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Kesavan C, Das A, Goyal P, Jackson CS, Strong DD, Strong RM. Vitamin D Deficiency (VDD) and Benefits of Supplementation in Veterans with IBS-D. Diagnostics (Basel) 2023; 13:2807. [PMID: 37685345 PMCID: PMC10486960 DOI: 10.3390/diagnostics13172807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/12/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Many veterans deployed to Gulf War areas suffer from persistent chronic diarrhea that is disabling and affects their quality of life. The causes for this condition have eluded investigators until recently and recent literature has shed light on the effect of vitamin D on the brain-gut axis. This study focused on determining clinical causes contributing to diarrhea and assessed whether reversing the identified causes, specifically vitamin D deficiency (VDD), could reduce the incidence of diarrhea in Gulf War veterans (GWVs). All patients completed a workup that included serologies (IBD, celiac), routine laboratory tests (CBC, chemistry panels, TSH, T4, CRP), cultures for enteric pathogens (C diff, bacteria, viruses, small intestinal bacterial overgrowth (SIBO)), and upper and lower endoscopies with histology and a trial of cholestyramine to exclude choleretic diarrhea and rifaximin for dysbiosis. A total of 4221 veterans were screened for chronic diarrhea, yielding 105 GWVs, of which 69 GWVs had irritable bowel syndrome with diarrhea (IBS-D). Paired t-tests demonstrated that all GWVs had VDD (t-11.62, df68 and sig(2-tailed) 0.0001) (defined as a vitamin D level less than 30 ng/mL with normal ranges of 30-100 ng/mL) but no positive serologies, inflammatory markers, abnormal endoscopies, cultures, or histology to explain their persistent diarrhea. There was no correlation with age, BMI, or inflammation. Some zip codes had a higher frequency of GWVs with VDD, but the number of deployments had no impact. Treatment with vitamin D supplementation (3000-5000 units), given in the morning, based on weight, reduced the number of bowel movements per day (p < 0.0001) without causing hypercalcemia. We suggest that VDD is important in the etiology of IBS-D in GWVs and that vitamin D supplementation significantly reduces diarrhea.
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Affiliation(s)
- Chandrasekhar Kesavan
- Department of Gastroenterology, VA Loma Linda Healthcare System, Loma Linda, CA 92357, USA; (C.K.); (A.D.); (C.S.J.)
- Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA; (P.G.); (D.D.S.)
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA 92357, USA
| | - Anjali Das
- Department of Gastroenterology, VA Loma Linda Healthcare System, Loma Linda, CA 92357, USA; (C.K.); (A.D.); (C.S.J.)
| | - Preeya Goyal
- Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA; (P.G.); (D.D.S.)
- Presbyterian Intercommunity Hospital, Los Angeles, CA 90602, USA
| | - Christian S. Jackson
- Department of Gastroenterology, VA Loma Linda Healthcare System, Loma Linda, CA 92357, USA; (C.K.); (A.D.); (C.S.J.)
- Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA; (P.G.); (D.D.S.)
| | - Donna D. Strong
- Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA; (P.G.); (D.D.S.)
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA 92357, USA
| | - Richard M. Strong
- Department of Gastroenterology, VA Loma Linda Healthcare System, Loma Linda, CA 92357, USA; (C.K.); (A.D.); (C.S.J.)
- Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA; (P.G.); (D.D.S.)
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Shin A, Xu H, Imperiale TF. The Prevalence, Humanistic Burden, and Health Care Impact of Irritable Bowel Syndrome Among United States Veterans. Clin Gastroenterol Hepatol 2023; 21:1061-1069.e1. [PMID: 35964894 PMCID: PMC9918609 DOI: 10.1016/j.cgh.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) in veterans is understudied. This study sought to investigate (1) prevalence of IBS; (2) phenotypic, environmental, and psychosocial factors associated with IBS; and (3) associations of IBS with health-related quality of life and health care use. METHODS From June 2018 to April 2020, we invited veterans to complete the Rome IV IBS questionnaire; Short Form-12; posttraumatic stress disorder (PTSD) checklist; Hospital Anxiety and Depression Scale; and questionnaires on general health, antibiotic use, infectious enteritis (IE), and health care use. RESULTS Among 858 veteran respondents, 244 (28.4%) met Rome IV IBS criteria (47.5% IBS with diarrhea, 16.8% IBS with constipation, 33.6% mixed IBS). IBS was associated with greater anxiety and depression and lower quality of life (all P < .001). Provisional PTSD, IE, and bowel problems after antibiotics were more common in IBS (all P < .001) as were multiple doctor visits (P < .01) and hospitalizations (P = .04). Comparisons across non-IBS and IBS subgroups revealed overall associations of psychological comorbidities (P < .01), multiple doctor visits (P < .01), hospitalizations (P = .03), IE (P < .01), and bowel problems after IE (P = .03) or antibiotics (P < .01) with subgroup. Highest anxiety and depression scores, PTSD, multiple doctor visits, hospitalizations, and bowel problems after IE were observed in IBS with constipation. In adjusted analyses, IBS was associated (all P < .001) with anxiety (odds ratio [OR], 3.47), depression (OR, 2.88), lower quality of life, PTSD (OR, 3.09), IE (OR, 4.44), bowel problems after antibiotics (OR, 1.84), multiple doctor visits (OR, 2.08), and hospitalizations (OR, 1.78). CONCLUSIONS IBS is prevalent among veterans and has a measurable impact on individuals and health care resources. Veterans with IBS may experience significant psychological impairment.
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Affiliation(s)
- Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Huiping Xu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Shaikh SD, Sun N, Canakis A, Park WY, Weber HC. Irritable Bowel Syndrome and the Gut Microbiome: A Comprehensive Review. J Clin Med 2023; 12:jcm12072558. [PMID: 37048642 PMCID: PMC10095554 DOI: 10.3390/jcm12072558] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits. It has a prevalence of 10 to 25% in the United States and has a high disease burden, as evidenced by reduced quality of life, decreased work productivity and increased healthcare utilization and costs. IBS has been associated with several intra-intestinal and extra-intestinal conditions, including psychiatric comorbidities. Although the pathophysiology of IBS has not been fully elucidated, it involves dysregulation of communication between the brain and gut (brain–gut axis) which is associated with alterations in intestinal motility, gut permeability, visceral hypersensitivity and gut microbiota composition. The purpose of this article is to review the role the gut microbiota plays in the pathophysiology of IBS, understand factors that affect the gut microbiome and explore the microbiome as a target of treatment.
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Prevalence of Gastrointestinal Symptoms and Irritable Bowel Syndrome Among Individuals With Symptomatic Posttraumatic Stress Disorder. J Clin Gastroenterol 2022; 56:592-596. [PMID: 35089910 DOI: 10.1097/mcg.0000000000001670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
GOALS Our aim was to describe the prevalence of irritable bowel syndrome (IBS) and other gastrointestinal symptoms in a sample of veterans with posttraumatic stress disorder (PTSD) and to examine the relationship between gastrointestinal symptoms, PTSD severity, depression severity, and number of prior traumatic events reported. BACKGROUND IBS and PTSD can co-occur; yet, little research has focused on describing the gastrointestinal symptoms and prevalence of IBS among veterans with PTSD. MATERIALS AND METHODS We examined baseline data from a randomized clinical trial of behavioral interventions for veterans with PTSD. Veterans completed questionnaires assessing gastrointestinal symptoms (Gastrointestinal Patient-Reported Outcome Measures Information Systems; PROMIS) and lifetime traumatic events. Multivariable regression analyses were performed to examine associations between gastrointestinal symptoms and the number of prior traumas reported PTSD severity, and depression symptom severity. RESULTS One hundred eighty-four veterans with a diagnosis of PTSD were included. Twenty-five percent met the Rome III criteria for IBS. Veterans reported gastrointestinal symptoms including abdominal/belly pain (36%), diarrhea (21%), constipation (18%), and bloating/gas (17%). In multivariable analyses, greater PTSD severity was associated with worse constipation ( P =0.008), diarrhea ( P =0.005), and gas/bloating ( P =0.001) when controlling for age and sex. Higher levels of depressive symptoms severity were associated with greater abdominal/belly pain ( P =0.04). CONCLUSIONS Among a sample of veterans with PTSD, rates of IBS and abdominal/belly pain are greater than general US population reference values. Although levels of constipation and bloating/gas are lower than general US population reference values, increased severity of PTSD was associated with increased gastrointestinal symptoms.
