Autonomic dysregulation in irritable bowel syndrome, functional dyspepsia and globus pharyngeus – a review of literature and pilot results

Czech version

Authors: Lipták P. ¹; Ďuriček M. ¹; Prokopič M. ¹; Bánovčin P. ml. ¹; Hyrdel R. ¹; Tonhajzerová I. ²
Authors‘ workplace: Interná klinika – gastroenterologická, JLF UK a UN Martin, Slovenská republika ¹; Ústav fyziológie, JLF v Martine, Univerzita Komenského, Slovenská republika ²
Published in: Gastroent Hepatol 2020; 74(4): 327-333
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.14735/amgh2020327

Overview

Introduction: Functional gastrointestinal disorders (FGID) represent a group of diseases with various symptoms. The etiopathogenesis of FGID is not fully understood; most likely it is multifactorial. It is assumed that the impaired influence of the autonomic nervous system on the organism also plays some role in the etiopathogenesis of FGID.

Aim: To evaluate the reactivity of the autonomic nervous system in patients with FGID under the various stress stimuli.

Methods: Patients diagnosed with dysfunction according to the ROME IV criteria are included in the study. Three groups of diagnoses are monitored: irritable bowel syndrome, functional dyspepsia and globus pharyngeus. The measurement consists of five phases, each lasting 5 min. The initial phase is the resting phase, when the resting (basal) values of the monitored parameters are recorded. The following are two different stress phases (mental arithmetic and cold pressor test); between them, there is a recovery phase. The measurement is also completed by the recovery phase. The measured parameters are baroreflex sensitivity (BRS) (indicative of parasympathetic response) and low frequency band of systolic blood pressure variability (LF-SBP) (indicative of sympathetic response).

Results: A statistically significant reduction in BRS was observed in patients with FGID compared to the control group in all of the protocol phases, with most reduced BRS in globus group patients. In the mental arithmetic phase, all FGID subgroups have statistically significantly higher LF-SBP values compared to the control group. These changes are also significant during the cold pressor test in patients with IBS and dyspepsia.

Discussion and conclusion: Based on published works, patients with FGID are most likely to have an impaired response of the autonomic nervous system to stress stimuli. This is also confirmed by our pilot results. However, the detailed mechanism of this dysregulation is still not precisely described. While parasympathetic regulation is reduced at rest and during stress, sympathetic regulatory effects are altered during the response to a stress stimulus.

Conflict of Interest: The authors declare that the article/manuscript complies with ethical standards, patient anonymity has been respected, and they state that they have no financial, advisory or other commercial interests in relation to the subject matter.

Publication Ethics: This article/manuscript has not been published or is currently being submitted for another review. The authors agree to publish their name and e-mail in the published article/ manuscript.

Dedication: The work was supported by grants VEGA 1/ 0044/ 18, VEGA 1/ 0190/ 20, project of the Ministry of Health of the Slovak Republic 2018/ 20-UKMT-16.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

stress – Irritable bowel syndrome – dyspepsia – globus – regulation

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