Gastroenterology

Gastroenterology

Volume 127, Issue 6, December 2004, Pages 1695-1703
Gastroenterology

Clinical-alimentary tract
Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome

https://doi.org/10.1053/j.gastro.2004.08.057Get rights and content

Background & Aims: Stress is an important causative factor in irritable bowel syndrome (IBS). It remains unknown whether stress-related changes in gut function are mediated by altered autonomic efferent gut-specific innervation. We studied the effect of acute physical and psychological stress on autonomic innervation and visceral sensitivity in healthy volunteers and patients with IBS. Methods: Twenty-four patients (20 women) with constipation-predominant IBS and 12 healthy volunteers (8 women) underwent either physical (cold water hand immersion) or psychological (dichotomous listening) stress on separate occasions. Assessments included stress perception (visual analogue scale), gut-specific autonomic innervation (rectal mucosal blood flow [RMBF] by laser Doppler flowmetry), and viscerosomatic sensitivity (anal and rectal electrosensitivity). Results: Patients with IBS had a heightened baseline perception of stress (P < .01). RMBF decreased during physical stress (29.6% ± 2.8% and 28.7% ± 3.9%) and psychological stress (24.4% ± 2.1% and 23.5% ± 4.3%) in patients with IBS and controls, respectively (mean ± SEM). During physical stress, rectal perception (23.2% ± 6% vs .6% ± 3% [IBS vs control group, P < .05]) and rectal pain thresholds (27.0% ± 4% vs 1.3% ± 5%, P < .001) decreased in patients with IBS only. Psychological stress reduced thresholds for rectal perception (19.4% ± 6% vs 8% ± 6%, P < .01) and rectal pain (28.4% ± 4% vs 3.4% ± 3.8%, P < .001) in patients with IBS only. Acute stress elevated anal perception thresholds in patients with IBS but not controls (physical stress: 14.7% ± 14% vs −9.3% ± 11%, P < .05; psychological stress: 24.7% ± 9% vs 11% ± 11%, P < .05). Conclusions: Acute stress alters gut-specific efferent autonomic innervation in both controls and patients with IBS, although normalization is delayed in IBS. By contrast, only patients with IBS show heightened visceral sensation, suggesting involvement of a different regulatory mechanism, either central or peripheral.

Section snippets

Patients and subjects

Twenty-four consecutive consenting patients (20 women and 4 men; mean age, 40 years; age range, 18–78 years) were recruited from the outpatient department of a secondary referral gastroenterological service. Ethnic background was as follows: 14 white, 7 Asian, and 3 black. All patients had constipation-predominant IBS as defined by the Rome II criteria19 and were not taking any regular medication. Subjects were interviewed and their case notes reviewed at recruitment to exclude psychiatric

Demographics

There were no statistical differences between the IBS and control groups in terms of age (P = .18), sex (P = .68), or ethnicity (P = .084).

HAD

There were no statistically significant differences between the groups in HAD scores for either anxiety (median of 7 [range, 1–15] vs 5 [range, 2–9], IBS vs controls; P = .257) or depression (median of 3 [range, 1–7] vs 3 [range, 1–5], IBS vs controls; P = .827). All patients and controls had normal HAD depression subscale scores. Three of 12 subjects in the

Discussion

We have shown for the first time that there is a direct and measurable alteration in hindgut autonomic innervation in response to acute physical and psychological stress in both healthy controls and patients with IBS. The magnitude of this alteration of level of activity of autonomic innervation (as measured by RMBF) was similar in patients with IBS and controls. This suggests that the acute autonomic efferent response to stress, both in initial nature and extent, is normal in patients with

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