#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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


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


Sources

1. Lin S, Mooney PD, Kurien M et al. Prevalence, investigational pathways and diagnostic outcomes in differing irritable bowel syndrome subtypes. Eur J Gastroenterol Hepatol 2014; 26 (10): 1176–1180. doi: 10.1097/MEG.0000 000000000171.

2. Krogsgaard LR, Engsbro AL, Bytzer P. The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults ≤ 50 years of age. Scand J Gastroenterol 2013; 48 (5): 523–529. doi: 10.3109/00365521.2013.775328.

3. Oshima T, Miwa H. Epidemiology of functional gastrointestinal disorders in Japan and in the world. J Neurogastroenterol Motil 2015; 21 (3): 320–329. doi: 10.5056/jnm14165.

4. Chang L, Toner BB, Fukudo S et al. Gender, age, society, culture, and the patient’s perspective in the functional gastrointestinal disorders. Gastroenterology 2006; 130 (5): 1435–1446. doi: 10.1053/j.gastro.2005.09.071.

5. Wang YT, Lim HY, Tai D et al. The impact of irritable bowel syndrome on health-related quality of life: a Singapore perspective. BMC Gastroenterol 2012; 12: 104. doi: 10.1186/1471-230X-12-104.

6. Jamali R, Raisi M, Matini M et al. Health related quality of life in irritable bowel syndrome patients, Kashan, Iran: a case control study. Adv Biomed Res 2015; 4: 75. doi: 10.4103/2277-9175.15 3902.

7. Buono JL, Mathur K, Averitt AJ et al. Economic burden of irritable bowel syndrome with diarrhea: retrospective analysis of a U.S. commercially insured population. J Manag Care Spec Pharm 2017; 23 (4) 453–460. doi: 10.18553/jmcp.2016.16138.

8. Nellesen D, Yee K, Chawla A et al. A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation. J Manag Care Pharm 2013; 19 (9): 755–764. doi: 10.18553/jmcp.2013.19.9.755.

9. Browning KN. Stress-induced modulation of vagal afferents. Neurogastroenterol Motil 2019; 31 (12): e13758. doi: 10.1111/nmo.13758.

10. Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil 2017; 23 (2): 151–163. doi: 10.5056/jnm16214.

11. Kellow JE, Azpiroz F, Delvaux M et al. Applied principles of neurogastroenterology: physiology/motility sensation. Gastroenterology 2006; 130 (5): 1412–1420. doi: 10.1053/j.gastro.2005.08.061.

12. Mayer EA, Savidge T, Shulman RJ. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology 2014; 146 (6): 1500–1512. doi: 10.1053/j.gastro.2014.02.037.

13. Honzikova N, Fiser B. Baroreflex sensitivity and essential hypertension in adolescents. Physiol Res 2009; 58 (5): 605–612.

14. Chapleau MW, Sabharwal R. Methods of assessing vagus nerve activity and reflexes. Heart Fail Rev 2011; 16 (2): 109–127. doi: 10.1007/s10741-010-9174-6.

15. Amaral JF, Borsato DMA, Freitas IMG et al. Autonomic and vascular control in prehypertensive subjects with a family history of arterial hypertension. Arq Bras Cardiol 2017; 110 (2): 166–174. doi: 10.5935/abc.20180006.

16. McEwen BS. Stressed or stressed out: what is the difference? J Psychiatry Neurosci 2005; 30 (5): 315–318.

17. Spaziani R, Bayati A, Redmond K et al. Vagal dysfunction in irritable bowel syndrome assessed by rectal distension and baroreceptor sensitivity. Neurogastroenterol Motil 2008; 20 (4): 336–342. doi: 10.1111/j.1365-2982.2007.01042.x.

18. Pytrus T, Iwanczak B, Iwanczak F. Baroreflex sensitivity in children with functional gastrointestinal disorders, insulin-dependent diabetes mellitus and in normal controls. J Pediatr Gastroenterol Nutr 2004; 39 (Suppl 1): S442.

19. Davydov DM, Naliboff B, Shahabi L et al. Baroreflex mechanisms in irritable bowel syndrome: part I. Traditional indices. Physiol Behav 2016; 157: 102–108. doi: 10.1016/j.physbeh.2016.01.042.

20. Salvioli B, Pellegatta G, Malacarne M et al. Autonomic nervous system dysregulation in irritable bowel syndrome. Neurogastroenterol Motil 2015; 27 (3): 423–430. doi: 10.1111/nmo.12512.

21. Davydov DM, Naliboff B, Shahabi L et al. Asymmetries in reciprocal baroreflex mechanisms and chronic pain severity: focusing on irritable bowel syndrome. Neurogastroenterol Motil 2018; 30 (2). doi: 10.1111/nmo.13186.

22. Polster AV, Friberg P, Le Neve B et al. Autonomic nervous system function in patients with irritable bowel syndrome (IBS): relevance for symptoms? Gastroenterology 2017; 152 (5) (Suppl 1): S724. doi: 10.1016/S0016-5085 (17) 32517-9.

23. Lorena SL, Figueiredo MJ, Almeida JR et al. Autonomic function in patients with functional dyspepsia assessed by 24-hour heart rate variability. Dig Dis Sci 2002; 47 (1): 27–31. doi: 10.1023/a: 1013246900041.

