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• W2125035146 abstract "This report reviews recent research on the psychosocial aspects of the functional gastrointestinal disorders (FGIDs). A review and evaluation of existing literature was conducted by a multidisciplinary committee of experts in this field. This report is a synopsis of a chapter published in the Rome III book. The committee reached consensus in finding considerable evidence supporting the association between psychological distress, childhood trauma and recent environmental stress, and several of the FGIDs but noted that this association is not specific to FGIDs. There is also considerable evidence that psychosocial variables are important determinants of the outcomes of global well-being, health-related quality of life, and health care seeking. In line with these descriptive findings, there is now increasing evidence that a number of psychological treatments and antidepressants are helpful in reducing symptoms and other consequences of the FGIDs in children and adults. The FGIDs are a result of complex interactions between biological, psychological, and social factors, and they can only be treated satisfactorily when all these factors are considered and addressed. Therefore, knowledge about the psychosocial aspects of FGIDs is fundamental and critical to the understanding, assessment, and treatment of these disorders. More extensive physician training is needed if these aspects of treatment are to be used effectively and widely in clinical practice. This report reviews recent research on the psychosocial aspects of the functional gastrointestinal disorders (FGIDs). A review and evaluation of existing literature was conducted by a multidisciplinary committee of experts in this field. This report is a synopsis of a chapter published in the Rome III book. The committee reached consensus in finding considerable evidence supporting the association between psychological distress, childhood trauma and recent environmental stress, and several of the FGIDs but noted that this association is not specific to FGIDs. There is also considerable evidence that psychosocial variables are important determinants of the outcomes of global well-being, health-related quality of life, and health care seeking. In line with these descriptive findings, there is now increasing evidence that a number of psychological treatments and antidepressants are helpful in reducing symptoms and other consequences of the FGIDs in children and adults. The FGIDs are a result of complex interactions between biological, psychological, and social factors, and they can only be treated satisfactorily when all these factors are considered and addressed. Therefore, knowledge about the psychosocial aspects of FGIDs is fundamental and critical to the understanding, assessment, and treatment of these disorders. More extensive physician training is needed if these aspects of treatment are to be used effectively and widely in clinical practice. Knowledge about the psychosocial aspects of the functional gastrointestinal disorders (FGIDs) is fundamental and critical to the understanding of the FGIDs and their effective treatment. Because physicians are traditionally trained to look for pathophysiologic explanations of observed phenomena, they may feel uncertain when faced with syndromes such as the FGIDs, chronic fatigue syndrome, and fibromyalgia, which cannot be explained in this manner. The FGIDs do not fit a simple pathophysiologic model. Rather, they result from complex interactions of biological, psychological, and social factors, and this report provides an up-to-date synthesis of current research in the area. The biopsychosocial model provides the conceptual basis of this report (Figure 1). Early life experiences, adult stressors (eg, divorce or bereavement), social support, and other social learning experiences affect both an individual’s physiologic and psychological responses, including distress, psychiatric disorders, and beliefs and coping strategies. The gut responds to environmental and physiology factors, but it also interacts directly with the brain, thereby providing 2-way interactions along the “brain-gut” axis (central nervous system/enteric nervous system connections; see the neurogastroenterology report in this supplement). Genetic factors can have direct physiologic effects, and the genetic makeup of an individual can also make him or her more susceptible to environmental or social factors, thus leading to changes in physiology. Therefore, while not specific to the FGIDs, psychological and social influences can affect the perception of symptoms, health care–seeking behaviors, and outcomes in patients with FGIDs. These psychosocial influences affect gut function, the experience of pain, health-related quality of life, work absenteeism, health care use, and medical and societal costs. This report provides recent evidence of these interactions and explores the mechanisms by which this biopsychosocial approach affects the illness experience and clinical outcome of patients with FGIDs. The report also discusses ways to apply this more integrated approach in clinical practice. There is substantial evidence of family aggregation of irritable bowel syndrome (IBS) and related disorders, which reflects genetic and environmental influences.1Locke III, G.R. Zinsmeister A. Talley N.J. Fett S.L. Melton J. Familial association in adults with functional gastrointestinal disorders.Mayo Clin Proc. 2000; 75: 907-912Abstract Full Text Full Text PDF PubMed Scopus (223) Google Scholar One study has found that a polymorphism in the serotonin reuptake transporter (SERT) gene that is associated with fibromyalgia2Offenbaecher M. Bondy B. de Jonge S. Glatzeder K. Kruger M. Schoeps P. Ackenheil M. Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region.Arthritis Rheum. 1999; 42: 2482-2488Crossref PubMed Scopus (266) Google Scholar, 3Cohen H. Buskila D. Neumann L. Ebstein R.P. Confirmation of an association between fibromyalgia and serotonin transporter promoter region (5-HTTLPR) polymorphism, and relationship to anxiety-related personality traits.Arthritis Rheum. 2002; 46: 845-847Crossref PubMed Scopus (159) Google Scholar and affective or anxiety disorders is also associated with diarrhea-predominant IBS,4Yeo A. Boyd P. Lumsden S. Saunders T. Handley A. Stubbins M. Knaggs A. Asquith S. Taylor I. Bahari B. Crocker N. Rallan R. Varsani S. Montgomery D. Alpers D.H. Dukes G.E. Purvis I. Hicks G.A. Association between a functional polymorphism in the serotonin transporter gene and diarrhoea predominant irritable bowel syndrome in women.Gut. 2004; 53: 1452-1458Crossref PubMed Scopus (218) Google Scholar although negative findings regarding this relationship also have been reported.5Camilleri M. Is there a SERT-ain association with IBS?.Gut. 2004; 53: 1396-1399Crossref PubMed Scopus (47) Google Scholar Additional association studies regarding polymorphisms in SERT and similar genes (eg, the enzyme catechol-O-methyltransferase6Diatchenko L. Slade G.D. Nackley A.G. Bhalang K. Sigurdsson A. Belfer I. Goldman D. Xu K. Shabalina S.A. Shagin D. Max M.B. Makarov S.S. Maixner W. Genetic basis for individual variations in pain perception and the development of a chronic pain condition.Hum Mol Genet. 2005; 14: 135-143Crossref PubMed Scopus (1008) Google Scholar) may clarify the possible influence of genetic factors on the development of functional bowel disorders. In addition, children learn behaviors from their parents who have FGIDs, and this learning appears to make an even stronger contribution to the risk of developing an FGID than genetic influences.7Levy R.L. Jones K.R. Whitehead W.E. Feld S.I. Talley N.J. Corey L.A. Irritable bowel syndrome in twins heredity and social learning both contribute to etiology.Gastroenterology. 2001; 121: 799-804Abstract Full Text Full Text PDF PubMed Scopus (346) Google Scholar A number of social learning phenomena can influence the clinical expression of abdominal pain, including modeling (ie, where children observe and learn to display the illness behavior of their parents) and positive reinforcement. Children of adult patients with IBS make more health care visits than the children of parents without IBS, and this increased medical help seeking is not confined to gastrointestinal (GI) symptoms.8Levy R.L. Whitehead W.E. Von Korff M.R. Saunders K.W. Feld A.D. Intergenerational transmission of gastrointestinal illness behavior.Am J Gastroenterol. 