Symptoms Of Functional Gastrointestinal Disorders Research Articles

High and low unstimulated salivary cortisol levels correspond to different symptoms of functional gastrointestinal disorders

Objective It was examined whether unstimulated salivary cortisol levels as a psychobiological marker of stress reactivity correspond to psychological assessments of pain perception, depressive mood, and anxiety in patients with functional gastrointestinal disorder (FGD). Methods A total of 30 patients was diagnosed according to the Rome diagnostic criteria for irritable bowel syndrome, nonulcer dyspepsia, or both conditions. Psychometric data were assessed by questionnaires, and salivary samples were collected for the measurement of cortisol levels after awakening and during the day. Patients were grouped by their awakening cortisol levels into low (G1), medium (G2), and high cortisol group (G3). Results Psychiatric comorbidity did not differ between the groups. Analysis of variance (ANOVA) showed significant group differences with respect to pain perception and depressive mood, with the highest pain in G1 and the highest depression in G3. Conclusion The reported results are in line with prior research on hypothalamus–pituitary–adrenal (HPA) axis dysregulation in patients suffering from somatoform disorders on the one hand (low cortisol levels) and high cortisol levels in depression on the other. It is remarkable that our sample of patients of whom all received the same diagnosis, i.e., FGD, can be subdivided according to functional gastrointestinal symptoms, which correspond to the two types of cortisol alterations. The data provide evidence for psychobiological subgroups in FGD patients. As a consequence, the predominant symptoms reported by patients with FGD should carefully be taken into account to specify (psychotherapeutic) treatment.

Dyspepsia and Irritable Bowel Syndrome After a Salmonella Gastroenteritis Outbreak: One-Year Follow-up Cohort Study

It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia has not been specifically addressed. We prospectively evaluated development of dyspepsia and IBS during a 1-year follow-up in a cohort of adult patients affected by a Salmonella enteritidis AGE outbreak. Questionnaires were sent to 1878 potential participants at baseline and 3, 6, and 12 months; 677 had experienced a Salmonella enteritidis AGE on June 23, 2002, and 1201 had not (randomly selected controls, matched for village of residence, age, and sex). At 12 months, 271 patients and 335 controls returned the questionnaires. Data permitted the establishment of dyspepsia and IBS diagnosis by Rome II criteria. Before the AGE outbreak, the prevalence of dyspepsia was similar in cases and controls (2.5% vs 3.8%); the prevalence of IBS was also similar (2.9% vs 2.3%). At 3, 6, and 12 months, the prevalence of both dyspepsia and IBS had increased significantly in exposed compared with unexposed subjects. Overlap between dyspepsia and IBS was frequent. At 1 year, the relative risk for development of dyspepsia was 5.2 (95% confidence interval, 2.7-9.8) and for IBS was 7.8 (95% confidence interval, 3.1-19.7). Prolonged abdominal pain and vomiting during AGE were positive predictors of dyspepsia. No predictive factors for IBS were found. Salmonella gastroenteritis is a significant risk factor not only for IBS but also for dyspepsia; at 1 year of follow-up, 1 in 7 and 1 in 10 subjects developed dyspepsia or IBS, respectively.

A clinical trial of alprazolam and fluoxetine for the treatment of the intractable functional gastrointestinal disorders

目的 比较阿普唑仑和氟西汀治疗功能性胃肠病(FGID)的疗效,并探讨抗焦虑药和抗抑郁药在治疗FGID中的作用和地位.方法在常规疗法基础上,分别联用阿普唑仑和氟西汀治疗323例顽固性功能性消化不良(FD)和肠易激综合征(IBS)8周,并与单用常规疗法对照,评测其治疗前后消化道症状和焦虑、抑郁自评量表积分变化.结果阿普唑仑组和氟西汀组的消化道症状有效率分别为50.9%和55.6%(P=0.552),均显著高于常规疗法的22.4%(P＜0.001);便秘主导型IBS消化道症状有效率三组差异无统计学意义(P=0.990);阿普唑仑组和氟西汀组FD和腹泻主导型IBS原有精神异常患者和无精神异常患者的消化道症状有效率分别为58.3%和50.8%,差异无统计学意义(P=0.328);阿普唑仑组和氟西汀组治疗前后焦虑自评量表(SAS)总分差值比较无统计学意义(P=0.067),抑郁自评量表(SDS)总分差值比较则氟西汀组优于阿普唑仑组(P＜0.001).结论阿普唑仑和氟西汀均能改善FGID的消化道症状,疗效与症状类别有关,与目前是否存在精神异常无关。

