Prospective Evaluation of Autonomic Function and Intestinal Blood Flow in Health and Irritable Bowel Syndrome Shows Differences Limited to Patients With Constipation Predominance.

Autor: Mazor Y; Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia., Leach MM; Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia., Jones M; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia., Ejova A; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, New South Wales, Australia., Fisher C; Department of Vascular Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia., Joffe D; Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia., Roach P; Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia., Kellow J; Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia., Malcolm A; Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: Neurogastroenterology and motility [Neurogastroenterol Motil] 2024 Dec 03, pp. e14975. Date of Electronic Publication: 2024 Dec 03.
DOI: 10.1111/nmo.14975
Abstrakt: Background: Autonomic dysfunction may contribute to symptom generation in irritable bowel syndrome (IBS), possibly driven by psychological morbidity and activation of the hypothalamic-pituitary-adrenal axis. Previous data are conflicting, perhaps due to lack of accounting for differential bowel patterns in IBS (constipation vs. diarrhea) or by diverse methodologies used to measure autonomic function. Our aim was to determine if autonomic response differed between IBS subtypes and healthy controls.
Methods: Forty female volunteers (20 IBS and 20 healthy) underwent comprehensive autonomic testing, fasting and postprandially, and in response to cold pressor and deep breathing challenges. Pulse transit time (PTT) and ultrasound measurements of intestinal blood flow were used as measures of systemic and local autonomic function, respectively. Outcomes were adjusted for baseline psychological comorbidities and gastric emptying (measured concurrently with scintigraphy).
Key Results: Findings, confined to IBS patients with predominant constipation (IBS-C), included (1) lower fasting and a trend to larger postprandial increase in superior mesenteric artery end-diastolic velocity; (2) lower fasting PTT, suggesting higher sympathetic tone, but no difference in postprandial PTT change; and (3) attenuated increase in postprandial aortic peak systolic velocity. Response to systemic autonomic challenges did not differ between IBS and health. Some psychological factors mediated differences between groups in the fasting, but not postprandial, state.
Conclusions and Inferences: IBS-C patients display systemic and local autonomic imbalance providing some support for recent therapies aimed at modulating autonomic state specifically in this patient group (e.g., acustimulation).
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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