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Hendrix J, Ranginani D, Montero AM, Lockett C, Xu H, James-Stevenson T, Shin A. Early adverse life events and post-traumatic stress disorder in patients with constipation and suspected disordered defecation. Neurogastroenterol Motil 2022; 34:e14195. [PMID: 34121276 PMCID: PMC8715864 DOI: 10.1111/nmo.14195] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Early adverse life events (EALs) and post-traumatic stress disorder (PTSD) are associated with irritable bowel syndrome (IBS). Disordered defecation (DD) presents with symptoms of IBS or functional constipation (FC) and is associated with psychological distress. However, the role of trauma and stress in chronic constipation is poorly defined. We aimed to examine EALS, PTSD, and psychological symptoms in patients with constipation and suspected DD. METHODS We conducted a survey study among adults with constipation who completed anorectal manometry (ARM) and balloon expulsion testing (BET). Data were collected on socio-demographics, EALs, PTSD, bowel symptoms, quality of life, and anxiety and depression. We performed comparisons between individuals with normal versus abnormal ARM or BET, subgroup analysis by detailed ARM and BET findings, and latent class analysis using individual EAL domains. KEY RESULTS Among 712 eligible patients, 69 completed the study. EALs and provisional PTSD were present in 75.4% and 27.5%, respectively; rates did not differ between those with normal versus abnormal ARM or BET. Normal testing was associated with higher rates of specific EAL domains (emotional abuse and mental illness), higher depression scores, and poorer mental component scores in both primary and subgroup comparisons (all p < 0.05). Normal testing was associated with a lower likelihood of high-EAL latent class (p = 0.01) membership. Presence of IBS or FC did not influence associations. CONCLUSIONS & INFERENCES Early adverse life events and PTSD are prevalent in patients with constipation and suspected DD. Those with normal ARM and BET have higher rates of prior emotional abuse and poorer mental health.
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Affiliation(s)
- Justin Hendrix
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dheeksha Ranginani
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anne Mary Montero
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carolyn Lockett
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Toyia James-Stevenson
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Glynn H, Möller SP, Wilding H, Apputhurai P, Moore G, Knowles SR. Prevalence and Impact of Post-traumatic Stress Disorder in Gastrointestinal Conditions: A Systematic Review. Dig Dis Sci 2021; 66:4109-4119. [PMID: 33433790 DOI: 10.1007/s10620-020-06798-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
Psychological distress is often observed in patients with gastrointestinal illness. To date, there has been limited research conducted to assess the prevalence and impact of post-traumatic stress disorder (PTSD) in gastrointestinal cohorts. The aim of this systematic review is to review the evidence for the prevalence of PTSD in gastrointestinal cohorts versus comparator groups (healthy controls and chronic illness groups), predictive factors associated with the development and management of PTSD and the impact on patient outcomes. Adult studies were identified through systematic searches of eight databases (MEDLINE, Embase, Emcare, PsycINFO, Ovid Nursing, CINAHL, Informit Health Collection, and Cochrane Library) in February 2020. The overall pooled prevalence rate of PTSD in GI cohorts was 36%; however, the prevalence rate in non-veteran-specific gastrointestinal cohorts of 18% across all GI classification groups is likely to be the more representative rate. The non-gastrointestinal chronic illness cohort PTSD prevalence rate was 11%. Predictors identified in the development of post-traumatic stress in gastrointestinal cohorts include: female gender, poor social support, life adversity, subjective pain, and dietary choices. Post-traumatic stress was found to exacerbate gastrointestinal symptoms in a Crohn's Disease sample, whereby disease exacerbation was four times in those who met the criteria for probable PTSD. Post-traumatic stress symptoms affect around one in five individuals (non-veteran status) with a gastrointestinal condition. Further research is needed to understand the psychological and biological mechanisms by which PTSD increases the risk of developing and exacerbating gastrointestinal symptoms.
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Affiliation(s)
- Heidi Glynn
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, Melbourne, VIC, 3122, Australia
| | - Stephan P Möller
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, Melbourne, VIC, 3122, Australia
| | - Helen Wilding
- St Vincent's Hospital Library Service, St Vincent's Hospital, Melbourne, Australia
| | - Pragalathan Apputhurai
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - Gregory Moore
- Monash Medical Centre, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, Melbourne, VIC, 3122, Australia.
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.
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7
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Grillo AR, Danitz SB, Dichter ME, Driscoll MA, Gerber MR, Hamilton AB, Wiltsey-Stirman S, Iverson KM. Strides Toward Recovery From Intimate Partner Violence: Elucidating Patient-Centered Outcomes to Optimize a Brief Counseling Intervention for Women. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8431-NP8453. [PMID: 30994401 DOI: 10.1177/0886260519840408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Women in the United States continue to experience intimate partner violence (IPV) at unprecedented rates, necessitating the development and implementation of personalized, effective healthcare-based interventions. Methods of developing patient-centered interventions for IPV should elicit the voice of the target population (i.e., women who experience IPV) while assuring that outcomes identified as important are incorporated into the refined intervention. This pilot study is part of a multiphase, larger study aiming to refine an IPV intervention and clinical outcome measurements prior to formal evaluation of the effectiveness of the intervention. Specifically, this study elucidates patient-centered outcomes identified by women who have experienced IPV. Women patients of the Veterans Health Administration (VHA) in New England participated in focus groups to provide feedback and desired outcomes of a new IPV intervention. Patient-centered outcomes were defined by the participants. Focus groups were transcribed and analyzed using conventional content analysis and matrix analysis. A total of 25 women participated in focus groups (n = 5) at two large VHA facilities. Participant feedback revealed five common themes related to desired outcomes. Women opined increased feelings of empowerment as a key outcome of engaging in an IPV intervention. Women desired increased social connectedness and support to be gained during treatment, citing providers and other survivors of IPV as exemplary sources. Self-esteem was viewed as critical to enhancing recovery, as was increased knowledge across domains of IPV (e.g., warning signs, the link between mental and physical health for self and children). Finally, women identified valued action and goal setting, such as achieving more independence, as an optimal outcome. Addressing IPV against women requires patient-centered interventions that specifically target the types of outcomes deemed important by the end users: women who experience IPV. Findings have implications for tailoring treatments for IPV and selecting measures that tap into women's desired outcomes.
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Affiliation(s)
- Alessandra R Grillo
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Sara B Danitz
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa E Dichter
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Mary A Driscoll
- VA Connecticut Healthcare System, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Megan R Gerber
- Boston University School of Medicine, Boston, MA, USA
- Women's Health Services, VA Boston Healthcare System, Boston, MA, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- University of California, Los Angeles, CA, USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford School of Medicine, Stanford, CA, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Creech SK, Pulverman CS, Crawford JN, Holliday R, Monteith LL, Lehavot K, Olson-Madden J, Kelly UA. Clinical Complexity in Women Veterans: A Systematic Review of the Recent Evidence on Mental Health and Physical Health Comorbidities. Behav Med 2021; 47:69-87. [PMID: 31403895 DOI: 10.1080/08964289.2019.1644283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A recent evidence map focused on women veterans underscored the limited number of articles published on mental health comorbid with physical health conditions in this population. The quality of this small body of research has yet to be evaluated. The aim of this systematic review was to evaluate and synthesize research published between 2008 and 2015 and identified in the Women Veterans' Health Research Evidence Map as related to mental and physical health comorbidities among women veterans. Following PRISMA guidelines, 23 published studies were identified and 21 were included in the review. In general, significant associations between several mental health conditions (e.g., depression, posttraumatic stress disorder, substance use disorders) and physical health disorders (e.g., cardiovascular disease, diabetes, gastrointestinal disorders, hypertension, obesity, pain, and urinary symptoms) and health behaviors (e.g., preventative care and treatment adherence) were noted. The majority of studies were rated as low risk of bias, with selection and detection bias most frequently observed across studies. Additionally, gaps in the recent literature were observed, including the need for further investigation of the role of medical conditions in complicating mental health symptoms and care provision. Results underscore the importance of healthcare providers attending to women veterans' mental and physical health simultaneously and irrespective of setting. Further, while the Department of Veterans Affairs continues to make sizable gains in its focus on women veterans' health, continued research on several health domains is needed to ensure adequate understanding of the health needs of women veterans.