2000; 95: 451-456Crossref PubMed Google Scholar Retrospective and prospective studies have shown that children whose mothers reinforce illness behaviors experience more severe stomachaches and miss more school than other children.9Levy R.L. Whitehead W.E. Walker L.S. Von Korff M. Feld A.D. Garner M. Christie D. Increased somatic complaints and health-care utilization in children effects of parent IBS status and parent response to gastrointestinal symptoms.Am J Gastroenterol. 2004; 99: 2442-2451Crossref PubMed Scopus (164) Google Scholar, 10Whitehead W.E. Crowell M.D. Heller B.R. Robinson J.C. Schuster M.M. Horn S. Modeling and reinforcement of the sick role during childhood predicts adult illness behavior.Psychosom Med. 1994; 6: 541-550Google Scholar Additional research supporting this mechanism comes from studies of children with recurrent abdominal pain (a child is considered to have recurrent abdominal pain when, in the absence of physical or laboratory findings, he or she has experienced at least 3 episodes of pain over a 3-month period that affect the child’s activities11Apley J. Naish N. Recurrent abdominal pains a field survey of 1000 children.Arch Dis Child. 1958; 33: 165-170Crossref PubMed Scopus (658) Google Scholar). Preliminary research has shown that when parents of children with recurrent abdominal pain are taught to reduce positive or sympathetic responses to their children’s reports of pain, the frequency of these complaints decreases.12Levy R.L. Garner M.D. Christie D.L. Whitsett S.F. Whitehead W.E. Walker L.S. Feld A. Changes in childhood recurrent abdominal pain and parental responses with cognitive behavior therapy (abstr).Gastroenterology. 2003; 124: A-530Google Scholar High frequency rates of sexual, physical, and emotional abuse in patients with FGIDs (30%–56%) have been reported from many different referral centers in the United States and Europe,13Talley N.J. Fett S.L. Zinsmeister A.R. Self-reported abuse and gastrointestinal disease in outpatients association with irritable bowel-type symptoms.Am J Gastroenterol. 1995; 90: 366-371PubMed Google Scholar, 14Delvaux M. Denis P. Allemand H. French Club of Digestive MotilitySexual and physical abuses are more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicenter inquiry.Eur J Gastroenterol Hepatol. 1997; 9: 345-352Crossref PubMed Scopus (107) Google Scholar, 15Scarinci I.C. McDonald-Haile J.M. Bradley L.A. Richter J.E. Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse a preliminary model.Am J Med. 1994; 97: 108-118Abstract Full Text PDF PubMed Scopus (201) Google Scholar, 16Heitkemper M. Jarrett M. Walker E. Landenburger K. Bond E.F. Effect of sexual and physical abuse on symptom experiences in women with irritable bowel syndrome.Nurs Res. 2001; 50: 1-9Google Scholar, 17Ali A. Toner B.B. Stuckless N. Gallop R. Diamant N.E. Gould M. Vidins E. Emotional abuse, self-blame and self-silencing in women with irritable bowel syndrome.Psychosom Med. 2000; 62: 76-82PubMed Google Scholar especially in specialist or secondary care clinics,18Longstreth G.F. Wolde-Tsadik G. Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates.Dig Dis Sci. 1993; 38: 1581-1589Crossref PubMed Scopus (260) Google Scholar, 19Drossman D.A. Leserman J. Nachman G. Li Z. Gluck H. Toomey T.C. Mitchell C.M. Sexual and physical abuse in women with functional or organic gastrointestinal disorders.Ann Intern Med. 1990; 113: 828-833Crossref PubMed Scopus (781) Google Scholar and these figures are significantly higher than those in healthy control groups. A similar high rate of abuse history is also found in non-GI painful conditions (eg, pelvic pain, headaches, fibromyalgia). Most, but not all, national probability studies have shown that abuse is associated with increased risk of abdominal pain and FGIDs.20McCauley J. Kern D.E. Kolodner K. Dill L. Schroeder A.F. DeChant H.K. Ryden J. Derogatis L.R. Bass E.B. Clinical characteristics of women with a history of childhood abuse unhealed wounds.JAMA. 1997; 277: 1362-1368Crossref PubMed Google Scholar, 21Talley N.J. Fett S.L. Zinsmeister A.R. Melton L.J. Gastrointestinal tract symptoms and self-reported abuse a population-based study.Gastroenterology. 