Comorbidity of posttraumatic stress disorder and irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a chronic disorder that has been found to be associated with psychiatric disorders and a history of physical and/or sexual abuse. To date, the relationship of posttraumatic stress disorder (PTSD) and IBS has not been investigated. The primary purpose of this study was to examine the relationship of IBS and PTSD.

METHOD

Fifty consecutive IBS patients admitted to a clinical treatment study were assessed for IBS, trauma history, and psychiatric disorders.

RESULTS

Twenty-seven IBS patients (54%) met criteria for a psychiatric diagnosis at some time in their lives. Twenty-two patients (44%) reported a trauma history. Eighteen (36%) were diagnosed with PTSD. Those IBS patients with a trauma history were more likely to have other comorbid psychiatric diagnoses.

CONCLUSION

These results suggest that IBS is often associated with psychiatric disorders, indicating that assessment and treatment of these comorbid conditions may be important in the treatment of IBS. PTSD, which had not been previously investigated in relation to IBS, had a high prevalence, indicating the need for careful trauma and PTSD assessment in patients with IBS. Patients with IBS who have a trauma history may be more at risk for other comorbid psychiatric disorders than IBS patients without a trauma history.

Regulation of the gastric emptying of glucose

The gastric emptying characteristics of physiological saline (0.9% NaCl) and glucose solutions of three different concentrations (0.05, 0.125, 0.25 g/ml) were examined in order to identify distinctions in the control of the stomach's activity. Saline emptied rapidly and exponentially. Glucose assumed, soon after filling the stomach, a slow and calorie-constant emptying pattern such that 2.13 kcal of glucose were delivered per minute to the duodenum for all three concentrations of glucose. When, by means of a catheter passed beyond the pylorus, glucose was infused into the duodenum in amounts varying from 26.5 to 120 kcal, an inhibition on the gastric emptying of physiological saline of 0.46 min/kcal of intraduodenal glucose was demonstrated. Since 2.13 kcal/min and 0.46 min/kcal are reciprocals, it appeared that in emptying saline, the gastroduodenal system acts as an "open-loop" system passing liquids from the stomach at a rate primarily determined by the volume of gastric contents. With glucose, however, a "closed-loop" system is established that assumes a steady-state balance between the delivery of glucose to the duodenum and the inhibition of this delivery evoked from the duodenum by the glucose that enters it.