Irritable bowel syndrome in childhood: Visceral hypersensitivity and psychosocial aspects

Gastroenterology and Endoscopic Units, University Federico II, Naples, Italy.
Neurogastroenterology and Motility (Impact Factor: 3.59). 04/2009; 21(9):940-e74. DOI: 10.1111/j.1365-2982.2009.01303.x
Source: PubMed

ABSTRACT Visceral hypersensitivity is often considered to play a major etiologic role in the pathophysiology of irritable bowel syndrome in adults, and some authors argue that this increased sensitivity is mainly due to psychological factors. In contrast, there are no data in children with irritable bowel syndrome which confirm this relationship. The aim of the study was to evaluate the relationship between psychosocial aspects and sensorymotor function in children affected by irritable bowel syndrome. Ten children fulfilling the Rome II criteria for irritable bowel syndrome and seven healthy controls were enrolled. We studied the thresholds and the perception of visceral stimuli in the rectum by means of an electronic barostat (isobaric phasic distentions, 3 mmHg/1 min, interval 1 min) and a validated questionnaire. Personality features were evaluated by means of the Big Five Questionnaire for Children. Sleep, mood disturbance, anxiety and individual performance (missed school days, school results and social activities) were also evaluated. Children with irritable bowel syndrome showed significantly lower thresholds for discomfort (14.8 +/- 3.5 vs 22.3 +/- 6.9 mmHg, P = 0.010) and a higher cumulative perception score (28.2 +/- 11.1 vs 12.3 +/- 8.0, P = 0.005) compared with healthy controls. A higher emotional instability (57.8 +/- 7.0 vs 48.7 +/- 10.1, P = 0.047), sleep disturbance (7.2 +/- 1.0 vs 9.3 +/- 0.5, P = 0.004) and anxiety (6.3 +/- 2.0 vs 2.3 +/- 1.7, P = 0.009) were observed in irritable bowel syndrome patients. Moreover, in a multivariate analysis, the cumulative perception score was significantly related to emotional instability (P = 0.042). In conclusion children with irritable bowel syndrome exhibit visceral hypersensitivity and psychosocial impairment. Emotional instability, as a personality feature in these children, seems to modulate the perception response to visceral stimulations.

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    • "The evidence suggests that disturbances in the quantity and quality of sleep are associated with emotional and behavioral problems, somatic complaints, problems in academic and social performance, and overall quality of life in adolescents from normal populations [1–4]. Sleep troubles are prevalent in adolescents [5] and even more so in adolescents with somatic problems or diseases such as migraine and tension-type headache [6], juvenile idiopathic arthritis (JIA) [7], irritable bowel syndrome [8], and bronchial asthma [9]. Studies on the effects of low amount or low quality of sleep on the psychosocial well-being of children and adolescents with chronic diseases are limited. "
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    ABSTRACT: The current study assessed the associations between sleep and psychosocial symptoms in 157 Finnish adolescents with inflammatory bowel disease (IBD). Sleep trouble was self-rated in Sleep Self-Report (SSR) and in Youth Self-Report (YSR). Psychosocial symptoms of the adolescents were assessed by the YSR and Child Behavior Checklist (CBCL). Patients reporting sleep trouble had significantly more psychosocial symptoms than their counterparts without sleep trouble. This was shown in the CBCL and YSR scales of total problems (P < 0.01), anxious/depressed mood (P < 0.05), and aggressive behavior (P < 0.01). Additionally, SSR sleep problem subscale scores indicating lower sleep quality (bedtime, sleep behavior) associated significantly with attention problems (P < 0.05). These results point out that sleep trouble should be recognized and treated in adolescents with IBD to possibly avoid the emerging of psychosocial symptoms.
    05/2014; 2014:379450. DOI:10.1155/2014/379450
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    • "These then synapse with second order neurons in the spinothalamic and spinoreticular tracts of the spinal cord, ultimately projecting to the thalamus where they are relayed to higher centres (Figure).45,47 Cortical perception of sensation is a critical component of the sensory pathway, as psychological profile and psychopathology have been shown to correlate with the response to visceral distension.48-50 Theoretically, disruption of the afferent pathway from the rectum, at any level from receptor to cortex, could potentially lead to impaired perception of rectal stimuli. "
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    ABSTRACT: Impaired or blunted rectal sensation, termed rectal hyposensitivity (RH), which is defined clinically as elevated sensory thresholds to rectal balloon distension, is associated with disorders of hindgut function, characterised primarily by symptoms of constipation and fecal incontinence. However, its role in symptom generation and the pathogenetic mechanisms underlying the sensory dysfunction remain incompletely understood, although there is evidence that RH may be due to 'primary' disruption of the afferent pathway, 'secondary' to abnormal rectal biomechanics, or to both. Nevertheless, correction of RH by various interventions (behavioural, neuromodulation, surgical) is associated with, and may be responsible for, symptomatic improvement. This review provides a contemporary overview of RH, focusing on diagnosis, clinical associations, pathophysiology, and treatment paradigms.
    Journal of neurogastroenterology and motility 10/2012; 18(4):373-84. DOI:10.5056/jnm.2012.18.4.373 · 2.30 Impact Factor
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    • "Children with FAP show a heightened sensitivity to detect visceral sensations, and exhibit a lower threshold for discomfort than unaffected children (Di Lorenzo et al., 2001; Iovino et al., 2009; Van Ginkel, Voskuljl, Benninga, Taminiau, & Boeckxstaens , 2001). Iovino et al. (2009) also report that emotional instability is associated with heightened visceral perception in youth with FAP. Other studies have reported a general hypersensitivity to sensory stimuli in children with FAP, including hypersensitivity to gastrointestinal sensations evoked by a water load (Walker et al., 2006) and excessive muscle tenderness and a lowered pressure-pain threshold (Alfvén, 1993b; Duarte, Goulart, & Penna, 2000). "
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    ABSTRACT: Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
    Journal of Child Psychology and Psychiatry 03/2012; 53(5):575-92. DOI:10.1111/j.1469-7610.2012.02535.x · 6.46 Impact Factor
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