1994; 107: 1040-1049Abstract PubMed Google Scholar, 22Walker E.A. Gelfand A. Katon W.J. Koss M.P. Von Korff M. Bernstein D. Russo J. Adult health status of women with histories of childhood abuse and neglect.Am J Med. 1999; 107: 332-339Abstract Full Text Full Text PDF PubMed Scopus (494) Google Scholar Compared with those without such a history, patients with FGIDs with abuse histories report more severe pain, greater psychological distress, greater impairment of functioning in their daily lives, and more frequent visits to the doctor.23Drossman D.A. Talley N.J. Olden K.W. Leserman J. Barreiro M.A. Sexual and physical abuse and gastrointestinal illness review and recommendations.Ann Intern Med. 1995; 123: 782-794Crossref PubMed Scopus (387) Google Scholar, 24Drossman D.A. Li Z. Leserman J. Toomey T.C. Hu Y. Health status by gastrointestinal diagnosis and abuse history.Gastroenterology. 1996; 110: 999-1007Abstract Full Text Full Text PDF PubMed Scopus (208) Google Scholar, 25Drossman D.A. Li Z. Leserman J. Keefe F.J. Hu Y.J. Toomey T.C. Effects of coping on health outcome among female patients with gastrointestinal disorders.Psychosom Med. 2000; 62: 309-317PubMed Google Scholar, 26Koloski N.A. Talley N.J. Boyce P.M. Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia a critical review of the literature on symptom and psychosocial factors.Am J Gastroenterol. 2001; 96: 1340-1349Crossref PubMed Google Scholar Certain types of abuse, such as rape, repeated or multiple abuses, and life-threatening physical abuse, are more likely to produce marked symptom severity, disability, and other adverse health outcomes than other forms of abuse.27Leserman J. Li Z. Hu Y.J.B. Drossman D.A. How multiple types of stressors impact on health.Psychosom Med. 1998; 60: 175-181PubMed Google Scholar In a rare study that examined the relationship between posttraumatic stress disorder and IBS, Irwin et al found 44% of 50 consecutive patients with IBS reported a trauma history and 36% were diagnosed with posttraumatic stress disorder.28Irwin C. Falsetti S.A. Lydiard R.B. Ballenger J.C. Brock C.D. Brener W. Comorbidity of posttraumatic stress disorder and irritable bowel syndrome.J Clin Psychiatry. 1996; 57: 576-578Crossref PubMed Scopus (118) Google Scholar Possible mechanisms mediating the association between abuse history and poor outcome include (1) concurrent psychiatric disorders, moderate levels of psychological distress, and the tendency to report a large number of bodily symptoms29Talley N.J. Boyce P.M. Jones M. Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study.Gut. 1998; 42: 47-53Crossref PubMed Scopus (135) Google Scholar, 30Naliboff B.D. Balice G. Mayer E.A. Psychosocial moderators of quality of life in irritable bowel syndrome.Eur J Surg Suppl. 1998; : 57-59PubMed Google Scholar, 31Creed F.H. Ratcliffe J. Fernandes L. Palmer S. Rigby C. Tomenson B. Guthrie E. Read N. Thompson D.G. Outcome in severe irritable bowel syndrome with and without depressive, panic and neurasthenic disorders.Br J Psychiatry. 2005; 186: 507-515Crossref PubMed Scopus (38) Google Scholar, 32Hobbis I.C. Turpin G. Read N.W. A re-examination of the relationship between abuse experience and functional bowel disorders.Scand J Gastroenterol. 2002; 37: 423-430Crossref PubMed Scopus (38) Google Scholar; (2) altered appraisal of bodily symptoms (ie, increased hypervigilance to normal bodily sensations) and maladaptive coping styles (eg, “catastrophizing,” feelings of helplessness or inability to control symptoms)25Drossman D.A. Li Z. Leserman J. Keefe F.J. Hu Y.J. Toomey T.C. Effects of coping on health outcome among female patients with gastrointestinal disorders.Psychosom Med. 2000; 62: 309-317PubMed Google Scholar, 33Drossman D.A. Hu Y. Jia H. Toner B.B. Whitehead W.E. Diamant N.E. Ringel Y. Dalton C. Bangdiwala S.I. The influence of psychosocial factors on health care utilization in patients with functional bowel disorders (FBD).Gastroenterology. 