Pre-experimental stress in patients with irritable bowel syndrome: high cortisol values already before symptom provocation with rectal distensions (original) (raw)
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International Journal of Psychophysiology, 2012
Objective: In this study, we investigated levels and relative ratios of adrenal hormones (including cortisol, dehydroepiandrosterone [DHEA], and DHEA-sulfate [DHEA-S]) and their psychophysiological correlates under acute psychosocial stress in individuals with irritable bowel syndrome (IBS). Methods: Fifty-three college students participated in the study (male: 42, female: 11; mean age: 22.64 years), including 13 individuals with IBS (IBS group) and 40 individuals without IBS (control group). The participants were exposed to a standardized laboratory stressor, which included delivering a speech and performing a mental arithmetic task. We measured subjective stress levels and salivary cortisol, DHEA, and DHEA-S levels at relevant time points before, during, and after the tasks. Results: DHEA-S level and the DHEA-S/DHEA ratio in the IBS group were significantly lower than those in the control group, and the cortisol/DHEA-S ratio in the IBS group was higher than that in the control group throughout the experiment. In the IBS group, the appraisal of a threat was positively correlated with cortisol levels (r = 0.61), and the appraisal of controllability was negatively correlated with cortisol levels (r = − 0.64) and with the cortisol/DHEA ratio (r = − 0.71). The control group showed a significant positive correlation between the appraisal of threat and cortisol levels (r = 0.32). Conclusion: The present study indicates that individuals with IBS had lower DHEA-S levels, and that their stressful cognitive appraisals under acute psychosocial stress caused the effects of cortisol to dominate. This adrenal hormone response may be involved in exacerbating abdominal symptoms in individuals with IBS.
BIOLOGICAL INTERACTION OF STRESS AND IRRITABLE BOWEL SYNDROME
A variety of stressors play a role in the development of irritable bowel syndrome. Irritable bowel syndrome is a biopsychosocial disorder that results from dysregulation of central or enteric nervous system function. The physiological effects of psychological and physical stressors on gut function and brain-gut interactions are mediated by outputs of the emotional motor system in terms of autonomic, neuroendocrine, attentional, and pain modulatory responses. Certain investigational studies reported to date indicate that the activation of CRF1 pathways may result in a combination of effects that are key features of symptoms in some irritable bowel syndrome patients. These include stimulation of colonic motility, defecation or watery diarrhea, gut hypersensitivity that increases the perception of stimuli within the bowel, focused attention (hypervigilance) toward the gut sensations, and mast cell activation. Blocking the CRF1 receptors may alleviate all these effects. Stress thus can be included in an integrative model explaining the pathophysiology of functional bowel disorder. Advances in the understanding of the relationship between stress and visceral perception may constitute a basis for a therapeutic approach of functional bowel disorders targeted on the central nervous system.
Gastroenterology, 2004
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.
Irritable bowel syndrome and psychological stress
Health SA Gesondheid, 1999
The purpose of this study was twofold. The first aim was to clarify the relationship between psychological stress and lrritable Bowel Syndrome (IBS) by establishing whether individuals suffering from IBS experience minor stress differently from healthy individuals in terms of its frequency or intensity. The second aim was more general and concerns theory building in a field filled with ambiguity and confusion. Two groups, one comprising IBS sufferers and the other healthy controls, completed the Daily Stress lnventory and the Occupational Stress lnventoryquestionnaires designed to measure minor daily and occupational stress respectively. The findings indicate that IBS sufferers do not experience more stress than healthy individuals, but they experience the stressors with greater intensity. ABSTRAK Die doel van die studie was tweeledig. Eerstens is daar gepoog om duidelikheid te kry oor die verband tussen sielkundige stres en Prikkelbare Dermsindroom (PDS), deur te bepaal of individue wat aan PDS ly geringe stres anders ervaar as gesonde individue in terme van gereeldheid of intensiteit. Die tweede doelwit was meer algemeen en spreek die kwessie van teorie ontwikkeling aan in 'n veld gevul met dubbelsinningheid en verwarring. Twee groepe, een bestaande uit PDS lyers en die ander 'n gesonde kontrolegroep, het die "Daily Stress Inventory'' en die "Occupational Stress Inventory" voltooi. Die vraelyste is ontwerp om onderskeidelik daaglikse stres en werkstres te meet. Die resultate dui daarop dat PDS lyers nie meer stres ervaar as die gesonde individue nie, maar dat hulle we1 die stressors ervaar met groter intensiteit.
Effect of prolonged stress on the adrenal hormones of individuals with irritable bowel syndrome
BioPsychoSocial Medicine, 2015
Background: The purpose of this study was to investigate the effect of prolonged stress on the salivary adrenal hormones (cortisol, dehydroepiandrosterone [DHEA], DHEA-sulfate [DHEA-S]) of individuals with irritable bowel syndrome (IBS). Methods: The participants were female college students, including 10 with IBS and 16 without IBS (control group), who were scheduled for a 2-week teaching practice at a kindergarten. Participants were asked to collect saliva for determining adrenal hormones immediately and 30 min after awakening and before sleep, 2 weeks before the practice, the first week of the practice, the second week of the practice, and a few days after the practice.
Stress-related alterations of visceral sensation: animal models for irritable bowel syndrome study
Journal of neurogastroenterology and motility, 2011
Stressors of different psychological, physical or immune origin play a critical role in the pathophysiology of irritable bowel syndrome participating in symptoms onset, clinical presentation as well as treatment outcome. Experimental stress models applying a variety of acute and chronic exteroceptive or interoceptive stressors have been developed to target different periods throughout the lifespan of animals to assess the vulnerability, the trigger and perpetuating factors determining stress influence on visceral sensitivity and interactions within the brain-gut axis. Recent evidence points towards adequate construct and face validity of experimental models developed with respect to animals' age, sex, strain differences and specific methodological aspects such as non-invasive monitoring of visceromotor response to colorectal distension as being essential in successful identification and evaluation of novel therapeutic targets aimed at reducing stress-related alterations in visce...
Literature Review on Stress and Psychosocial Determinants of Irritable Bowel Syndrome
Psychology, 2016
In recent years, the irritable bowel syndrome (IBS) has developed into a multi-factorial disease involving visceral hyperactivity, changes in the nervous and humoral communication between the enteric nervous system and the central nervous system, altered intestinal microflora, and increased intestinal permeability and minimal enteral inflammation. Psychological and social factors can affect the communication between the central and enteric nervous system, and there is evidence that is involved at the IBS and affect the response to treatment and outcome. There are indications that abuse history and stressful life events are implicated in initiation of functional gastrointestinal disorders. Genetic factors and social learning mechanisms have been proposed in order to explain grouping of IBS in families Τhe psychological characteristics, such as anxiety, depression, and comorbid psychiatric disorders, health beliefs have important role in the management of patients with IBS associated with both symptoms and results. This knowledge can be the trigger for a better and more holistic treatment of IBS, by giving to patient the opportunity for a better quality of life.