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Subtle involvement of the parasympathetic nervous system in patients with irritable bowel syndrome

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Abstract

This study comprises assessment of autonomic function in irritable bowel syndrome (IBS) patients, focusing on meal-related changes. In 18 IBS patients (4 males, mean age 45±3.0 [SEM] years) and 19 healthy volunteers (6 males, mean age 41±3.5 years) blood pressure, heart rate, heart rate variability and muscle sympathetic nerve activity (MSNA) were assessed before, during and after consumption of a standardized meal. In pre- and postprandial phase Valsalva maneuver, cold pressor test (CPT) and deep breathing test were carried out and Visual Analog Scale (VAS) scores for nausea, bloating and pain were obtained.

In the IBS group, the meal induced significantly higher VAS scores for pain (P=0.002) and bloating (P=0.02). During food intake, the increase in blood pressure, heart rate and MSNA was equal in patients and controls, but the increase of LF/HF ratio of heart rate variability was significantly higher in the IBS group (median [quartiles] 2.29 [1.14–3.00] versus 0.77 [0.25–1.81]; P=0.03). IBS patients scored lower on pre- and postprandial RRmax/RRmin ratio during deep breathing (DB ratio, P=0.03). The increase in MSNA (burst frequency) in response to CPT tended to be higher in the IBS patients (P=0.07). We conclude that reactivity to food intake, measured as muscle sympathetic nerve activity, is normal in IBS patients. The lower DB ratio and higher LF/HF ratio during food intake in IBS patients is an indication of a reduced parasympathetic reactivity. These results suggest that reduced baseline activity as well as responsiveness of the parasympathetic system could play a role in the pathogenesis of IBS.

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References

  1. Accarino AM, Azpiroz F, Malagelada JR (1995) Selective dysfunction of mechanosensitive intestinal afferents in irritable bowel syndrome. Gastroenterology 108:636–43

    Article  CAS  PubMed  Google Scholar 

  2. Burke D, Sundlof G, Wallin G (1977) Postural effects on muscle nerve sympathetic activity in man. J Physiol 272:399–14

    CAS  PubMed  Google Scholar 

  3. Camilleri M (2001) Management of the irritable bowel syndrome. Gastroenterology 120:652–68

    Article  CAS  PubMed  Google Scholar 

  4. Chelimsky G, Chelimsky T (2001) Familial association of autonomic and gastrointestinal symptoms. Clin Auton Res 11:383–86

    Article  CAS  PubMed  Google Scholar 

  5. Cox HS, Kaye DM, Thompson JM, Turner AG, Jennings GL, Itsiopoulos C, Esler MD (1995) Regional sympathetic nervous activation after a large meal in humans. Clin Sci (Colch) 89:145–54

    CAS  PubMed  Google Scholar 

  6. Dapoigny M, Stockbrugger RW, Azpiroz F, Collins S, Coremans G, Muller-Lissner S, Oberndorff A, Pace F, Smout A, Vatn M, Whorwell P (2003) Role of alimentation in irritable bowel syndrome. Digestion 67:225–33

    Article  CAS  PubMed  Google Scholar 

  7. Drossman DA (1999) The functional gastrointestinal disorders and the Rome II process. Gut 45(Suppl 2):II1–II5

    Article  PubMed  Google Scholar 

  8. Eckberg DL (1980) Parasympathetic cardiovascular control in human disease: a critical review of methods and results. Am J Physiol 239:H581–H593

    CAS  PubMed  Google Scholar 

  9. Elsenbruch S, Orr WC (2001) Diarrhea- and constipation-predominant IBS patients differ in postprandial autonomic and cortisol responses. Am J Gastroenterol 96:460–66

    Article  CAS  PubMed  Google Scholar 

  10. Evans PR, Bennett EJ, Bak YT, Tennant CC, Kellow JE (1996) Jejunal sensorimotor dysfunction in irritable bowel syndrome: clinical and psychosocial features. Gastroenterology 110:393–04

    Article  CAS  PubMed  Google Scholar 

  11. Fagius J, Berne C (1994) Increase in muscle nerve sympathetic activity in humans after food intake. Clin Sci (Colch) 86:159–67

    CAS  PubMed  Google Scholar 

  12. Ford MJ, Miller PM, Eastwood J, Eastwood MA (1987) Life events, psychiatric illness and the irritable bowel syndrome. Gut 28:160–65

    Article  CAS  PubMed  Google Scholar 

  13. Heitkemper M, Burr RL, Jarrett M, Hertig V, Lustyk MK, Bond EF (1998) Evidence for autonomic nervous system imbalance in women with irritable bowel syndrome. Dig Dis Sci 43:2093–098

    Article  CAS  PubMed  Google Scholar 

  14. Heitkemper M, Jarrett M, Cain KC, Burr R, Levy RL, Feld A, Hertig V (2001) Autonomic nervous system function in women with irritable bowel syndrome. Dig Dis Sci 46:1276–284

    Article  CAS  PubMed  Google Scholar 

  15. Kanazawa M, Endo Y, Whitehead WE, Kano M, Hongo M, Fukudo S (2004) Patients and nonconsulters with irritable bowel syndrome reporting a parental history of bowel problems have more impaired psychological distress. Dig Dis Sci 49:1046–053

    Article  PubMed  Google Scholar 

  16. Karling P, Nyhlin H, Wiklund U, Sjoberg M, Olofsson BO, Bjerle P (1998) Spectral analysis of heart rate variability in patients with irritable bowel syndrome. Scand J Gastroenterol 33:572–76

