Article

Childhood Trauma Is Associated With Hypothalamic-Pituitary-Adrenal Axis Responsiveness in Irritable Bowel Syndrome

Center for Neurobiology of Stress, David Geffen School of Medicine, University of California, Los Angeles, California 90095-7378, USA.
Gastroenterology (Impact Factor: 13.93). 09/2009; 137(6):1954-62. DOI: 10.1053/j.gastro.2009.08.058
Source: PubMed

ABSTRACT A history of early adverse life events (EALs) is associated with a poorer outcome and higher levels of distress in adult patients with functional gastrointestinal disorders. An EAL is thought to predispose individuals to develop a range of chronic illnesses by inducing persistent changes in the central stress response systems, including the hypothalamic-pituitary-adrenal (HPA) axis. We sought to determine if EALs affect the HPA axis response to a visceral stressor in irritable bowel syndrome (IBS) patients and healthy controls, and to determine if this is affected by sex or related to symptoms or quality of life.
Forty-four IBS patients (25 women, 19 men) and 39 healthy controls (21 women, 18 men) were assessed for gastrointestinal and psychological symptoms and EALs by validated questionnaires and interview. All subjects underwent a visceral stressor (sigmoidoscopy). Salivary cortisol was collected at baseline and serially for 1 hour poststressor.
Twenty-one IBS patients and 18 controls had EALs. In subjects with and without IBS, an EAL was associated with higher mean (+/-SD) cortisol levels (0.32 +/- 0.2 vs 0.20 +/- 0.1 microg/dL; P = .003) and higher area under the curve (28.1 +/- 17 vs 18.6 +/- 13 microg x min/dL; P = .005) after the stressor compared with subjects without EALs. In IBS, a faster resolution of cortisol to basal values corresponded to lower symptom severity (r = -0.36, P < .05) and better disease-specific quality of life (r = 0.33, P < .05).
HPA axis hyperresponsiveness to a visceral stressor is related more to a history of EALs than to the presence of IBS. However, HPA axis reactivity has a moderating effect on IBS symptoms.

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    • "It is well known that early traumatic and painful experiences such as burns can induce long-term alterations in sensory and pain processing in children.21 Similarly, though different from neonatal stress, childhood trauma and abuse that are strongly associated to IBS in adults result in modifications in the hypothalamic-pituitary-adrenal axis.22 However, somatic pain researchers have also shown that long-term consequences of NICU admission are not only characterized by enhanced perceptual sensitization to prolonged painful stimulation but also by hypoalgesia to brief heat pain stimuli23 suggesting that modifications of pain processing may occur in various directions. "
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    • "A significant increase in 5-HT-positive cell number and 5-HT content after CRD stimulation was also observed in the colon of animals, which experienced maternal separation (Ren et al., 2007). Videlock et al. (2009) demonstrated that IBS patients and controls with a history of early adverse life events (EAL) have a greater cortisol response to a visceral stressor compared to individuals without EAL, suggesting the involvement of the HPA axis. "
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    Frontiers in Pharmacology 07/2012; 3:127. DOI:10.3389/fphar.2012.00127 · 3.80 Impact Factor
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    • "Exposure to adverse environments such as inadequate parenting during childhood may lead to serious life-long effects due to impaired brain development and dysregulation of the brain-gut axis [1], [51]. Moreover, chronic sustained stress, particularly as a primary life event, has been demonstrated to be an important factor in both FGID onset and modulation [49], [52]. The mother's parental style during childhood may be associated with dysregulation of emotional inhibition [53], [54] and the onset of GI symptoms [55], [56]. "
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