Prevalence of Functional Gastrointestinal Disorders in Women Who Report Domestic Violence to the Police

Retrospective studies found an association between past sexual, physical, or psychological abuse and functional gastrointestinal disorders (FGIDs). However, there are no studies evaluating such an association concurrently with the ongoing abuse. Our aim was to investigate the prevalence of the main FGIDs, functional dyspepsia and irritable bowel syndrome, in 70 women reporting a situation of domestic violence to the police and to evaluate the level of psychological distress and its relationship with the presence of FGID. Through an interview between a social worker and the woman reporting abuse, digestive symptoms, psychological status, and type of abuse were recorded. These data were matched against police records. Functional dyspepsia and irritable bowel syndrome were diagnosed according to Rome II criteria. Seventy-one percent of the women had an FGID: 67% functional dyspepsia, 47% irritable bowel syndrome, and 43% both. In two thirds of the cases, FGID onset occurred simultaneously with or soon after abuse onset. Only 34% of the women had sought medical attention for FGID symptoms. No differences were found between women with or without FGID regarding age and type or duration of abuse; psychological distress tended to be more severe in the group of women with FGIDs. Most women who suffer domestic violence (reported to the police) have functional dyspepsia and/or irritable bowel syndrome and also have elevated psychological distress. This has important implications, not only for comprehensive health care of women in a situation of abuse, but also for medical treatment of women with FGIDs.

Repeated exposure to water avoidance stress in rats: a new model for sustained visceral hyperalgesia

Chronic stress plays an important role in the development and exacerbation of symptoms in functional gastrointestinal disorders. To better understand the mechanisms underlying this relationship, we aimed to characterize changes in visceral and somatic nociception, colonic motility, anxiety-related behavior, and mucosal immune activation in rats exposed to 10 days of chronic psychological stress. Male Wistar rats were submitted daily to either 1-h water avoidance (WA) stress or sham WA for 10 consecutive days. The visceromotor response to colorectal distension, thermal somatic nociception, and behavioral responses to an open field test were measured at baseline and after chronic WA. Fecal pellets were counted after each WA stress or sham WA session as a measure of stress-induced colonic motility. Colonic samples were collected from both groups and evaluated for structural changes and neutrophil infiltration, mast cell number by immunohistochemistry, and cytokine expression by quantitative RT-PCR. Rats exposed to chronic WA (but not sham stress) developed persistent visceral hyperalgesia, whereas only transient changes in somatic nociception were observed. Chronically stressed rats also exhibited anxiety-like behaviors, enhanced fecal pellet excretion, and small but significant increases in the mast cell numbers and the expression of IL-1beta and IFN-gamma. Visceral hyperalgesia following chronic stress persisted for at least a month. Chronic psychological stress in rats results in a robust and long-lasting alteration of visceral, but not somatic nociception. Visceral hyperalgesia is associated with other behavioral manifestations of stress sensitization but was only associated with minor colonic immune activation arguing against a primary role of mucosal immune activation in the maintenance of this phenomenon.

Review article: drugs interfering with visceral sensitivity for the treatment of functional gastrointestinal disorders – the clinical evidence

At present, the concept of visceral hypersensitivity provides the leading hypothesis regarding the generation of symptoms in functional gastrointestinal disorders. This paper discusses the current clinical evidence for drugs that have been proposed to interfere with visceral sensitivity in functional gastrointestinal disorders. Several possible pharmacological targets have been identified to reduce visceral pain and to reverse the processes underlying the persistence of visceral hypersensitivity. However, most of the available evidence comes from experimental animal models and cannot simply be extrapolated to patients with functional gastrointestinal disorders. In this review, we selected five drug classes that have been shown to exhibit visceral analgesic properties in experimental studies, and of which data were available regarding their clinical efficacy. These included opioid substances, serotonergic agents, antidepressants, somatostatin analogues and alpha(2)-adrenergic agonists. Although clinical trials show a limited benefit, in particular for serotonergic agents, the evidence illustrating that these effects result from normalization of visceral sensation is currently lacking. Therefore, we conclude that the concept of targeting visceral hypersensitivity as a treatment for functional gastrointestinal disorders is still controversial. Future evaluations require patient selection based on the presence of visceral hypersensitivity and application of compounds that exhibit 'true' viscerosensory effects.