24. Elsenbruch S, Wang Z, Orr WC et al. Time-frequency analysis of heart rate variability using short-time fourier analysis. Physiol Meas 2000; 21 (2): 229–240. doi: 10.1088/0967-33 34/21/2/303.

25. Huizinga JD, Mathewson KJ, Yuan Y et al. Probing heart rate variability to determine parasympathetic dysfunction. Physiol Rep 2018; 6 (10): e13713. doi: 10.14814/phy2.13713.

26. Mazurak N, Seredyuk N, Sauer H et al. Heart rate variability in the irritable bowel syndrome: a review of the literature. Neurogastroenterol Motil 2012; 24 (3): 206–216. doi: 10.1111/j.1365-2982.2011.01866.x.

27. Jang A, Hwang SK, Padhye NS et al. Effects of cognitive behavior therapy on heart rate variability in young females with constipation-predominant irritable bowel syndrome: a parallel-group trial. J Neurogastroenterol Motil 2017; 23 (3): 435–445. doi: 10.5056/jnm17017.

28. Guo WJ, Yao SK, Zhang YL et al. Impaired vagal activity to meal in patients with functional dyspepsia and delayed gastric emptying. J Int Med Res 2018; 46 (2): 792–801. doi: 10.1177/0300060517726442.

29. Vargas-Luna FM, Huerta-Franco MR, Schurman JV et al. Heart rate variability and gastric electrical response to a cold pressor task in youth with functional dyspepsia. Dig Dis Sci 2020; 65 (4): 1074–1081. doi: 10.1007/s10620-019-05848-4.

30. Martínez-Martínez LA, Mora T, Vargas A et al. Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case-control studies. J Clinical Rheumatol 2014; 20 (3): 146–150. doi: 10.1097/RHU.00 00000000000089.

31. Zhou W, Debg Q, Jia L et al. Acute effect of transcutaneous electroacupuncture on globus pharyngeus: a randomized, single-blind, crossover trial. Front Med 2020; 7: 179. doi: 10.3389/fmed.2020.00179.

32. Mazurak N, Seredyuk N, Sauer H et al. Heart rate variability in the irritable bowel syndrome: a review of the literature. Neurogastroenterol Motil 2012; 24 (3): 206–216. doi: 10.1111/j.1365-2982.2011.01866.x.

33. Tanaka T, Manabe N, Hata J et al. Characterization of autonomic dysfunction in patients with irritable bowel syndrome using fingertip blood flow. Neurogastroenterol Motil 2008; 20 (5): 498–504. doi: 10.1111/j.1365-2982.2007.01039.x.

34. Manabe N, Tanaka T, Hata J et al. Pathophysiology underlying irritable bowel syndrome – from the viewpoint of dysfunction of autonomic nervous system activity. J Smooth Muscle Res 2009; 45 (1): 15–23. doi: 10.1540/jsmr.45.15.

35. Višňovcová Z, Tonhajzerová I. Biomedicínsky princíp a využitie elektrodermálnej odpovede v klinickej praxi. Cognitive Remediation J 2013; 1: 10 –15.

36. Edebol-Carlman H et al. Cognitive behavioral therapy for irritable bowel syndrome: the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions – an uncontrolled trial. Scand J Pain 2018; 18 (1): 81–91. doi: 10.1515/sjpain-2017-0153.

37. Phillips K, Wright BJ, Kent S. Irritable bowel syndrome and symptom severity: evidence of negative attention bias, diminished vigour, and autonomic dysregulation. J Psychosom Res 2014; 77 (1): 13–19. doi: 10.1016/j.jpsychores.2014.04.009.

38. Lee IS, Preissl H, Giel K et al. Attentional and physiological processing of food images in functional dyspepsia patients: a pilot study. Sci Rep 2018; 8 (1): 1388. doi: 10.1038/s41598-017-19112-0.

39. Parati G, Saul JP, di Rienzo M et al. Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation. A critical appraisal. Hypertension 1995; 25 (6): 1276–1286. doi: 10.1161/01.hyp.25.6.1276.

40. Behuliak M, Bencze M, Polgárová K et al. Hemodynamic response to gabapentin in conscious spontaneously hypertensive rats. Hypertension 2018; 72 (3): 676–685. doi: 10.1161/HYPERTENSIONAHA.118.09909.

41. Stauss HM, Mrowka R, Nafz B et al. Does low frequency power of arterial blood pressure reflect sympathetic tone? J Auton Nerv Syst 1995; 54 (2): 145–115. doi: 10.1016/0165-1838 (94) 00000-a.

42. Firulescu L, May RW, Ferrer GF et al. Divergent hypertension-inducing manifestations between anxiety and depression: a cardio (anxiety) vascular (depression) perspective. Ann Depress Anxiety 2017; 4 (2): 1087.

43. Cheng P, Shih W, Alberto M et al. Autonomic response to a visceral stressor is dysregulated in irritable bowel syndrome and correlates with duration of disease. Neurogastroenterol Motil 2013; 25 (10): e650–e659. doi: 10.1111/nmo.12177.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Article was published in

Gastroenterology and Hepatology

Issue 4

2020 Issue 4

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#