Skip to main content
SpringerLink
Log in

Endocrine dysregulation in women with irritable bowel syndrome according to Rome II criteria

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

The etiology of the irritable bowel syndrome (IBS) is unexplained: biological, psychological and social factors must be considered. This study examined if differences in HPA-axis activity already exist in those who do not yet fulfill IBS criteria (i.e. “subthreshold IBS”). We also investigated whether there were differences between those who reported clinically relevant (i.e. distressing) IBS symptoms and those who did not. Thirty-six women were subdivided into three groups (IBS group, subthreshold IBS group, control group). Results showed differences in morning cortisol levels (U = 11.58; p < 0.05), with IBS patients showing a lower cortisol response compared to controls. Subthreshold IBS patients were comparable to controls regarding endocrine function. Diurnal cortisol levels did not differ between groups. Group comparisons between distressed subjects and non-distressed subjects regarding cortisol levels did not reach significance. The finding of endocrine abnormalities (at least in a sub-set of patients) is important since these might be associated with deficient pain processing in IBS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Agreus, L., Svardsudd, K., Talley, N. J., Jones, M. P., & Tibblin, G. (2001). Natural history of gastroesophageal reflux disease and functional abdominal disorders: A population-based study. American Journal of Gastroenterology, 96, 2905–2914.

    Article  CAS  PubMed  Google Scholar 

  • Bach, D. R., Erdmann, G., Schmidtmann, M., & Monnikes, H. (2006). Emotional stress reactivity in irritable bowel syndrome. European Journal of Gastroenterology and Hepatology, 18, 629–636.

    Article  PubMed  Google Scholar 

  • Blanchard, E. B., Lackner, J. M., Jaccard, J., Rowell, D., Carosella, A. M., Powell, C., … Kuhn, E. (2008). The role of stress in symptom exacerbation among IBS patients. Journal of Psychosomatic Research, 64, 119–128.

  • Bohmelt, A. H., Nater, U. M., Franke, S., Hellhammer, D. H., & Ehlert, U. (2005). Basal and stimulated hypothalamic-pituitary-adrenal axis activity in patients with functional gastrointestinal disorders and healthy controls. Psychosomatic Medicine, 67, 288–294.

    Article  PubMed  Google Scholar 

  • Bradford, K., Shih, W., Videlock, E. J., Presson, A. P., Naliboff, B. D., Mayer, E. A., & Chang, L. (2012). Association between early adverse life events and irritable bowel syndrome. Clinical Gastroenterology Hepatology, 10, 385–390.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chang, L., Sundaresh, S., Elliott, J., Anton, P. A., Baldi, P., Licudine, A., … Mayer, E. A. (2009). Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome. Neurogastroenterology and Motility, 21, 149–159.

  • Clow, A., Thorn, L., Evans, P., & Hucklebridge, F. (2004). The awakening cortisol response: Methodological issues and significance. Stress, 7, 29–37.

    Article  CAS  PubMed  Google Scholar 

  • Dang, J., Ardila-Hani, A., Amichai, M. M., Chua, K., & Pimentel, M. (2012). Systematic review of diagnostic criteria for IBS demonstrates poor validity and utilization of Rome III. Neurogastroenterology and Motility, 24, 853–e397.

    Article  PubMed  Google Scholar 

  • Dickhaus, B., Mayer, E. A., Firooz, N., Stains, J., Conde, F., Olivas, T. I., … Naliboff, B. D. (2003). Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress. American Journal of Gastroenterology, 98, 135–143.

  • Dinan, T. G., Quigley, E. M., Ahmed, S. M., Scully, P., O’Brien, S., O’Mahony, L., … Keeling, P. W. (2006). Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: Plasma cytokines as a potential biomarker? Gastroenterology, 130, 304–311.

  • Drossman, D. A., & Dumitrascu, D. L. (2006). Rome III: New standard for functional gastrointestinal disorders. Journal of Gastrointestinal and Liver Diseases, 15, 237–241.

    PubMed  Google Scholar 

  • Drossman, D. A., Leserman, J., Nachman, G., Li, Z. M., Gluck, H., Toomey, T. C., & Mitchell, C. M. (1990). Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Annals of Internal Medicine, 113, 828–833.

    Article  CAS  PubMed  Google Scholar 

  • Ehlert, U., Nater, U. M., & Bohmelt, A. (2005). High and low unstimulated salivary cortisol levels correspond to different symptoms of functional gastrointestinal disorders. Journal of Psychosomatic Research, 59, 7–10.

