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Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism
  1. Tim Vanuytsel1,2,
  2. Sander van Wanrooy1,
  3. Hanne Vanheel1,
  4. Christophe Vanormelingen1,
  5. Sofie Verschueren1,
  6. Els Houben1,
  7. Shadea Salim Rasoel1,
  8. Joran Tόth1,
  9. Lieselot Holvoet1,
  10. Ricard Farré1,
  11. Lukas Van Oudenhove1,
  12. Guy Boeckxstaens1,2,
  13. Kristin Verbeke1,
  14. Jan Tack1,2
  1. 1Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
  2. 2Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium.
  1. Correspondence to Professor Jan Tack, Department of Gastroenterology, Leuven University Hospital, Herestraat 49, Leuven 3000, Belgium; jan.tack{at}


Objective Intestinal permeability and psychological stress have been implicated in the pathophysiology of IBD and IBS. Studies in animals suggest that stress increases permeability via corticotropin-releasing hormone (CRH)-mediated mast cell activation. Our aim was to investigate the effect of stress on intestinal permeability in humans and its underlying mechanisms.

Design Small intestinal permeability was quantified by a 2 h lactulose–mannitol urinary excretion test. In a first study, 23 healthy volunteers were subjected to four different conditions: control; indomethacin; public speech and anticipation of electroshocks. In a second study, five test conditions were investigated in 13 volunteers: control; after pretreatment with disodium cromoglycate (DSCG); administration of CRH; DSCG+CRH and DSCG+public speech.

Results Indomethacin, as a positive comparator (0.071±0.040 vs 0.030±0.022; p<0.0001), and public speech (0.059±0.040; p<0.01), but not the shock protocol increased intestinal permeability. Similarly, salivary cortisol was only increased after public speech. Subgroup analysis demonstrated that the effect of public speech on permeability was only present in subjects with a significant elevation of cortisol. CRH increased the lactulose–mannitol ratio (0.042±0.021 vs 0.028±0.009; p=0.02), which was inhibited by the mast cell stabiliser DSCG. Finally, intestinal permeability was unaltered by public speech with DSCG pretreatment.

Conclusions Acute psychological stress increases small intestinal permeability in humans. Peripheral CRH reproduces the effect of stress and DSCG blocks the effect of both stress and CRH, suggesting the involvement of mast cells. These findings provide new insight into the complex interplay between the central nervous system and GI function in man.

  • Stress
  • Epithelial Barrier
  • Mast Cells
  • Inflammatory Bowel Disease
  • Irritable Bowel Syndrome

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