Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress

• Published in: Gut Vol. 53; no. 8; pp. 1102 - 1108
• Main Authors: Posserud, I, Agerforz, P, Ekman, R, Björnsson, E S, Abrahamsson, H, Simrén, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.08.2004; BMJ; BMJ Publishing Group LTD; Copyright 2004 by Gut
• Subjects: ACTH; Adrenocorticotropic Hormone; Adrenocorticotropic Hormone - blood; Adult; Aged; alternating type IBS; Anxiety; Anxiety - physiopathology; Arousal; Arousal - physiology; Biological and medical sciences; blood; constipation predominant irritable bowel syndrome; corticotropin releasing factor; Corticotropin-Releasing Hormone; Corticotropin-Releasing Hormone - blood; CRF; Defecation; diarrhoea predominant irritable bowel syndrome; Epinephrine; Epinephrine - blood; Female; Gastroenterologi och hepatologi; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; HAD scale; Heart Rate; Heart Rate - physiology; Hormones; hospital anxiety and depression scale; Humans; Hydrocortisone; Hydrocortisone - blood; IBS; IBS-A; IBS-C; IBS-D; interquartile range; IQR; Irritable Bowel Syndrome; Irritable Bowel Syndrome - physiopathology; Irritable Bowel Syndrome - psychology; Male; Medical sciences; Middle Aged; Nervous system; neuroendocrine response; Norepinephrine; Norepinephrine - blood; Other diseases. Semiology; Pain; Pain - physiopathology; Pathophysiology; physiology; physiopathology; Psychological; psychology; rectal sensitivity; Rectum; Rectum - physiopathology; Sensory Thresholds; Sensory Thresholds - physiology; Spielberger state trait anxiety inventory; STAI; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Stress; Stress response; Stress, Psychological - physiopathology; VAS; visual analogue scale; Human; Response; Irritable bowel syndrome; Gastroenterology; Digestive diseases; Intestinal disease; Stress
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.2003.017962

Background and aims: Stress often worsens the symptoms of irritable bowel syndrome (IBS). We hypothesised that this might be explained by altered neuroendocrine and visceral sensory responses to stress in IBS patients. Subjects and methods: Eighteen IBS patients and 22 control subjects were assessed using rectal balloon distensions before, during, and after mental stress. Ten controls and nine patients were studied in supplementary sessions. Rectal sensitivity (thresholds and intensity—visual analogue scale (VAS)) and perceived stress and arousal (VAS) were determined. Plasma levels of corticotropin releasing factor (CRF), adrenocorticotropic hormone (ACTH), cortisol, noradrenaline, and adrenaline were analysed at baseline, immediately after stress, and after the last distension. Heart rate was recorded continuously. Results: Thresholds were increased during stress in control subjects (p<0.01) but not in IBS patients. Both groups showed lower thresholds after stress (p<0.05). Repeated distensions without stress did not affect thresholds. Both groups showed increased heart rate (p<0.001) and VAS ratings for stress and arousal (p<0.05) during stress. Patients demonstrated higher ratings for stress but lower for arousal than controls. Basal CRF levels were lower in patients (p<0.05) and increased significantly during stress in patients (p<0.01) but not in controls. Patients also responded with higher levels of ACTH during stress (p<0.05) and had higher basal levels of noradrenaline than controls (p<0.01). Controls, but not patients, showed increased levels of adrenaline and noradrenaline in response to stress (p<0.05). Conclusions: Stress induced exaggeration of the neuroendocrine response and visceral perceptual alterations during and after stress may explain some of the stress related gastrointestinal symptoms in IBS.