    Article  PubMed  Google Scholar 

  • FitzGerald, L. Z., Kehoe, P., & Sinha, K. (2009). Hypothalamic–pituitary–adrenal axis dysregulation in women with irritable bowel syndrome in response to acute physical stress. Western Journal of Nursing Research, 31, 818–836.

    Article  PubMed  Google Scholar 

  • Halder, S. L., Locke, G. R, 3rd, Schleck, C. D., Zinsmeister, A. R., Melton, L. J, 3rd, & Talley, N. J. (2007). Natural history of functional gastrointestinal disorders: A 12-year longitudinal population-based study. Gastroenterology, 133, 799–807.

    Article  PubMed  Google Scholar 

  • Heim, C., Ehlert, U., Hanker, J. P., & Hellhammer, D. H. (1998). Abuse-related posttraumatic stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in women with chronic pelvic pain. Psychosomatic Medicine, 60, 309–318.

    Article  CAS  PubMed  Google Scholar 

  • Heim, C., Ehlert, U., & Hellhammer, D. H. (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25, 1–35.

    Article  CAS  PubMed  Google Scholar 

  • Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D. (2007). Several daily measurements are necessary to reliably assess the cortisol rise after awakening: State- and trait components. Psychoneuroendocrinology, 32, 80–86.

    Article  CAS  PubMed  Google Scholar 

  • Hungin, A. P., Whorwell, P. J., Tack, J., & Mearin, F. (2003). The prevalence, patterns and impact of irritable bowel syndrome: An international survey of 40,000 subjects. Alimentary Pharmacology and Therapeutics, 17, 643–650.

    Article  CAS  PubMed  Google Scholar 

  • Kennedy, P. J., Clarke, G., O’Neill, A., Groeger, J. A., Quigley, E. M., Shanahan, F., … Dinan, T. G. (2014a). Cognitive performance in irritable bowel syndrome: Evidence of a stress-related impairment in visuospatial memory. Psychological Medicine, 44, 1553–1566.

  • Kennedy, P. J., Cryan, J. F., Quigley, E. M., Dinan, T. G., & Clarke, G. (2014b). A sustained hypothalamic-pituitary-adrenal axis response to acute psychosocial stress in irritable bowel syndrome. Psychological Medicine, 44, 3123–3134.

    Article  CAS  PubMed  Google Scholar 

  • Kuehl, L. K., Michaux, G. P., Richter, S., Schachinger, H., & Anton, F. (2010). Increased basal mechanical pain sensitivity but decreased perceptual wind-up in a human model of relative hypocortisolism. Pain, 149, 539–546.

    Article  CAS  PubMed  Google Scholar 

  • Lederbogen, F., Kuhner, C., Kirschbaum, C., Meisinger, C., Lammich, J., Holle, R., … Ladwig, K. H. (2010). Salivary cortisol in a middle-aged community sample: Results from 990 men and women of the KORA-F3 Augsburg study. European Journal of Endocrinology, 163, 443–451.

  • Leibbrand, R., Cuntz, U., & Hiller, W. (2002). Assessment of functional gastrointestinal disorders using the Gastro-Questionnaire. International Journal of Behavioral Medicine, 9, 155–172.

    Article  PubMed  Google Scholar 

  • Levy, R. L., Cain, K. C., Jarrett, M., & Heitkemper, M. M. (1997). The relationship between daily life stress and gastrointestinal symptoms in women with irritable bowel syndrome. Journal of Behavioral Medicine, 20, 177–193.

    Article  CAS  PubMed  Google Scholar 

  • Locke, G. R, 3rd, Weaver, A. L., Melton, L. J, 3rd, & Talley, N. J. (2004). Psychosocial factors are linked to functional gastrointestinal disorders: A population based nested case-control study. American Journal of Gastroenterology, 99, 350–357.

    Article  PubMed  Google Scholar 

  • Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006). Functional bowel disorders. Gastroenterology, 130, 1480–1491.

    Article  PubMed  Google Scholar 

  • Markert, C., Suarez-Hitz, K., Ehlert, U., & Nater, U. M. (2014). Distress criterion influences prevalence rates of functional gastrointestinal disorders. BMC Gastroenterology, 14, 215.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mayer, E. A. (2000). The neurobiology of stress and gastrointestinal disease. Gut, 47, 861–869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mearin, F., Badia, X., Balboa, A., Baro, E., Caldwell, E., Cucala, M., … Talley, N. J. (2001). Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scandinavian Journal of Gastroenterology, 36, 1155–1161.

