Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome

Abstract

Background/AimsTo determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. MethodsIn a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, interleukin-10 produced by unstimulated peripheral blood mononuclear cells, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom score and IBS-specific quality of life. ResultsThe nurse-delivered 8-session CSM intervention is more effective than usual care in reducing abdominal pain, reducing Gastrointestinal Symptom score, and enhancing quality of life. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low frequency/high frequency ratio (sympathovagal balance) had less benefit from CSM on abdominal pain. Salivary cortisol, IL-10, and lactulose/mannitol ratio were not statistically significant in predicting CSM benefit. Baseline symptom severity interacts with treatment, namely the benefit of CSM is greater in those with higher baseline symptoms. ConclusionsCognitively-focused therapies may be less effective in reducing abdominal pain in IBS patients with higher sympathetic tone. Whether this a centrally-mediated patient characteristic or related to heightened arousal remains to be determined.

Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial

“…In a previous study that investigated the association between baseline HRV and changes in GI symptoms after a cognitively focused behavioral intervention in patients with IBS, IBS patients with lower HF and a higher LF/HF ratio at baseline exhibited less benefit from the intervention with regard to GI symptoms than those with higher HF and lower LF/HF at baseline. 23 The authors of that study suggested that IBS patients with lower HF and higher LH/HF ratio at baseline may not be eligible for cognitively focused behavioral interventions. However, that sample had a mean age of 41 years (intervention group) and symptom duration was not reported, which could affect ANS function in IBS patients.…”

“…Jarrett et al 38 reported no difference in the HRV patterns between IBS patients and healthy controls in a study of 7 to 10 yearold children in contrast to previous studies of adults. 3,23,36 They suggested that age and symptom duration could affect ANS function in IBS patients. Likewise, we anticipated that ANS dysfunction could be reversed with CBT in a young population because the duration of dysfunction is shorter, and the associated physiologic changes may not be severe.…”

“…3,5 Non-pharmacologic treatments, such as cognitive behavior therapy (CBT), have been effective in improving somatic symptoms of IBS. 15,22,23 The mechanism by which CBT improves somatic symptoms is related to the regulation of brain-gut axis function. 15,22,24 HRV is an objective, noninvasive biomarker that reflects current ANS function correlated with IBS symptoms.…”

“…Moreover, sustained effects of CBT have not been adequately tested in IBS patients. 23 Therefore, the specific aims of this study are to evaluate (1) the responses of HRV, GI symptoms, anxiety, depression, and stress to an 8-week CBT intervention and (2) the associations of changes in HRV responses with changes in GI symptoms, anxiety, depression, and stress in young female nursing students with IBS-C. We hypothesized that the CBT group would have increased HF power and decreased LF/HF ratio correlating with improvements in GI symptoms, anxiety, depression, and stress, whereas the control group would have no significant changes. We further hypothesized that these stated changes would be observed immediately after CBT and sustained at 16 and 24 weeks following the completion of CBT.…”

COMT Val158Met Polymorphism and Symptom Improvement Following a Cognitively Focused Intervention for Irritable Bowel Syndrome

“…Self-management programs are effective behavioral interventions for many patients with IBS (Lackner et al, 2007). Our nurse-delivered Comprehensive Self-Management (CSM) intervention was developed and tested in three randomized controlled trials (RCTs) (Heitkemper et al, 2004; Jarrett et al, 2016; Jarrett et al, 2009). Our CSM intervention is based on an IBS biopsychosocial conceptual model (Drossman & Dumitrascu, 2006); and is grounded in cognitive behavioral therapy (CBT) and includes cognitively focused strategies (Barney, Weisman, Jarrett, Levy, & Heitkemper, 2010).…”