2000; 118: A842Abstract Full Text PDF PubMed Google Scholar, 34Salmon P. Skaife K. Rhodes J. Abuse, dissociation, and somatization in irritable bowel syndrome towards an explanatory model.J Behav Med. 2003; 26: 1-18Crossref PubMed Scopus (104) Google Scholar; (3) impaired adult relationships (lack of social support)35Biggs A.M. Aziz Q. Tomenson B. Creed F. Effect of childhood adversity on health related quality of life in patients with upper abdominal or chest pain.Gut. 2004; 53: 180-186Crossref PubMed Scopus (47) Google Scholar; (4) centrally lowered threshold for perceiving afferent GI signals; and (5) increased autonomic function and/or intestinal motility due to hyperarousal.23Drossman D.A. Talley N.J. Olden K.W. Leserman J. Barreiro M.A. Sexual and physical abuse and gastrointestinal illness review and recommendations.Ann Intern Med. 1995; 123: 782-794Crossref PubMed Scopus (387) Google Scholar, 36Jarrett M.E. Burr R.L. Cain K.C. Hertig V. Weisman P. Heitkemper M.M. Anxiety and depression are related to autonomic nervous system function in women with irritable bowel syndrome.Dig Dis Sci. 2003; 48: 386-394Crossref PubMed Scopus (80) Google Scholar Stressful life events are associated with symptom exacerbation among adults with IBS37Whitehead W.E. Crowell M.D. Robinson J.C. Heller B.R. Schuster M.M. Effects of stressful life events on bowel symptoms subjects with irritable bowel syndrome compared to subjects without bowel dysfunction.Gut. 1992; 33: 825-830Crossref PubMed Scopus (367) Google Scholar and heartburn38Naliboff B.D. Mayer M. Fass R. FitzGerald L.Z. Chang L. Bolus R. Mayer E.A. The effect of life stress on symptoms of heartburn.Psychosom Med. 2004; 66: 426-434Crossref PubMed Scopus (116) Google Scholar and children with recurrent abdominal pain and are also associated with frequent health care seeking for patients with IBS.37Whitehead W.E. Crowell M.D. Robinson J.C. Heller B.R. Schuster M.M. Effects of stressful life events on bowel symptoms subjects with irritable bowel syndrome compared to subjects without bowel dysfunction.Gut. 1992; 33: 825-830Crossref PubMed Scopus (367) Google Scholar, 39Walker L.S. Garber J. Smith C.A. Van Slyke D.A. Claar R.L. The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain.J Consult Clin Psychol. 2001; 69: 85-91Crossref PubMed Scopus (163) Google Scholar Chronic life stress has been found to be the main predictor of IBS symptom intensity over 16 months, even after adjusting for IBS symptom severity, anxiety, and demographic features.40Bennett E.J. Tennant C.C. Piesse C. Badcock C.A. Kellow J.E. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome.Gut. 1998; 43: 256-261Crossref PubMed Scopus (341) Google Scholar These data indicate a direct relationship between stress and outcomes in patients with FGIDs and show that this relationship can be mediated by psychiatric disorders. Patients with IBS, like many other medical patient groups, experience levels of depression and anxiety intermediate between groups of psychiatric patients and healthy controls.41Drossman D.A. Do psychosocial factors define symptom severity and patient status?.Am J Med. 1999; 107: 41S-50SAbstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar There is also an increased prevalence (40%–60%) of psychiatric disorders in clinic patients with some FGIDs (notably IBS) compared with healthy controls (<20%) and patients with similar abdominal symptoms that can be explained by underlying organic GI disease (<25%).42Drossman D.A. Camilleri M. Mayer E.A. Whitehead W.E. AGA technical review on irritable bowel syndrome.Gastroenterology. 2002; 123: 2108-2131Abstract Full Text Full Text PDF PubMed Scopus (1204) Google Scholar The most common disorders are anxiety, depressive, panic, posttraumatic stress, and somatization disorders. These disorders frequently precede or occur simultaneously with the FGID, indicating that the psychiatric disorder cannot always be regarded as a response to the FGID. The self-reporting of numerous bodily symptoms (somatization) is a common phenomenon among clinic patients with FGIDs and in population-based studies of FGIDs.43Locke III, G.R. Weaver A.L. Melton III, L.J. Talley N.J. Psychosocial factors are linked to functional gastrointestinal disorders a population based nested case-control study.Am J Gastroenterol. 