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Affiliation(s)
- Suzannah K Creech
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System.,Department of Psychiatry, Dell Medical School, University of Texas
| | - Carey S Pulverman
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System.,Department of Psychiatry, Dell Medical School, University of Texas
| | - Jennifer N Crawford
- VA San Diego Healthcare System.,Department of Psychiatry, University of California San Diego
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Center
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Center
| | - Keren Lehavot
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Healthcare System.,Department of Psychiatry and Behavioral Science, University of Washington.,Department of Health Services, University of Washington School of Public Health
| | - Jennifer Olson-Madden
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Center
| | - Ursula A Kelly
- Atlanta VA Health Care System.,Nell Hodgson Woodruff School of Nursing, Emory University
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Heenan PE, Keenan JI, Bayer S, Simon M, Gearry RB. Irritable bowel syndrome and the gut microbiota. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1695635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Phoebe E. Heenan
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Simone Bayer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Myrthe Simon
- Department of Medicine, Vrije Universiteit, Amsterdam, Netherlands
| | - Richard B. Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Impact of occupational stress on irritable bowel syndrome pathophysiology and potential management in active duty noncombat Greek military personnel: a multicenter prospective survey. Eur J Gastroenterol Hepatol 2019; 31:954-963. [PMID: 31107738 DOI: 10.1097/meg.0000000000001439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is one of the gut-brain axis interaction disorders. It has global distribution with varying prevalence and particular financial and psychological consequences. IBS has been associated with stress and anxiety, conditions that are usually prevalent in the army. There are scarce data investigating the impact of IBS on noncombat active duty military without reports of Greek military or stress in the occupational environment. MATERIALS AND METHODS The main exclusion criteria in our noncombat military multicenter prospective survey were gastrointestinal pathologies, malignancies, hematochezia, recent infections and antibiotics prescription, and pregnancy. Questionnaires included a synthesis of baseline information, lifestyle, and diet, psychological and stress-investigating scales and the IBS diagnosis checklist. Hospital Anxiety and Depression Scale and Rome IV criteria were utilized. RESULTS Among 1605 participants included finally, the prevalence of IBS was 8% and 131 cases were identified. Women were more vulnerable to IBS, although male sex was prevalent at a ratio of 3.5 : 1 (male:female) in the entire sample. The mean age of all participants was 23.85 years; most of the IBS patients were older than thirty. Abnormal anxiety scores and high levels of occupational stress were related to an IBS diagnosis. DISCUSSION This prospective multicenter survey showed, for the first time, the potential impact of occupational stress on IBS in active duty noncombat Greek Military personnel. The diagnosis of IBS by questionnaire is a quick, affordable way that can upgrade, by its management, the quality of life and relieve from the military burden. Our results are comparable with previous studies, although large-scale epidemiological studies are required for the confirmation of a possible causative relationship.
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11
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Ng QX, Soh AYS, Loke W, Venkatanarayanan N, Lim DY, Yeo WS. Systematic review with meta-analysis: The association between post-traumatic stress disorder and irritable bowel syndrome. J Gastroenterol Hepatol 2019; 34:68-73. [PMID: 30144372 DOI: 10.1111/jgh.14446] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by symptoms of hyperarousal and hypervigilance. Increasing research on the "gut-brain" axis (bidirectional signaling between the gut and the brain) has drawn links between PTSD and irritable bowel syndrome (IBS), an exceedingly common yet incompletely understood gastrointestinal condition. This meta-analysis thus aimed to examine the body of evidence and extent of association of PTSD with IBS. METHODS Using the keywords [early abuse OR childhood abuse OR violence OR trauma OR PTSD] AND [irritable bowel syndrome or IBS], a preliminary search on the PubMed, Medline, Embase, ScienceDirect, PsychINFO, Web of Science, and Google Scholar databases yielded 11,257 papers published in English between January 1, 1988, and May 1, 2018. Of these, only eight studies were included in the final meta-analysis. RESULTS The eight studies (four cross-sectional and four cohort) contained a total of 648,375 subjects. Most studies were from the USA and conducted on army veterans. The funnel plot revealed a roughly symmetrical distribution of studies, and Egger test was not significant for publication bias (P = 0.583). Random-effects meta-analysis found PTSD to be a significant risk factor for IBS (pooled odds ratio 2.80, 95% confidence interval: 2.06 to 3.54, P < 0.001). CONCLUSIONS Overall, PTSD is associated with an increased likelihood of IBS. This is the first meta-analysis to specifically examine the association between PTSD and IBS, and it provides insights into the probable (patho)physiology and management of IBS, supporting a holistic consideration of the psychosocial aspects of IBS and further research into effective multi-modal therapeutics.
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Affiliation(s)
- Qin Xiang Ng
- National University Hospital, National University Health System, Singapore.,MOH Holdings Pte Ltd, Singapore
| | - Alex Yu Sen Soh
- National University Hospital, National University Health System, Singapore
| | | | | | | | - Wee-Song Yeo
- National University Hospital, National University Health System, Singapore
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12
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Reduced Symptoms of Post-Traumatic Stress Disorder and Irritable Bowel Syndrome Following Mindfulness-Based Stress Reduction Among Veterans. J Altern Complement Med 2018; 24:1159-1165. [DOI: 10.1089/acm.2018.0135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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13
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van den Berk Clark C, Chang J, Servey J, Quinlan JD. Women’s Health and the Military. Prim Care 2018; 45:677-686. [DOI: 10.1016/j.pop.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Due to methodological heterogeneity, the exact prevalence of military sexual trauma (MST) is unknown. To elucidate our understanding of the pervasiveness of this important social issue, a meta-analysis was conducted. A computerized database search in PsycINFO, PubMed, and PILOTS revealed 584 unique citations for review. Of these identified studies, 69 met the inclusion criteria for the meta-analysis. The results revealed that 15.7% of military personnel and veterans report MST (3.9% of men, 38.4% of women) when the measure includes both harassment and assault. Additionally, 13.9% report MST (1.9% of men, 23.6% of women) when the measure assesses only assault and 31.2% report MST (8.9% of men, 52.5% of women) when the measure assesses only harassment. Regardless of the type of victimization incident (i.e., harassment or assault), women evidenced significantly larger prevalence rates compared to men. Self-report measure and interviews were associated with higher prevalence rates than the review of veterans affair (VA) medical records when measuring both harassment and assault and only harassment. No significant differences were observed among prevalence rates based on VA, non-VA, or both VA and non-VA recruitment. Ultimately, the findings suggest that MST is a pervasive problem, among both men and women in the military, highlighting the importance of this line of research.
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Affiliation(s)
- Laura C Wilson
- 1 Department of Psychological Science, University of Mary Washington, Fredericksburg, VA, USA
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15
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Luty J. Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue. BJPSYCH ADVANCES 2018. [DOI: 10.1192/bja.2017.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SUMMARYThis is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and ‘alternative’ or ‘complementary’ interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.LEARNING OBJECTIVES•To become aware of the high prevalence of medically unexplained syndromes•To review the effectiveness of treatment of medically unexplained syndromes•To be familiar with the conflict between health professionals and patients and the difficulty this continues to createDECLARATION OF INTERESTNone.