A POPULATION BASED CASE-CONTROL STUDY OF FOOD CONSUMPTION AND FUNCTIONAL GASTROINTESTINAL DISORDERS

Purpose: Diet has been implicated to play a role in functional gastrointestinal disorders (FGID) in studies and our previous analysis showed that nutrient consumption between FGID cases and controls differed only slightly. The purpose of this study is to compare the dietary consumption of food items commonly implicated to exacerbate gut symptoms between individuals with FGID and without symptoms in a population-based sample. Methods: A validated self-report Bowel Disease Questionnaire was mailed to an age- and gender-stratified random sample of persons aged 20–50 years from Olmsted County, MN. All persons who reported either FGID symptoms (IBS or dyspepsia) or no gastrointestinal symptoms were invited to undergo a blinded physician interview and physical exam and to complete a validated Harvard Food Frequency Questionnaire (HFFQ). A subset of 53 cases and 58 controls maintained one week diet diaries. The Wilcoxon rank sum test was used for the statistical analysis. Results: 222 of the 260 eligible (85%) subjects participated and 221 provided diet data: 102 were FGID cases and 119 were healthy controls. Shown in the table below, cases and controls consumed similar number of servings per week of the following food items: wheat-containing foods, lactose-containing foods, caffeinated drinks, fructose-sweetened beverages, and alcoholic beverages. Cases also consumed a similar amount of serotonin-containing foods as controls (4 v. 4.5 servings) as well as similar amounts of tryptophan-containing foods (802.9 units v. 706.4 units). When norepinephrine and epinephrine-containing foods were evaluated, a similar proportion of cases and controls consumed 7 or more servings of coffee and tea (53% v. 53%) but cases were slightly more likely to consume 7 servings per week of chocolate, nuts, bananas, oranges, and raisins (57% v 45%, p = 0.10).TableConclusions: No differences were seen in the consumption of frequently-suspected “culprit” foods between community residents with and without FGID symptoms. Furthermore, little difference was seen in the consumption of food items containing serotonin, tryptophan, and norepinephrine and epinephrine.

Central nervous system involvement in functional gastrointestinal disorders

Although functional gastrointestinal disorders (FGID) are common, their pathophysiology remains incompletely understood. It is generally accepted that dysfunction of the bidirectional pathways between the gastrointestinal tract and the central nervous system (the ‘brain–gut axis’) at any level can cause FGID symptoms. In this review article, we focus on the role of the central nervous system in the brain–gut axis. First, we describe the functional anatomy of the brain–gut axis. Second, we focus on the results from brain-imaging studies both in healthy volunteers and in FGID patients. These new investigational techniques made identification of brain regions critically involved in processing of visceral afferent information possible. Differences in central nervous system response to visceral stimuli between controls and FGID patients will be highlighted. Third, we will address the issue of high comorbidity with psychiatric disorders. Some hypotheses about common pathophysiological substrates will be discussed.

Evolving concepts in functional gastrointestinal disorders: promising directions for novel pharmaceutical treatments