2004; 99: 350-357Crossref PubMed Scopus (252) Google Scholar Recent work suggests there is a separate dimension of somatic distress that may be partly genetically determined and that also overlaps with anxiety and depression.44Gillespie N.A. Zhu G. Heath A.C. Hickie I.B. Martin N.G. The genetic aetiology of somatic distress.Psychol Med. 2000; 30: 1051-1061Crossref PubMed Scopus (51) Google Scholar Although seen less commonly, some patients experience numerous bodily symptoms that have been present for many years and are associated with marked disability. This picture is recognized in the psychiatric literature as “somatization disorder” and is overrepresented in specialist clinics.45North C.S. Downs D. Clouse R.E. Alrakawi A. Dokucu M.E. Cox J. Spitznagel E.L. Alpers D.H. The presentation of irritable bowel syndrome in the context of somatization disorder.Clin Gastroenterol Hepatol. 2004; 2: 787-795Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar Children with recurrent abdominal pain also have higher levels of anxiety and depression than healthy children, and levels of anxiety and depression are often related to the duration of symptoms in these children.46Walker L.S. Heflinger C.A. Quality of life predictors in paediatric abdominal pain patients findings at initial assessment and five year follow-up.in: Drotar D.D. Measuring health-related quality of life in children and adolescents implications for research and practice. Lawrence Erlbaum, Mahwah, NJ1998: 237-252Google Scholar Depressed children with recurrent abdominal pain report numerous bodily symptoms in response to daily stressors, suggesting that stress reactivity is important in these children.39Walker L.S. Garber J. Smith C.A. Van Slyke D.A. Claar R.L. The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain.J Consult Clin Psychol. 2001; 69: 85-91Crossref PubMed Scopus (163) Google Scholar Psychiatric disorders are associated with alterations in the processing of visceral sensation in patients with FGIDs.47Guthrie E. Barlow J. Fernandes L. Ratcliffe J. Read N. Thompson D.G. Tomenson B. Creed F. North of England IBS Research GroupChanges in tolerance to rectal distension correlate with changes in psychological state in patients with severe irritable bowel syndrome.Psychosom Med. 2004; 66: 578-582Crossref PubMed Scopus (62) Google Scholar Patients with FGIDs who have a concomitant psychiatric diagnosis may also manifest alterations in gut-related autonomic nervous system function, affecting gut motility and sensation. Psychiatric disorders may directly impair health-related quality of life.30Naliboff B.D. Balice G. Mayer E.A. Psychosocial moderators of quality of life in irritable bowel syndrome.Eur J Surg Suppl. 1998; : 57-59PubMed Google Scholar, 48Creed F. Ratcliffe J. Fernandez L. Tomenson B. Palmer S. Rigby C. Guthrie E. Read N. Thompson D. Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome.Ann Intern Med. 2001; 134: 860-868Crossref PubMed Google Scholar Environmental stressors and related changes in mood alter the function of the GI tract and GI symptom perception in persons with GI diseases such as gastroesophageal reflux disease and those with FGIDs. The relationship of stressors to GI function is viewed as a direct consequence of the bidirectional modulation of GI function by the central nervous system, including motor responses, pain modulation, and even immune function.49Mulak A. Bonaz B. Irritable bowel syndrome a model of the brain-gut interactions.Med Sci Monit. 2004; 10: RA55-RA62PubMed Google Scholar, 50Mayer E.A. Naliboff B.D. Chang L. Coutinho S.V. Stress and the gastrointestinal tract v. stress and irritable bowel syndrome.Am J Physiol Gastrointest Liver Physiol. 2001; 280: G519-G524PubMed Google Scholar, 51Mayer E.A. The neurobiology of stress and gastrointestinal disease.Gut. 2000; 47: 861-869Crossref PubMed Scopus (476) Google Scholar These interactive relationships are important for FGIDs in that they provide the foundation for hypotheses of central nervous system dysregulation as causative in FGID symptom onset and maintenance.50Mayer E.A. Naliboff B.D. Chang L. Coutinho S.V. Stress and the gastrointestinal tract v. stress and irritable bowel syndrome.Am J Physiol Gastrointest Liver Physiol. 