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16
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Greenwood-Van Meerveld B, Johnson AC. Mechanisms of Stress-induced Visceral Pain. J Neurogastroenterol Motil 2018; 24:7-18. [PMID: 29291604 PMCID: PMC5753899 DOI: 10.5056/jnm17137] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 12/13/2022] Open
Abstract
Evidence suggests that long-term stress facilitates visceral pain through sensitization of pain pathways and promotes chronic visceral pain disorders such as the irritable bowel syndrome (IBS). This review will describe the importance of stress in exacerbating IBS-induced abdominal pain. Additionally, we will briefly review our understanding of the activation of the hypothalamic-pituitary-adrenal axis by both chronic adult stress and following early life stress in the pathogenesis of IBS. The review will focus on the glucocorticoid receptor and corticotropin-releasing hormone-mediated mechanisms in the amygdala involved in stress-induced visceral hypersensitivity. One potential mechanism underlying persistent effects of stress on visceral sensitivity could be epigenetic modulation of gene expression. While there are relatively few studies examining epigenetically mediated mechanisms involved in stress-induced visceral nociception, alterations in DNA methylation and histone acetylation patterns within the brain, have been linked to alterations in nociceptive signaling via increased expression of pro-nociceptive neurotransmitters. This review will discuss the latest studies investigating the long-term effects of stress on visceral sensitivity. Additionally, we will critically review the importance of experimental models of adult stress and early life stress in enhancing our understanding of the basic molecular mechanisms of nociceptive processing.
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Affiliation(s)
- Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK,
USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK,
USA
- VA Medical Center, University of Oklahoma Health Science Center, Oklahoma City, OK,
USA
| | - Anthony C Johnson
- VA Medical Center, University of Oklahoma Health Science Center, Oklahoma City, OK,
USA
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17
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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18
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Lee CE, Yong PJ, Williams C, Allaire C. Factors Associated with Severity of Irritable Bowel Syndrome Symptoms in Patients with Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:158-164. [PMID: 28870721 DOI: 10.1016/j.jogc.2017.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/25/2017] [Accepted: 06/15/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study sought to examine factors associated with severity of irritable bowel syndrome (IBS) by using the Birmingham IBS symptom scale in patients presenting with endometriosis to a tertiary referral centre. METHODS A prospective research cohort of patients presenting to a tertiary referral centre for endometriosis was evaluated for the presence and severity of IBS between December 2013 and April 2015. Patients with endometriosis had a diagnosis of IBS by using the Rome III criteria and were evaluated for severity of IBS symptoms by using the Birmingham IBS symptom scale. Multifactorial variables, including stage of endometriosis at the time of previous surgery, clinical examination findings, mood disorder questionnaire scores, and lifestyle factors, were evaluated using the t test and Spearman rank correlation test. RESULTS A total of 194 of 373 (52%) women with confirmed endometriosis had a diagnosis of IBS. Factors associated with severity of IBS symptoms in patients with endometriosis included lower-stage endometriosis (P = 0.004), presence of mood disorders (P <0.001), tenderness on physical examination (P ≤ 0.001), a history of sexual assault (P ≤ 0.02), and presence of sleep disturbance (P ≤ 0.01). Evaluation of the subscales of the Birmingham IBS symptom scale revealed a strong association between the previously identified factors and the pain subscale. CONCLUSION Using the Birmingham IBS symptom scale, our study revealed more severe IBS symptoms in patients with lower-stage endometriosis and identified other variables highly associated with severity of IBS. Continued research is required to characterize further the clinical importance of IBS symptoms in patients with endometriosis-associated pelvic pain.
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Affiliation(s)
- Caroline E Lee
- Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, SK.
| | - Paul J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Christina Williams
- Department of Obstetrics and Gynaecology, University of British Columbia, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
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19
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McLeay SC, Harvey WM, Romaniuk MN, Crawford DH, Colquhoun DM, Young RM, Dwyer M, Gibson JM, O'Sullivan RA, Cooksley G, Strakosch CR, Thomson RM, Voisey J, Lawford BR. Physical comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans. Med J Aust 2017; 206:251-257. [PMID: 28359007 DOI: 10.5694/mja16.00935] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD. DESIGN, SETTING AND PARTICIPANTS Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 - July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety. RESULTS The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten. CONCLUSION PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.
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Affiliation(s)
| | | | | | | | | | | | - Miriam Dwyer
- Gallipoli Medical Research Institute, Brisbane, QLD
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20
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He YQ, Lang XQ, Lin L, Ji L, Yuan XY, Chen Q, Ran YM, Chen HS, Li L, Wang JM, Wang ZG, Gregersen H, Zou DW, Liang HP, Yang M. P2X3 receptor-mediated visceral hyperalgesia and neuronal sensitization following exposure to PTSD-like stress in the dorsal root ganglia of rats. Neurogastroenterol Motil 2017; 29. [PMID: 27781340 DOI: 10.1111/nmo.12976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with posttraumatic stress disorder (PTSD) often share co-morbidity with chronic pain conditions. Recent studies suggest a role of P2X3 receptors and ATP signaling in pain conditions. However, the underlying mechanisms of visceral hyperalgesia following exposure to PTSD-like stress conditions remain unclarified. METHODS The behavior and hormones relevant for PTSD were studied. Visceromotor responses (VMR) and the abdominal withdrawal reflexes (AWR) to colorectal distention (CRD) were recorded to determine P2X3-receptor-mediated alteration of hyperalgesia following single-prolonged stress (SPS) exposure. Immunofluorescence, Western blotting, and patch-clamp were used. KEY RESULTS The escape latency, adrenocorticotropic hormone and cortisol were increased on days 7-14. Visceromotor responses and AWR was reduced at day 1 in SPS rats but increased to higher levels than in controls after exposure to day 7. Intrathecal administration of the P2X3-receptor antagonist TNP-ATP abolished the CRD response. Based on immunofluorescence and Western blotting analysis, SPS-treated rats exhibited reduced P2X3 expression in dorsal root ganglia (DRG) after day 1 compared with controls. P2X3 expression in DRG was enhanced on day 7 after SPS and the increase of the P2X3 expression was maintained on day 14 and 21 compared with controls. The P2X3-receptor agonist α,β-me ATP (10 μM) induced a fast desensitizing inward current in DRG neurons of both control and SPS-treated rats. The average peak current densities in SPS-treated group were increased 3.6-fold. TNP-ATP (100 nM) markedly blocked all fast α,β-me ATP-induced inward currents in the DRG neurons both in control and SPS-treated rats. CONCLUSIONS & INFERENCES The data indicate an important role of P2X3 signaling in visceral hyperalgesia following PTSD-like stress.
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Affiliation(s)
- Y-Q He
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - X-Q Lang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - L Lin
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - L Ji
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - X-Y Yuan
- Department of Gastroenterology, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Q Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Y-M Ran
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - H-S Chen
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - L Li
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - J-M Wang
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Z-G Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China.,Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - H Gregersen
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China
| | - D-W Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - H-P Liang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China.,Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - M Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China.,Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
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21
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Park SH, Videlock EJ, Shih W, Presson AP, Mayer EA, Chang L. Adverse childhood experiences are associated with irritable bowel syndrome and gastrointestinal symptom severity. Neurogastroenterol Motil 2016; 28:1252-60. [PMID: 27061107 PMCID: PMC4956522 DOI: 10.1111/nmo.12826] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 03/01/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early adverse life events (EALs) are associated with irritable bowel syndrome (IBS). Exposure to EALs as assessed by the Adverse Childhood Experiences (ACE) questionnaire is associated with greater disease prevalence, but ACE has not been studied in gastrointestinal disorders. Study aims were to: (i) Estimate the prevalence of EALs in the IBS patients using the ACE questionnaire; (ii) Determine correlations between ACE and Early Trauma Inventory Self Report-Short Form (ETI-SR) scores to confirm its validity in IBS; and (iii) Correlate ACE scores with IBS symptom severity. METHODS A total of 148 IBS (73% women, mean age = 31 years) and 154 HCs (59% women, mean age = 30 years) completed the ACE and ETI-SR between June 2010 and April 2015. These surveys measured EALs before age 18 in the domains of physical, sexual, and emotional abuse, and general trauma. IBS and abdominal pain severity was measured by a 20-point scale (0 = none, 20 = worst symptoms). KEY RESULTS The ACE score increased the odds of having IBS (odds ratio [OR] = 2.05, 95% confidence interval [CI]: 1.21-3.48, p = 0.008). Household mental illness (p < 0.001), emotional abuse (p = 0.004), and incarcerated household member (p = 0.019) were significant predictors of IBS. Adverse childhood experiences and ETI-SR scores were strongly correlated (r = 0.59, p < 0.001). ACE, but not ETI-SR, modestly correlated with IBS severity (r = 0.17, p = 0.036) and abdominal pain (r = 0.20, p = 0.015). CONCLUSIONS & INFERENCES The ACE questionnaire is a useful instrument to measure EALs in IBS based on its use in large studies, its ability to measure prevalence across different EAL domains, and its correlation with symptom severity.