    Article  CAS  PubMed  Google Scholar 

  17. Lee CT, Chuang TY, Lu CL, Chen CY, Chang FY, Lee SD (1998) Abnormal vagal cholinergic function and psychological behaviors in irritable bowel syndrome patients: a hospital-based Oriental study. Dig Dis Sci 43:1794–799

    Article  CAS  PubMed  Google Scholar 

  18. Low PA (1997) Laboratory evaluation of autonomic function. In: Low PA (ed) Clinical autonomic disorders. Philadelphia, Lippincott-Raven Publishers, pp 179–08

  19. Mathias CJ, Bannister R (1999) Investigation of autonomic disorders. In: Mathias CJ, Bannister R (eds) Autonomic failure, a textbook of clinical disorders of the autonomic nervous system.Oxford, Oxford University Press, pp 169–95

  20. McKee DP, Quigley EM (1993) Intestinal motility in irritable bowel syndrome: is IBS a motility disorder? Part 2.Motility of the small bowel, esophagus, stomach, and gall-bladder. Dig Dis Sci 38:1773–782

    Article  CAS  PubMed  Google Scholar 

  21. Orr WC, Elsenbruch S, Harnish MJ (2000) Autonomic regulation of cardiac function during sleep in patients with irritable bowel syndrome. Am J Gastroenterol 95:2865–871

    Article  CAS  PubMed  Google Scholar 

  22. Rossi P, Andriesse GI, Oey PL, Wieneke GH, Roelofs JM, Akkermans LM (1998) Stomach distension increases efferent muscle sympathetic nerve activity and blood pressure in healthy humans. J Neurol Sci 161:148–55

    Article  CAS  PubMed  Google Scholar 

  23. Smart HL, Atkinson M (1987) Abnormal vagal function in irritable bowel syndrome. Lancet 2:475–78

    Article  CAS  PubMed  Google Scholar 

  24. Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G (1983) Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 34:234–39

    CAS  PubMed  Google Scholar 

  25. Swarbrick ET, Hegarty JE, Bat L, Williams CB, Dawson AM (1980) Site of pain from the irritable bowel. Lancet 2:443–46

    Article  CAS  PubMed  Google Scholar 

  26. Thompson JJ, Elsenbruch S, Harnish MJ, Orr WC (2002) Autonomic functioning during REM sleep differentiates IBS symptom subgroups. Am J Gastroenterol 97:3147–153

    Article  PubMed  Google Scholar 

  27. Vallbo AB, Hagbarth KE, Torebjork HE, Wallin BG (1979) Somatosensory, proprioceptive, and sympathetic activity in human peripheral nerves. Physiol Rev 59:919–57

    CAS  PubMed  Google Scholar 

  28. van Orshoven NP, Oey PL, van Schelven LJ, Roelofs JM, Jansen PA, Akkermans LM (2004) Effect of gastric distension on cardiovascular parameters: gastrovascular reflex is attenuated in the elderly. J Physiol 555:573–83

    Article  CAS  PubMed  Google Scholar 

  29. van Schelven LJ, Oey PL, Klein IH, Barnas MG, Blankestijn PJ, Wieneke GH (2000) Observer variations in short period spectral analysis of heart rate variability. J Auton Nerv Syst 79:144–48

    Article  CAS  PubMed  Google Scholar 

  30. Wallin BG (1999) Intraneural recordings of normal and abnormal sympathetic activity in humans. In: Mathias CJ, Bannister R (eds) Autonomic failure. A textbook of clinical disorders of the autonomic nervous system. Oxford, Oxford University Press, pp 223–25

  31. Waring WS, Chui M, Japp A, Nicol EF, Ford MJ (2004) Autonomic cardiovascular responses are impaired in women with irritable bowel syndrome. J Clin Gastroenterol 38:658–63

    Article  PubMed  Google Scholar 

  32. Whitehead WE, Palsson OS (1998) Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception. Gastroenterology 115:1263–271

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rudolf Magnus Institute of Neuroscience, Dept. of Clinical Neurophysiology, University Medical Centre Utrecht, Utrecht, The Netherlands

    Narender P. van Orshoven & P. Liam Oey MD, PhD

  2. Gastrointestinal Research Unit, Depts. of Gastroenterology and Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands

    Gunnar I. Andriesse, André J. Smout & Louis M. A. Akkermans

  3. Dept. of Biomedical Engineering, University Medical Centre Utrecht, Utrecht, The Netherlands

    Leonard J. van Schelven

  4. Rudolf Magnus Institute of Neuroscience, Dept. of Neurology and Neurosurgery, section: Clinical Neurophysiology, University Medical Centre Utrecht, Room F02.230, 85500, 3508 GA, Utrecht, The Netherlands

    P. Liam Oey MD, PhD

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  1. Narender P. van Orshoven
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  2. Gunnar I. Andriesse
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  3. Leonard J. van Schelven
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  4. André J. Smout
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  5. Louis M. A. Akkermans
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  6. P. Liam Oey MD, PhD
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Correspondence to P. Liam Oey MD, PhD.

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van Orshoven, N.P., Andriesse, G.I., van Schelven, L.J. et al. Subtle involvement of the parasympathetic nervous system in patients with irritable bowel syndrome. Clin Auton Res 16, 33–39 (2006). https://doi.org/10.1007/s10286-006-0307-x

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  • DOI: https://doi.org/10.1007/s10286-006-0307-x

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