2001; 280: G519-G524PubMed Google Scholar, 52Monnikes H. Tebbe J.J. Hildebrandt M. Arck P. Osmanoglou E. Rose M. Klapp B. Wiedenmann B. Heymann-Monnikes I. Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity.Dig Dis. 2001; 19: 201-211Crossref PubMed Scopus (224) Google Scholar, 53Tache Y. Martinez V. Million M. Wang L. Stress and the gastrointestinal tract: III. Stress-related alterations of gut motor function: role of brain-corticotropin-releasing factor receptors.Am J Physiol Gastrointest Liver Physiol. 2001; 280: G173-G177PubMed Google Scholar Patients with IBS may show exaggerated motility to psychological stress, balloon distention, eating, and injection of cholecystokinin.54Harvey R.F. Read A.E. Effect of cholecystokinin on colon motility and symptoms in patients with the irritable bowel syndrome.Lancet. 1973; 1: 1-3Abstract PubMed Scopus (165) Google Scholar, 55Simren M. Castedal M. Svedlund J. Abrahamsson H. Bjornsson E. Abnormal propagation pattern of duodenal pressure waves in the irritable bowel syndrome (IBD).Dig Dis Sci. 2000; 45: 2151-2161Crossref PubMed Scopus (78) Google Scholar, 56Ford M.J. Camilleri M. Zinsmeister A.R. Hanson R.B. Psychosensory modulation of colonic sensation in the human transverse and sigmoid colon.Gastroenterology. 1995; 109: 1772-1780Abstract Full Text PDF PubMed Scopus (161) Google Scholar Such contractions are principally nonperistaltic (but can also be propulsive) contractions that could contribute to IBS symptoms by retarding (or accelerating) the movement of gas and stool or by more direct pain mechanisms. Laboratory stressors also produce increased smooth muscle tone in the rectum, which has been associated with IBS.57Whitehead W.E. Crowell M.D. Davidoff A.L. Palsson O.S. Schuster M.M. Pain from rectal distension in women with irritable bowel syndrome relationship to sexual abuse.Dig Dis Sci. 1997; 42: 796-804Crossref PubMed Scopus (94) Google Scholar However, a critical role for motility disturbance in producing symptoms in a majority of patients with IBS has not been clearly shown. Although the literature on autonomic nervous system function suggests that abnormalities exist among patients with FGIDs,58Tougas G. The autonomic nervous system in functional bowel disorders.Gut. 2000; 47: iv78-iv80PubMed Google Scholar the prevalence of these abnormalities and their role in the pathophysiology of functional symptom generation or exacerbation are unclear. Most studies are of small samples with mixed symptom features and poor control of potentially confounding variables, such as menstrual cycle in women, psychological status, and comorbid conditions. Cardiovascular autonomic nervous system measures used in these studies may not be sensitive markers for GI autonomic nervous system function; pancreatic polypeptide levels (ie, abdominal vagal activation) and mucosal blood flow may provide better measures. A variety of neuroendocrine pathways have been implicated in stress-induced alterations in GI function.53Tache Y. Martinez V. Million M. Wang L. Stress and the gastrointestinal tract: III. Stress-related alterations of gut motor function: role of brain-corticotropin-releasing factor receptors.Am J Physiol Gastrointest Liver Physiol. 2001; 280: G173-G177PubMed Google Scholar, 59Heitkemper M. Jarrett M. Cain K. Shaver J. Bond E. Woods N.F. Walker E. Increased urine catecholamines and cortisol in women with irritable bowel syndrome.Am J Gastroenterol. 1996; 91: 906-913PubMed Google Scholar Activation of central nervous system circuits that include the emotional motor system lead to neuroendocrine responses such as the release of corticotrophin-releasing factor, cortisol, and norepinephrine and epinephrine. There is a positive correlation between subjective sleep disturbances and GI symptoms, but whether this is purely a secondary phenomenon is not clear.60Jarrett M. Heitkemper M. Cain K.C. Burr R.L. Hertig V. 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• W2125035146 title "Psychosocial Aspects of the Functional Gastrointestinal Disorders" @default.
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