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Affiliation(s)
- S. H. Park
- Oppenheimer Family Center for the Neurobiology of Stress and Resilience; David Geffen School of Medicine; University of California, Los Angeles; Los Angeles CA USA
| | - E. J. Videlock
- Oppenheimer Family Center for the Neurobiology of Stress and Resilience; David Geffen School of Medicine; University of California, Los Angeles; Los Angeles CA USA
| | - W. Shih
- Department of Biostatistics; David Geffen School of Medicine; University of California, Los Angeles; Los Angeles CA USA
| | - A. P. Presson
- Division of Epidemiology; Department of Internal Medicine; University of Utah; Salt Lake City UT USA
| | - E. A. Mayer
- Oppenheimer Family Center for the Neurobiology of Stress and Resilience; David Geffen School of Medicine; University of California, Los Angeles; Los Angeles CA USA
| | - L. Chang
- Oppenheimer Family Center for the Neurobiology of Stress and Resilience; David Geffen School of Medicine; University of California, Los Angeles; Los Angeles CA USA
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Ohmura Y, Yoshida T, Konno K, Minami M, Watanabe M, Yoshioka M. Serotonin 5-HT7 Receptor in the Ventral Hippocampus Modulates the Retrieval of Fear Memory and Stress-Induced Defecation. Int J Neuropsychopharmacol 2016; 19:pyv131. [PMID: 26647382 PMCID: PMC4926794 DOI: 10.1093/ijnp/pyv131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/12/2015] [Accepted: 11/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with posttraumatic stress disorder or panic disorder are often troubled by inappropriate retrieval of fear memory. Moreover, these disorders are often comorbid with irritable bowel syndrome. The main aim of the present study is to elucidate the involvement of hippocampal serotonergic systems in fear memory retrieval and stress-induced defecation. METHODS AND RESULTS Microinjection of serotonin7 receptor antagonist, but not other serotonin receptor antagonists (serotonin 1A, 2A, 2C, 3, 4, and 6), into the rat ventral hippocampus significantly suppressed the expression of freezing behavior, an index of fear memory retrieval, and decreased the amount of feces, an index of stress-induced defecation, in the contextual fear conditioning test. Electrophysiological data indicated that the serotonin7 receptor agonist increased the frequency of action potentials in the ventral hippocampal CA3 pyramidal neuron via the activation of the hyperpolarization-activated nonselective cation current Ih. Moreover, in situ hybridization demonstrated that Htr7 mRNA was abundantly expressed in the CA3 compared with other subregions of the hippocampus and that these Htr7 mRNA-positive cells coexpressed hyperpolarization-activated cyclic nucleotide-gated channel 2 and 4 mRNAs, which are components of the Ih channel. CONCLUSIONS These results indicated that the released serotonin activates the serotonin7 receptor in the CA3 ventral hippocampus subregion, enhances the sensitivity to inputs via hyperpolarization-activated cyclic nucleotide 2 and 4 channels, and thereby facilitates fear memory retrieval. The serotonin7 receptor might be a target of drug development for the treatment of mental disorders involving fear memory and gastrointestinal problems.
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Affiliation(s)
- Yu Ohmura
- Department of Neuropharmacology, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan (Dr Ohmura, Yoshida, and Yoshioka); Department of Anatomy, and (Drs Konno and Watanabe); Department of Pharmacology (Dr Minami), Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Japan.
| | - Takayuki Yoshida
- Department of Neuropharmacology, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan (Dr Ohmura, Yoshida, and Yoshioka); Department of Anatomy, and (Drs Konno and Watanabe); Department of Pharmacology (Dr Minami), Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Kohtarou Konno
- Department of Neuropharmacology, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan (Dr Ohmura, Yoshida, and Yoshioka); Department of Anatomy, and (Drs Konno and Watanabe); Department of Pharmacology (Dr Minami), Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Masabumi Minami
- Department of Neuropharmacology, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan (Dr Ohmura, Yoshida, and Yoshioka); Department of Anatomy, and (Drs Konno and Watanabe); Department of Pharmacology (Dr Minami), Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Masahiko Watanabe
- Department of Neuropharmacology, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan (Dr Ohmura, Yoshida, and Yoshioka); Department of Anatomy, and (Drs Konno and Watanabe); Department of Pharmacology (Dr Minami), Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Mitsuhiro Yoshioka
- Department of Neuropharmacology, Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan (Dr Ohmura, Yoshida, and Yoshioka); Department of Anatomy, and (Drs Konno and Watanabe); Department of Pharmacology (Dr Minami), Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
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23
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Riddle MS, Welsh M, Porter CK, Nieh C, Boyko EJ, Gackstetter G, Hooper TI. The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study. Am J Gastroenterol 2016; 111:93-104. [PMID: 26729548 PMCID: PMC4759150 DOI: 10.1038/ajg.2015.386] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Functional gastrointestinal disorders occur more frequently among deployed veterans, although studies evaluating the relative impact of risk factors, including stress and antecedent infectious gastroenteritis (IGE), are limited. We examined risk factors for new-onset irritable bowel syndrome (IBS) among active duty participants in the military's Millennium Cohort Study. METHODS Medical encounter data from 2001 to 2009, limited to Cohort members on active duty, were used to identify incident IBS cases (any and highly probable). IGE was identified using medical encounter or self-report. Covariate data were obtained from the Millennium Cohort Study surveys and analyzed using Cox proportional hazards methods. RESULTS Overall, 41,175 Cohort members met the eligibility criteria for inclusion and 314 new-onset cases of IBS were identified among these. Significant risk factors (adjusted hazard ratio, 95% confidence interval) included antecedent IGE (2.05, 1.53-2.75), female gender (1.96, 1.53-2.52), number of life stressors (1: 1.82, 1.37-2.41; 2: 2.86, 2.01-4.06; 3+: 6.69, 4.59-9.77), and anxiety syndrome (1.74, 1.17-2.58). Limited to highly probable IBS, a stronger association with antecedent IGE was observed, particularly when based on medical encounter records (any IGE: 2.20, 1.10-4.43; medical encounter IGE only: 2.84, 1.33-6.09). Precedent anxiety or depression and IGE interacted with increased IBS risk compared with IGE alone. CONCLUSIONS These results confirm previous studies on the association between sociodemographic or life stressors and IBS. IGE was significantly associated with IBS risk. Whether deployed or not, US service members often encounter repeated exposure to high levels of stress, which, combined with other environmental factors such as IGE, may result in long-term debilitating functional gastrointestinal disorders.
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Affiliation(s)
- Mark S Riddle
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Marleen Welsh
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Chad K Porter
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Chiping Nieh
- Health Research and Analysis, Rockville, Maryland, USA
| | - Edward J Boyko
- Department of Veterans Affairs, Puget Sound Health Care System, Puget Sound, Washington, USA
| | - Gary Gackstetter
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tomoko I Hooper
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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24
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Padhy SK, Sahoo S, Mahajan S, Sinha SK. Irritable bowel syndrome: Is it "irritable brain" or "irritable bowel"? J Neurosci Rural Pract 2015; 6:568-77. [PMID: 26752904 PMCID: PMC4692018 DOI: 10.4103/0976-3147.169802] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Irritable bowel syndrome (IBS) has been recognized as one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. In the Western world, IBS appears to affect up to 20% of the population at any given time but in Asian countries, the median value of IBS prevalence defined by various criteria ranges between 6.5% and 10.1%, and community prevalence of 4% is found in North India. Those attending gastroenterology clinics represent only the tip of the iceberg. The disorder substantially impairs the quality of life, and the overall health-care costs are high. IBS has therefore gained increased attention from clinicians, researchers, and pharmaceutical industries. It is often frustrating to both patients and physicians as the disease is usually chronic in nature and difficult to treat. However, the understanding of IBS has been changing from time to time and still most of its concepts are unknown. In this review we have discussed, debated, and synthesized the evidence base, focusing on underlying mechanisms in the brain and bowel. We conclude that it is both brain and bowel mechanisms that are responsible. The clinical implication of such mechanisms is discussed.
