prospectively studied every 6 months over 18 months. In addition to bowel symptom interference and abdominal pain, measures of personality (neuroticism), childhood abuse history, depression, and anxiety were obtained. The hypothesized model was tested via Path Modelling. Results: Childhood abuse was found to be directly associated with neuroticism but only indirectly associated with baseline interference and mood disorders (via neuroticism). The data further supported an ongoing cycle of elevations in mood disorders and pain/interference by bowel symptoms. The data supported direct effects of interference at one time point on interference at the subsequent time point in addition to indirect effects of prior anxiety and depression. Repeating the model with pain frequency as the outcome yielded almost identical findings which suggests the findings are generalized across domains of symptoms and quality-of-life. Conclusion: Our data provide support for a model characterized by a 'vicious circle' between mood disorders and FGID symptoms in adulthood, with initial input from early life factors.

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