  • Nicholl, B. I., Halder, S. L., Macfarlane, G. J., Thompson, D. G., O’Brien, S., Musleh, M., & McBeth, J. (2008). Psychosocial risk markers for new onset irritable bowel syndrome-results of a large prospective population-based study. Pain, 137, 147–155.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • O’Donnell, K., Badrick, E., Kumari, M., & Steptoe, A. (2008). Psychological coping styles and cortisol over the day in healthy older adults. Psychoneuroendocrinology, 33, 601–611.

    Article  PubMed  Google Scholar 

  • Olafsdottir, L. B., Gudjonsson, H., Jonsdottir, H. H., Bjornsson, E., & Thjodleifsson, B. (2012). Natural history of functional gastrointestinal disorders: Comparison of two longitudinal population-based studies. Digestive and Liver Disease, 44, 211–217.

    Article  PubMed  Google Scholar 

  • Patacchioli, F. R., Angelucci, L., Dellerba, G., Monnazzi, P., & Leri, O. (2001). Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS). Journal of Endocrinological Investigation, 24, 173–177.

    Article  CAS  PubMed  Google Scholar 

  • Posserud, I., Agerforz, P., Ekman, R., Bjornsson, E. S., Abrahamsson, H., & Simren, M. (2004). Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. Gut, 53, 1102–1108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003). Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology, 28, 916–931.

    Article  CAS  PubMed  Google Scholar 

  • Schulz, P., Jansen, L., & Schlotz, W. (2005). Stressreaktivität: Theoretisches Konzept und Messung [Stress reactivity: Theoretical concept and measurement]. Diagnostica, 51, 124–133.

    Article  Google Scholar 

  • Schulz, P., Schlotz, W., & Becker, P. (2004). TICS Trierer Inventar zum chronischen Stress [Trier Inventory for the Assessment of Chronic Stress]. Manual. Göttingen: Hogrefe.

    Google Scholar 

  • Suarez, K., Mayer, C., Ehlert, U., & Nater, U. M. (2010). Psychological stress and self-reported functional gastrointestinal disorders. The Journal of Nervous and Mental Disease, 198, 226–229.

    Article  PubMed  Google Scholar 

  • Suarez-Hitz, K. A., Otto, B., Bidlingmaier, M., Schwizer, W., Fried, M., & Ehlert, U. (2012). Altered psychobiological responsiveness in women with irritable bowel syndrome. Psychosomatic Medicine, 74, 221–231.

    Article  PubMed  Google Scholar 

  • Thompson, W. G., Longstreth, G. F., Drossman, D. A., Heaton, K. W., Irvine, E. J., & Muller-Lissner, S. A. (1999). Functional bowel disorders and functional abdominal pain. Gut, 45, II43–II47.

    PubMed  PubMed Central  Google Scholar 

  • Whitehead, W. E., Crowell, M. D., Robinson, J. C., Heller, B. R., & Schuster, M. M. (1992). Effects of stressful life events on bowel symptoms: Subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut, 33, 825–830.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Whitehead, W. E., & Drossman, D. A. (2010). Validation of symptom-based diagnostic criteria for irritable bowel syndrome: A critical review. American Journal of Gastroenterology, 105, 814–820.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Clinical Biopsychology, University of Marburg, Gutenbergstr.18, 35032, Marburg, Germany

    Charlotte Markert & Urs M. Nater

  2. Department of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestr.14, 8050, Zurich, Switzerland

    Kerstin Suarez-Hitz & Ulrike Ehlert

Authors
  1. Charlotte Markert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kerstin Suarez-Hitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulrike Ehlert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Urs M. Nater
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charlotte Markert.

Ethics declarations

Conflict of interest

Charlotte Markert, Kerstin Suarez-Hitz, Ulrike Ehlert and Urs M. Nater declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of the Canton of Zurich and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Markert, C., Suarez-Hitz, K., Ehlert, U. et al. Endocrine dysregulation in women with irritable bowel syndrome according to Rome II criteria. J Behav Med 39, 519–526 (2016). https://doi.org/10.1007/s10865-016-9718-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-016-9718-x

Keywords

Search

Navigation