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Affiliation(s)
- Susanta Kumar Padhy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonali Mahajan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj Kumar Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mohanty AF, Muthukutty A, Carter ME, Palmer MN, Judd J, Helmer D, McAndrew LM, Garvin JH, Samore MH, Gundlapalli AV. Chronic multisymptom illness among female Veterans deployed to Iraq and Afghanistan. Med Care 2015; 53:S143-8. [PMID: 25767968 DOI: 10.1097/mlr.0000000000000314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic multisymptom illness (CMI) may be more prevalent among female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) deployed Veterans due to deployment-related experiences. OBJECTIVES To investigate CMI-related diagnoses among female OEF/OIF/OND Veterans. RESEARCH DESIGN We estimated the prevalence of the International Classification of Disease-9th edition-Clinical Modification coded CMI-related diagnoses of chronic fatigue syndrome, fibromyalgia (FM), and irritable bowel syndrome (IBS) among female OEF/OIF/OND Veterans with Veterans Health Administration (VHA) visits, FY2002-2012 (n=78,435). We described the characteristics of female Veterans with and without CMI-related diagnoses and VHA settings of first CMI-related diagnoses. RESULTS The prevalence of CMI-related diagnoses among female OEF/OIF/OND Veterans was 6397 (8.2%), over twice as high as the prevalence 95,424 (3.9%) among the totality of female Veterans currently accessing VHA (P<0.01). There were statistically significant differences in age, education, marital status, military component, service branch, and proportions of those with depression and/or post-traumatic stress disorder diagnoses across females with and without CMI-related diagnoses. Diagnoses were mainly from primary care, women's health, and physical medicine and rehabilitation clinics. CONCLUSIONS CMI-related diagnoses were more prevalent among female OEF/OIF/OND Veterans compared with all female Veterans who currently access VHA. Future studies of the role of mental health diagnoses as confounders or mediators of the association of OEF/OIF/OND deployment and CMI are warranted. These and other factors associated with CMI may provide a basis for enhanced screening to facilitate recognition of these conditions. Further work should evaluate models of care and healthcare utilization related to CMI in female Veterans.
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Affiliation(s)
- April F Mohanty
- *Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Department of Internal Medicine, University of Utah School of Medicine †Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT ‡Department of Veteran Affairs, War Related Illness and Injury Study Center, New Jersey Health Care System, East Orange, NJ §Department of Education and Counseling Psychology, University of Albany, Albany, NY
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Abstract
As more women have joined the US military, there has been a shift in the overall veteran population. Those who served in the US military, especially women, have undergone experiences that will impact their overall health and wellbeing. It is therefore critical for providers to better understand US military culture and be prepared on how to ask patients about their military experience. Health care providers need to be aware of the unique medical, psychiatric, and psychosocial needs of women veterans in order to best serve this patient population.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6421, USA.
| | - Maryann K Overland
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6421, USA
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Moloney RD, O'Mahony SM, Dinan TG, Cryan JF. Stress-induced visceral pain: toward animal models of irritable-bowel syndrome and associated comorbidities. Front Psychiatry 2015; 6:15. [PMID: 25762939 PMCID: PMC4329736 DOI: 10.3389/fpsyt.2015.00015] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/28/2015] [Indexed: 12/12/2022] Open
Abstract
Visceral pain is a global term used to describe pain originating from the internal organs, which is distinct from somatic pain. It is a hallmark of functional gastrointestinal disorders such as irritable-bowel syndrome (IBS). Currently, the treatment strategies targeting visceral pain are unsatisfactory, with development of novel therapeutics hindered by a lack of detailed knowledge of the underlying mechanisms. Stress has long been implicated in the pathophysiology of visceral pain in both preclinical and clinical studies. Here, we discuss the complex etiology of visceral pain reviewing our current understanding in the context of the role of stress, gender, gut microbiota alterations, and immune functioning. Furthermore, we review the role of glutamate, GABA, and epigenetic mechanisms as possible therapeutic strategies for the treatment of visceral pain for which there is an unmet medical need. Moreover, we discuss the most widely described rodent models used to model visceral pain in the preclinical setting. The theory behind, and application of, animal models is key for both the understanding of underlying mechanisms and design of future therapeutic interventions. Taken together, it is apparent that stress-induced visceral pain and its psychiatric comorbidities, as typified by IBS, has a multifaceted etiology. Moreover, treatment strategies still lag far behind when compared to other pain modalities. The development of novel, effective, and specific therapeutics for the treatment of visceral pain has never been more pertinent.
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Affiliation(s)
- Rachel D Moloney
- Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork , Cork , Ireland
| | - Siobhain M O'Mahony
- Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork , Cork , Ireland ; Department of Anatomy and Neuroscience, University College Cork , Cork , Ireland
| | - Timothy G Dinan
- Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork , Cork , Ireland ; Department of Psychiatry, University College Cork , Cork , Ireland
| | - John F Cryan
- Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork , Cork , Ireland ; Department of Anatomy and Neuroscience, University College Cork , Cork , Ireland
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Wang WF, Guo XX, Yang YS. Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Mil Med Res 2015; 2:15. [PMID: 26301101 PMCID: PMC4546320 DOI: 10.1186/s40779-015-0042-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/09/2015] [Indexed: 12/31/2022] Open
Abstract
Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as "Gulf War syndrome". The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.
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Affiliation(s)
- Wei-Feng Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Xiao-Xu Guo
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, 100853 China
| | - Yun-Sheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, 100853 China
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Fadgyas-Stanculete M, Buga AM, Popa-Wagner A, Dumitrascu DL. The relationship between irritable bowel syndrome and psychiatric disorders: from molecular changes to clinical manifestations. J Mol Psychiatry 2014; 2:4. [PMID: 25408914 PMCID: PMC4223878 DOI: 10.1186/2049-9256-2-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/15/2014] [Indexed: 12/19/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional syndrome characterized by chronic abdominal pain accompanied by altered bowel habits. Although generally considered a functional disorder, there is now substantial evidence that IBS is associated with a poor quality of life and significant negative impact on work and social domains. Neuroimaging studies documented changes in the prefrontal cortex, ventro-lateral and posterior parietal cortex and thalami, and implicate alteration of brain circuits involved in attention, emotion and pain modulation. Emerging data reveals the interaction between psychiatric disorders including generalized anxiety disorder, panic disorder, major depressive disorder, bipolar disorder, and schizophrenia and IBS, which suggests that this association should not be ignored when developing strategies for screening and treatment. Psychological, social and genetic factors appear to be important in the development of IBS symptomatology through several mechanisms: alteration of HPA axis modulation, enhanced perception of visceral stimuli or psychological vulnerability. Elucidating the molecular mechanisms of IBS with or without psychiatric comorbidities is crucial for elucidating the pathophysiology and for the identification of new therapeutical targets in IBS.
