umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The emotional motor system and gastrointestinal symptoms
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is a significant comorbidity between anxiety/depression and functional gastrointestinal syndromes, such as irritable bowel syndrome (IBS) and functional dyspepsia. The pathophysiological link between emotions and the gut is not known. A model of an emotional motor system (EMS) which reacts to interoceptive and exteroceptive stress has been proposed. EMS consists of specific brain structures including anterior cingulate cortex (ACC), amygdala, hippocampus and hypothalamus and mediates their communication to the rest of the body (including the gastrointestinal tract) through the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS) and by a pain modulation system. The aim of this thesis was to test the EMS model by studying the relationship between symptoms of anxiety and depression and IBS-like symptoms in patients with recurrent unipolar depression, in patients with IBS and in a sample of a normal Swedish population. The peripheral limb of EMS (ANS, HPA axis and the pain modulations system) was tested in patients with IBS and control subjects. Spectral heart rate variability was used to investigate ANS function in patients with refractory IBS and in healthy controls. The HPA axis function was tested by a weight adjusted low dose dexamethasone suppression test in control subjects. The influence of catecholamine degradation on pain modulation was tested by analyzing val158met catechol-o-methyl transferase (COMT) polymorphism in patients with IBS and in control subjects.

We found a significant relationship between symptoms of anxiety/depression and IBS-like symptoms in patients with recurrent unipolar depression, in patients with IBS and in a sample of the normal population. Interestingly, patients with recurrent unipolar depression in remission had no more IBS-like symptoms than controls, indicating that the gastrointestinal symptoms may resolve when depression is treated to remission.

Patients with IBS have an increased mid-frequency power in rest and in supine position (after tilt test) compared to healthy controls indicating an increased sympathetic ANS drive.

The symptoms of diarrhea and early satiety has in the litterature been associated to the stimulation of corticotropin releasing hormone (CRH) receptors and was also in our study related to HPA axis function tested by a low dose dexamethasone test. Interestingly both hypo- and hyperfunction of the HPA axis was related to these symptoms in control subjects.

The val158met COMT polymorphism was associated to IBS-like symptoms. Control subjects with IBS-like symptoms (defined by the upper quartile in total GSRS-IBS score) had a higher frequency of the met/met and a significantly lower frequency of the val/met genotype. Also patients with IBS tended to have a lower frequency of the heterozygous val/met genotype so we conclude that this genotype may be protective against IBS/IBS like symptoms. In addition, the val/val genotype in patients with IBS was associated to diarrhea symptoms.

Conclusions: Our results support the model of an emotional motor system in the genesis of functional gastrointestinal symptoms by the finding of the association of IBS-like symptoms and mood disturbances, and by finding alterations in the peripheral limbs of EMS (ANS, HPA axis and catecholamines) in subjects with IBS and IBS-like symptoms.

Place, publisher, year, edition, pages
Umeå: Medicin , 2008. , 62 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1196
Keyword [en]
Anxiety, ANS, autonomic nervous system, cortisol, DST, emotional motor system, functional, gastrointestinal symptoms, GSRS-IBS, gut, HADS, heart rate variability, HPA axis, IBS, irritable bowel syndrome, stress, unipolar depression, val158met COMT polymorphism
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:umu:diva-1802ISBN: 978-91-7264-602-5 (print)OAI: oai:DiVA.org:umu-1802DiVA: diva2:142021
Public defence
2008-09-19, Sal B, 1D, Tandläkarhögskolan, NUS, Umeå, 09:00 (English)
Opponent
Available from: 2008-09-03 Created: 2008-09-03 Last updated: 2010-01-18Bibliographically approved
List of papers
1. No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission
Open this publication in new window or tab >>No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission
2007 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 19, no 11, 896-904 p.Article in journal (Refereed) Published
Abstract [en]

There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23–86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21–85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (rs = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.

Place, publisher, year, edition, pages
Oxford: Blackwell, 2007
Keyword
adult, aged, aged; 80 and over, anxiety/complications/physiopathology, case-control studies, depression/*complications/*physiopathology/psychology, female, health surveys, humans, irritable bowel syndrome/*complications/*physiopathology/psychology, male, middle aged, prevalence, recurrence, remission; spontaneous, severity of illness index
Identifiers
urn:nbn:se:umu:diva-8752 (URN)doi:10.1111/j.1365-2982.2007.00967.x (DOI)17973640 (PubMedID)
Available from: 2008-02-08 Created: 2008-02-08 Last updated: 2011-03-30Bibliographically approved
2. Spectral analysis of heart rate variability in patients with irritable bowel syndrome.
Open this publication in new window or tab >>Spectral analysis of heart rate variability in patients with irritable bowel syndrome.
Show others...
1998 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 33, no 6, 572-576 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Autonomic dysfunction, both adrenergic and cholinergic, has been associated with the irritable bowel syndrome (IBS). The accuracy of the methods in use, however, has been limited by the need for active co-operation by the patients, with consequent difficulties in standardization. The aim of this study was to investigate the function of the autonomic nervous system in patients with IBS by using spectral analysis of the heart rate variability, an accurate method depending very little on patient cooperation. METHODS: Eighteen patients with IBS were compared with 36 sex- and age-matched controls. Spectral analysis of heart rate variability was performed to quantify sympathetic and parasympathetic nerve activity. RESULTS: The patients with IBS had significantly higher sympathetic activity than controls (P = 0.005). There was no significant (P = 0.308) increase in parasympathetic activity. There were no significant differences in heart rate or blood pressure between the patients and controls. CONCLUSION: Spectral analysis of heart rate variability has been used to assess the function of the autonomic nervous system in patients with IBS. IBS patients have significantly increased symphathetic activity, whereas parasympathetic activity does not differ from that of controls.

Identifiers
urn:nbn:se:umu:diva-22272 (URN)10.1080/00365529850171800 (DOI)9669625 (PubMedID)
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2017-12-13
3. Gastrointestinal symptoms are associated with hypothalamic-pituitary-adrenal axis suppression in healthy individuals.
Open this publication in new window or tab >>Gastrointestinal symptoms are associated with hypothalamic-pituitary-adrenal axis suppression in healthy individuals.
2007 (English)In: Scand J Gastroenterol, ISSN 0036-5521, Vol. 42, no 11, 1294-1301 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-16983 (URN)10.1080/00365520701395945 (DOI)17852841 (PubMedID)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2011-05-17Bibliographically approved
4. The val158met Catechol-O-methyl-transferase (COMT) polymorphism is associated with irritable bowel syndrome-like symptoms
Open this publication in new window or tab >>The val158met Catechol-O-methyl-transferase (COMT) polymorphism is associated with irritable bowel syndrome-like symptoms
Show others...
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-3355 (URN)
Available from: 2008-09-03 Created: 2008-09-03 Last updated: 2011-05-17Bibliographically approved

Open Access in DiVA

fulltext(905 kB)1255 downloads
File information
File name FULLTEXT01.pdfFile size 905 kBChecksum SHA-1
1ad2605a98e829dc972811819982e24eddd3006a94d3c3cb82a354265b84dd8ad0785f7a
Type fulltextMimetype application/pdf

By organisation
Public Health and Clinical Medicine
Gastroenterology and Hepatology

Search outside of DiVA

GoogleGoogle Scholar
Total: 1255 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 582 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf