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Sex specific alterations in autonomic function among patients with irritable bowel syndrome
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  1. K Tillisch1,
  2. E A Mayer2,
  3. J S Labus3,
  4. J Stains3,
  5. L Chang4,
  6. B D Naliboff5
  1. 1CNS/WH: Center for Neurovisceral Sciences and Women’s Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  2. 2CNS/WH: Center for Neurovisceral Sciences and Women’s Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Departments of Medicine, Physiology, and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  3. 3CNS/WH: Center for Neurovisceral Sciences and Women’s Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  4. 4CNS/WH: Center for Neurovisceral Sciences and Women’s Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  5. 5CNS/WH: Center for Neurovisceral Sciences and Women’s Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
  1. Correspondence to:
    Dr K Tillisch
    CNS/WH: Center for Neurovisceral Sciences and Women’s Health, CURE Building 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA; ktillischmednet.ucla.edu

Abstract

Background: Irritable bowel syndrome (IBS) is associated with increased psychological symptoms, early life stressors, and alterations in visceral perception and brain responses to noxious visceral stimuli. The autonomic nervous system (ANS) is a likely mediator for these brain-gut interactions. The few studies directly examining ANS measures have been suggestive of alterations in some IBS patients, but no studies to date have examined the potentially critical variables of sex differences or response to visceral stimulation.

Aims: (1) To test differences in ANS function during rest and during a visceral stressor (rectosigmoid balloon distension) between IBS patients and healthy control subjects. (2) To examine the role of sex on the autonomic responses of IBS patients.

Methods: Baseline autonomic measures were evaluated from 130 Rome I positive IBS patients and 55 healthy control subjects. Data were also collected from a subset of 46 IBS patients and 16 healthy control subjects during a sigmoid balloon distension study. Heart rate variability measures of peak power ratio (PPR) and peak power high frequency (PPHF) were analysed to assess sympathetic balance and parasympathetic response, respectively. Peripheral sympathetic response was measured by skin conductance.

Results: IBS patients showed a greater skin conductance response to visceral distension than controls. IBS patients had higher PPR and lower PPHF across conditions. Male IBS patients had higher skin conductance and PPR than females and lower PPHF.

Conclusions: IBS patients have altered autonomic responsiveness to a visceral stressor, with increased sympathetic and decreased parasympathetic activity. These differences are predominantly seen in males.

  • IBS, irritable bowel syndrome
  • IBS-C, constipation predominant IBS
  • IBS-D, diarrhoea predominant IBS
  • IBS-A, alternating bowel habit of IBS
  • ANS, autonomic nervous system
  • PPHF, peak power high frequency
  • PPR, peak power ratio
  • SC, skin conductance
  • SNS, sympathetic nervous system
  • PNS, parasympathetic nervous system
  • HRV, heart rate variability
  • HAD, hospital anxiety and depression scale
  • irritable bowel syndrome
  • functional bowel disorders
  • autonomic function

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Supplementary materials

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    Files in this Data Supplement:

    • [view PDF] - Table 2. Baseline autonomic nervous system (ANS) measures of irritable bowel syndrome (IBS) patients by bowel habit (corrected).

Footnotes

  • Conflict of interest: None declared.

  • Published online first 28 May 2005

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