In recent years there has been an increasing appreciation of the complexity of functional gastrointestinal disorders. These represent a spectrum of conditions which may affect any part of the gastrointestinal tract in which there appears to be dysregulation of visceral function and afferent sensation and a strong association with emotional factors and stress. There is a clear psychological dimension, with up to 60% of irritable bowel syndrome (IBS) patients reported to have psychological co-morbidities and altered pain perception is also common in comparison with control populations. The role of the enteric nervous system, the sensory pathways and the brain as well as the influence of the latter on sympathetic and parasympathetic outflow have likewise attracted increasing interest and have led to exciting new methods to study their complex interactions. The concept of low-grade inflammation, such as might occur after infection, acting as a trigger for neuromuscular dysfunction has also led to the broad integrative hypotheses that help to explain the biopsychosocial dimensions seen in functional gastrointestinal disease. The multi-component model places a major emphasis on neurogastroenterology and enteric and neuro-immune interactions where new approaches to pharmacotherapy lie. Drugs may affect motility, visceral sensation and other aspects of gut function such as secretion or absorption. More particularly, however, has been the search for and attempts to influence important mediators of these primary gut functions. Such targets include serotonin and selected 5-HT receptors, which are involved in gut motility, visceral sensation and other aspects of gut function, CCK receptors which are involved in the mediation of pain in the gut and nociception in the CNS, opioid receptors involved in pain in the brain, spinal cord and periphery, muscarinic M 3-receptors, substance P and neurokinin A and B receptors which are involved in motor adaptation and pain transmission in association with inflammation, gabba receptors involved in nociception and cannabinoid receptors which are involved in the control of acetyl choline release in the gut. With a better understanding of the structures and pathways involved in visceral perception and hyperalgesia, in the CNS, spinal cord and the gut and new pharmacological tools we will be better able to elucidate the neuropharmacology of visceral perception and its relationship to gut dysfunction. It is likely that there will be multiple therapeutic options based on the spectrum of abnormalities capable of causing the spectrum of symptoms of functional gastrointestinal disorders in any individual patient.

Central neural mechanisms mediating human visceral hypersensitivity.

Although visceral hypersensitivity is thought to be important in generating symptoms in functional gastrointestinal disorders, the neural mechanisms involved are poorly understood. We recently showed that central sensitization (hyperexcitability of spinal cord sensory neurones) may play an important role. In this study, we demonstrate that after a 30-min infusion of 0.15 M HCl acid into the healthy human distal esophagus, we see a reduction in the pain threshold to electrical stimulation of the non-acid-exposed proximal esophagus (9.6 +/- 2.4 mA) and a concurrent reduction in the latency of the N1 and P2 components of the esophageal evoked potentials (EEP) from this region (10.4 +/- 2.3 and 15.8 +/- 5.3 ms, respectively). This reduced EEP latency indicates a central increase in afferent pathway velocity and therefore suggests that hyperexcitability within the central visceral pain pathway contributes to the hypersensitivity within the proximal, non-acid-exposed esophagus (secondary hyperalgesia/allodynia). These findings provide the first electrophysiological evidence that central sensitization contributes to human visceral hypersensitivity.

Perceptual responses in patients with inflammatory and functional bowel disease

BACKGROUND AND AIMSEnhanced visceral sensitivity following a transient inflammatory process in the gut has been postulated as an aetiological mechanism of irritable bowel syndrome (IBS). In this study we compared...

Intestinal and extraintestinal symptoms in functional gastrointestinal disorders.

Functional gastrointestinal disorders such as irritable bowel syndrome or functional dyspepsia have traditionally been regarded as syndromes limited to the digestive system. However, both clinical experience and published evidence show that patients with such disorders also report a series of other symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level. Some of these extraintestinal symptoms can be explained in the context of an evolving comprehensive disease model which views functional gastrointestinal disorders as manifestations of alterations in the interactions between the nervous system, the viscera and the musculoskeletal system. Alterations in central circuits concerned with arousal, attention and fear, cognitions about bodily symptoms and possible alterations in the hypothalamic pituitary adrenal (HPA) axis may all contribute to the wide range of symptoms reported by affected patients.

Functional bowel disorders in apparently healthy people

Symptoms of functional gastrointestinal disorder were sought by a questionnaire administered to 301 apparently healthy subjects in young, middle-aged, and elderly categories. Abdominal pain, a feeling of incomplete evacuation after defecation, urgency, scybala, runny stools, straining at stool, borborygmi, distension, heartburn, and laxative use were all very common. The typical symptom pattern of the spastic irritable bowel syndrome (IBS) occurred in 13.6% of subjects. Seven percent suffered noncolonic pain that was commonly associated with heartburn. A further 3.7% had painless diarrhea without the features of the spastic IBS. Six percent suffered painless constipation. Constipation seemed to increase with age. Thus four clinically distinct functional bowel syndromes existed in almost one-third of the subjects studied. Most of these had not consulted a doctor. Hospital-based studies of the IBS derive from a selected minority of patients and may not be applicable to all sufferers.