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Spectral analysis of heart rate variability in patients with irritable bowel syndrome.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
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1998 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, 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.

Place, publisher, year, edition, pages
1998. Vol. 33, no 6, 572-576 p.
URN: urn:nbn:se:umu:diva-22272DOI: 10.1080/00365529850171800PubMedID: 9669625OAI: diva2:214239
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2009-05-04
In thesis
1. The emotional motor system and gastrointestinal symptoms
Open this publication in new window or tab >>The emotional motor system and gastrointestinal symptoms
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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1196
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
urn:nbn:se:umu:diva-1802 (URN)978-91-7264-602-5 (ISBN)
Public defence
2008-09-19, Sal B, 1D, Tandläkarhögskolan, NUS, Umeå, 09:00 (English)
Available from: 2008-09-03 Created: 2008-09-03 Last updated: 2010-01-18Bibliographically approved

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