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Affiliation(s)
- Mihaela Fadgyas-Stanculete
- />Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ana-Maria Buga
- />Department of Psychiatry, University of Medicine, Rostock, Germany
| | - Aurel Popa-Wagner
- />Department of Psychiatry, University of Medicine, Rostock, Germany
- />Department of Molecular Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan L Dumitrascu
- />2nd Department of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Specific Pain Complaints in Iraq and Afghanistan Veterans Screening Positive for Post-Traumatic Stress Disorder. PSYCHOSOMATICS 2014; 55:172-8. [DOI: 10.1016/j.psym.2013.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 01/20/2013] [Accepted: 01/21/2013] [Indexed: 11/22/2022]
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Maguen S, Madden E, Cohen B, Bertenthal D, Seal K. Association of mental health problems with gastrointestinal disorders in Iraq and Afghanistan veterans. Depress Anxiety 2014; 31:160-5. [PMID: 23494973 DOI: 10.1002/da.22072] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/20/2012] [Accepted: 01/16/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastrointestinal disorders (GIDs) represent a large public health burden, affecting an estimated 60-70 million Americans annually. Our goal was to examine the relationship between GID and the most common mental health disorders in a national group of newly returning veterans. We also evaluated gender differences in the association of mental health disorders and GID. METHODS We utilized a retrospective, longitudinal cohort analysis of veterans' health records. Participants were 603,221 Iraq and Afghanistan veterans who were new users of VA healthcare from October 7, 2001 (start of the war in Afghanistan) to December 31, 2010. RESULTS The prevalence of GID in newly returning veterans was nearly 20%, and veterans with a mental health disorder were at least twice as likely to have a GID as those without mental health disorders. For women, the increased risk of all GIDs was greatest among those with depression. Among men, the increased risk of irritable bowel syndrome (IBS) was greatest among those with posttraumatic stress disorder. IBS was the GID most strongly associated with mental health conditions among both genders. CONCLUSIONS The large proportion of newly returning veterans with GIDs and comorbid mental health diagnoses is concerning. Successful detection and treatment of GIDs associated with mental health disorders will require integrated efforts from primary care and mental health.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
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32
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Abstract
OBJECTIVE This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship. METHODS Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators. RESULTS Individuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27-3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. The association of reported trauma with chronic fatigue syndrome was larger than the association with either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires. CONCLUSIONS Findings are consistent with the hypothesis that traumatic events are associated with an increased prevalence of functional somatic syndromes. The analyses also highlight limitations of the existing literature and emphasize the importance of prospective studies, examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.
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Shah E, Rezaie A, Riddle M, Pimentel M. Psychological disorders in gastrointestinal disease: epiphenomenon, cause or consequence? Ann Gastroenterol 2014; 27:224-230. [PMID: 24974805 PMCID: PMC4073018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/03/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Psychological disorders have been associated with irritable bowel syndrome (IBS) for decades in the absence of other objective etiology. However, such associations are also evident in other chronic diseases with more clearly defined pathogenesis such as ulcerative colitis. In this study, we examined the prevalence and severity of psychological disorders among IBS and ulcerative colitis (UC) patients relative to healthy controls. METHODS A review was conducted of English-language literature to identify case-control studies reporting the prevalence of depression or anxiety in IBS and UC populations relative to healthy controls. Our primary endpoint was the pooled prevalence or average score of depression or anxiety in an IBS or UC population relative to healthy control. RESULTS Seven case-control studies evaluating IBS and three evaluating UC were included. All IBS and UC studies reported excess prevalence and severity of depression as well as anxiety, relative to healthy controls. The prevalence of depression in excess of healthy controls was 39% in UC case-control trials and 33% in IBS studies, and excess anxiety was present in UC (42%) and IBS (19%) case-control trials as well. Anxiety and depression scores were higher (representing more severe symptoms) in both UC and IBS patients compared to healthy controls. CONCLUSIONS Anxiety and depressive disorders are associated with both IBS and UC. The non-specific association between these psychological and gastrointestinal disorders could suggest that chronic gastrointestinal illness might affect psychosocial behavior.
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Affiliation(s)
- Eric Shah
- GI Motility Program Cedars-Sinai Medical Center, Los Angeles, CA (Eric Shah, Ali Rezaie, Mark Pimentel), USA
| | - Ali Rezaie
- GI Motility Program Cedars-Sinai Medical Center, Los Angeles, CA (Eric Shah, Ali Rezaie, Mark Pimentel), USA
| | - Mark Riddle
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland (Mark Riddle), USA
| | - Mark Pimentel
- GI Motility Program Cedars-Sinai Medical Center, Los Angeles, CA (Eric Shah, Ali Rezaie, Mark Pimentel), USA,
Correspondence to: Mark Pimentel, MD, FRCP(C), Director, GI Motility Program, Cedars-Sinai Medical Center, 8730 Alden Drive, Suite 201E, Los Angeles, California, 90048 USA, Tel.: +1 310 423 6143, Fax: +1 310 423 8356, e-mail:
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Cheney AM, Booth BM, Davis TD, Mengeling MA, Torner JC, Sadler AG. The role of borderline personality disorder and depression in the relationship between sexual assault and body mass index among women veterans. VIOLENCE AND VICTIMS 2014; 29:742-756. [PMID: 25905125 DOI: 10.1891/0886-6708.vv-d-12-00171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article examines lifetime sexual assault (LSA) and mental health history as risk factors associated with body mass index (BMI) in a population of women veterans. This cross-sectional study of a retrospective cohort of 948 Veterans Affairs (VA)-enrolled midwestern enlisted rank women veterans included computer-assisted telephone interviews. Findings show that 33.4% of the participants had a BMI of 30.0 or more meeting the criteria for obesity and 62.5% reported lifetime attempted or completed sexual assault. Greater BMI was positively associated with older age, less education, LSA, depression, and borderline personality disorder (BPD) and negatively associated with current substance use disorder in multivariate models. Mediation analysis found that the relationship between sexual assault and BMI was completely mediated by BPD and depression. Interventions should combine physical and mental health care in gender-specific services for overweight women veterans with trauma histories and mental health conditions.
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Tang QL, Lin GY, Zhang MQ. Cognitive-behavioral therapy for the management of irritable bowel syndrome. World J Gastroenterol 2013; 19:8605-8610. [PMID: 24379577 PMCID: PMC3870505 DOI: 10.3748/wjg.v19.i46.8605] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/04/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common disorder, reported to be found in 5%-20% of the general population. Its management accounts for up to 25% of a gastroenterologist’s workload in the outpatient department, and the main symptoms are abdominal pain, bloating, and altered bowel habits. Despite a great amount of available pharmacological treatments aimed at a wide variety of gastrointestinal and brain targets, many patients have not shown adequate symptom relief. In recent years, there has been increasing evidence to suggest that psychological treatments, in particular cognitive-behavioral therapy (CBT), are effective for the management of IBS. This review discusses CBT for the management of IBS. CBT has proved to be effective in alleviating the physical and psychological symptoms of IBS and has thus been recommended as a treatment option for the syndrome.
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Goodwin L, Bourke JH, Forbes H, Hotopf M, Hull L, Jones N, Rona RJ, Wessely S, Fear NT. Irritable bowel syndrome in the UK military after deployment to Iraq: what are the risk factors? Soc Psychiatry Psychiatr Epidemiol 2013; 48:1755-65. [PMID: 23636672 DOI: 10.1007/s00127-013-0699-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/18/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Diarrhoea and vomiting (D & V) was common in military personnel during deployment to the initial phases of the Iraq war. D & V is an established risk factor for irritable bowel syndrome (IBS). This study examined the prevalence of IBS in a military sample with a history of deployment to Iraq and the association between D & V and common mental disorder (CMD) with IBS. METHODS The study used data from a two-phase cohort study of military/personnel. The sample was restricted to individuals who had been deployed to Iraq before phase 1 of the study and who had completed the self-report D & V question. A measure of probable IBS was derived at both phases of the study based on self-reported symptoms in the previous month. CMD was assessed by the General Health Questionnaire (GHQ-12). RESULTS Fifty-nine percent of the sample reported a D & V event and 6.6 % met the criteria for probable IBS at phase 1. Reporting D & V, thinking one might be killed on deployment, poor physical health and CMD were associated with probable IBS at phase 1. CMD at phase 1 was strongly associated with chronic symptoms of IBS. CONCLUSIONS There was a high prevalence of D & V during deployment to the early stages of the Iraq war, yet the prevalence of probable IBS on return from deployment was relatively low. D & V was strongly associated with IBS after deployment, and CMD was a risk factor for chronic symptoms of IBS.
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Affiliation(s)
- Laura Goodwin
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, SE5 9RJ, UK,
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He YQ, Chen Q, Ji L, Wang ZG, Bai ZH, Stephens RL, Yang M. PKCγ receptor mediates visceral nociception and hyperalgesia following exposure to PTSD-like stress in the spinal cord of rats. Mol Pain 2013; 9:35. [PMID: 23837410 PMCID: PMC3751645 DOI: 10.1186/1744-8069-9-35] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 07/04/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinical studies indicate that patients with post-traumatic stress disorder (PTSD) frequently share comorbidity with numerous chronic pain conditions. However, the sustained effects of PTSD-like stress over time on visceral nociception and hyperalgesia have been rarely studied, and the underlying mechanisms of stress-induced modulation of visceral hyperalgesia remain elusive. The purpose of this study was to investigate the characterization of visceral nociception and hyperalgesia over time in rats exposed to PTSD-like stress, and to explore the potential role of protein kinase C gamma (PKCγ) in mediating visceral hyperalgesia following exposure to PTSD-like stress. RESULTS On day 1, the rats exposed to single-prolonged stress (SPS, an established animal model for PTSD) exhibited an analgesic response and its visceromotor response (VMR) to graded colorectal distention (CRD) at 40 and 60 mmHg was reduced compared with the control group (all P < 0.05). On day 6, the VMR returned to the baseline value. However, as early as 7 days after SPS, VMR dramatically increased compared with its baseline value and that in the controls (all P < 0.001) and this increase persisted for 28 days, with the peak on day 9. Abdominal withdrawal reflex (AWR) scores were higher in SPS rats than in controls on days 7, 9, 14, 21 and 28 (all P < 0.001). Intrathecal administration of GF109203X (an inhibitor of PKC gamma), attenuated the SPS-induced increase in both VMR and AWR scores on days 7, 14, 21 and 28 (all P < 0.05). PKCγ protein expression determined by immunofluorescence was reduced in the spinal cord within 3 days after the exposure to SPS (P < 0.01), which returned to normal levels between days 4 and 6, and significantly increased from day 7, and this increase was maintained on days 14, 21, and 28 (all P < 0.001), with the peak on day 9. In addition, Western blotting showed a consistent trend in the changes of PKCγ protein expression. CONCLUSIONS The modified SPS alters visceral sensitivity to CRD, and contributes to the maintenance of visceral hyperalgesia, which is associated with enhanced PKCγ expression in the spinal cord. Functional blockade of the PKCγ receptors attenuates SPS-induced visceral hyperalgesia. Thus, the present study identifies a specific molecular mechanism for visceral hyperalgesia which may pave the way for novel therapeutic strategies for PTSD-like conditions.
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Cour F, Robain G, Claudon B, Chartier-Kästler E. [Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]. Prog Urol 2012; 23:780-92. [PMID: 23830273 DOI: 10.1016/j.purol.2012.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 10/15/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions. MATERIAL AND METHODS Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience. RESULTS A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry. CONCLUSIONS Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.
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Affiliation(s)
- F Cour
- Service d'urologie, université de Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Canadian Digestive Health Foundation Public Impact Series 3: irritable bowel syndrome in Canada. Incidence, prevalence, and direct and indirect economic impact. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:252-6. [PMID: 22590697 DOI: 10.1155/2012/861478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning irritable bowel syndrome.
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Surdea-Blaga T, Băban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol 2012; 18:616-26. [PMID: 22363132 PMCID: PMC3281218 DOI: 10.3748/wjg.v18.i7.616] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 09/22/2011] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
From a pure motor disorder of the bowel, in the past few years, irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity, alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system, alteration of the gut microflora, an increased intestinal permeability and minimum intestinal inflammation. Psychological and social factors can interfere with the communication between the central and enteric nervous systems, and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome. There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders. In order to explain clustering of IBS in families, genetic factors and social learning mechanisms have been proposed. The psychological features, such as anxiety, depression as well as the comorbid psychiatric disorders, health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.
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Larauche M, Mulak A, Taché Y. Stress and visceral pain: from animal models to clinical therapies. Exp Neurol 2012; 233:49-67. [PMID: 21575632 PMCID: PMC3224675 DOI: 10.1016/j.expneurol.2011.04.020] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/07/2011] [Accepted: 04/28/2011] [Indexed: 02/07/2023]
Abstract
Epidemiological studies have implicated stress (psychosocial and physical) as a trigger of first onset or exacerbation of irritable bowel syndrome (IBS) symptoms of which visceral pain is an integrant landmark. A number of experimental acute or chronic exteroceptive or interoceptive stressors induce visceral hyperalgesia in rodents although recent evidence also points to stress-related visceral analgesia as established in the somatic pain field. Underlying mechanisms of stress-related visceral hypersensitivity may involve a combination of sensitization of primary afferents, central sensitization in response to input from the viscera and dysregulation of descending pathways that modulate spinal nociceptive transmission or analgesic response. Biochemical coding of stress involves the recruitment of corticotropin releasing factor (CRF) signaling pathways. Experimental studies established that activation of brain and peripheral CRF receptor subtype 1 plays a primary role in the development of stress-related delayed visceral hyperalgesia while subtype 2 activation induces analgesic response. In line with stress pathways playing a role in IBS, non-pharmacologic and pharmacologic treatment modalities aimed at reducing stress perception using a broad range of evidence-based mind-body interventions and centrally-targeted medications to reduce anxiety impact on brain patterns activated by visceral stimuli and dampen visceral pain.
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Affiliation(s)
- Muriel Larauche
- CURE/Digestive Diseases Research Center, Digestive Diseases Division, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90073, USA.
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Larauche M, Mulak A, Taché Y. Stress-related alterations of visceral sensation: animal models for irritable bowel syndrome study. J Neurogastroenterol Motil 2011; 17:213-34. [PMID: 21860814 PMCID: PMC3155058 DOI: 10.5056/jnm.2011.17.3.213] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/12/2011] [Indexed: 12/11/2022] Open
Abstract
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 visceral sensitivity. Underlying mechanisms of stress-induced modulation of visceral pain involve a combination of peripheral, spinal and supraspinal sensitization based on the nature of the stressors and dysregulation of descending pathways that modulate nociceptive transmission or stress-related analgesic response.
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Affiliation(s)
- Muriel Larauche
- CURE/Digestive Diseases Research Center and Center for Neurobiology of Stress, Digestive Diseases Division, Department of Medicine, David Geffen School of Medicine, UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Agata Mulak
- CURE/Digestive Diseases Research Center and Center for Neurobiology of Stress, Digestive Diseases Division, Department of Medicine, David Geffen School of Medicine, UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Yvette Taché
- CURE/Digestive Diseases Research Center and Center for Neurobiology of Stress, Digestive Diseases Division, Department of Medicine, David Geffen School of Medicine, UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Katiraei P, Bultron G. Need for a comprehensive medical approach to the neuro-immuno-gastroenterology of irritable bowel syndrome. World J Gastroenterol 2011; 17:2791-800. [PMID: 21734786 PMCID: PMC3120938 DOI: 10.3748/wjg.v17.i23.2791] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/08/2011] [Accepted: 03/15/2011] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is defined by the Rome III criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.
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Larauche M, Mulak A, Taché Y. Stress and visceral pain: from animal models to clinical therapies. Exp Neurol 2011. [PMID: 21575632 DOI: 10.1016/j.expneurol.2011.04.020.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological studies have implicated stress (psychosocial and physical) as a trigger of first onset or exacerbation of irritable bowel syndrome (IBS) symptoms of which visceral pain is an integrant landmark. A number of experimental acute or chronic exteroceptive or interoceptive stressors induce visceral hyperalgesia in rodents although recent evidence also points to stress-related visceral analgesia as established in the somatic pain field. Underlying mechanisms of stress-related visceral hypersensitivity may involve a combination of sensitization of primary afferents, central sensitization in response to input from the viscera and dysregulation of descending pathways that modulate spinal nociceptive transmission or analgesic response. Biochemical coding of stress involves the recruitment of corticotropin releasing factor (CRF) signaling pathways. Experimental studies established that activation of brain and peripheral CRF receptor subtype 1 plays a primary role in the development of stress-related delayed visceral hyperalgesia while subtype 2 activation induces analgesic response. In line with stress pathways playing a role in IBS, non-pharmacologic and pharmacologic treatment modalities aimed at reducing stress perception using a broad range of evidence-based mind-body interventions and centrally-targeted medications to reduce anxiety impact on brain patterns activated by visceral stimuli and dampen visceral pain.
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Affiliation(s)
- Muriel Larauche
- CURE/Digestive Diseases Research Center, Digestive Diseases Division, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90073, USA.
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