Contribution of Gender to Pathophysiology and Clinical Presentation of IBS: Should Management Be Different in Women?

Ouyang, Ann; Wrzos, Helena

doi:10.1111/j.1572-0241.2006.00975.x

Cited by 55 publications

(47 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Gender, sex, and the pathophysiology of IBS There are multiple points at which sex and gender may influence the GI tract, brain-gut axis, and subsequent clinical outcomes including response to behavioral and drug therapies in patients with IBS [11]. Diverse factors such as mood, stress, gender role, hormones, as well as inflammatory mediators may modulate the brain-gut axis.…”

Section: Gender and Symptom Reportingmentioning

confidence: 99%

Irritable bowel syndrome: Does gender matter?

Heitkemper

Jarrett

2008

Journal of Psychosomatic Research

View full text Add to dashboard Cite

Section: Gender and Symptom Reportingmentioning

confidence: 99%

Irritable bowel syndrome: Does gender matter?

Heitkemper

Jarrett

2008

Journal of Psychosomatic Research

View full text Add to dashboard Cite

“…For example visceral pain disorders such as functional dyspepsia or chronic pelvic pain, somatic pain disorders such as fibromyalgia or migraines, and affective disorders such as chronic fatigue syndrome, anxiety or depression, all have female-predominate sex ratios. 7,78,79 These sex-related differences in symptom expression begin around puberty, with the surge of gonadal hormones, but continues to increase through the mid-forties. 80 Interestingly, the rate of newly diagnosed IBS patients decreases after the age of 50 and the sex ratio for IBS patients is similar in the elderly.…”

Section: Sex Linked Differences In Visceral Sensitivitymentioning

confidence: 99%

“…[1][2][3][4][5][6] Risk factors for IBS include being female and exposure to chronic stress. [7][8][9][10][11] A common feature of IBS is that for many patients, their symptoms are worsened by stress and overlap with other stress disorders, including anxiety, depression, and post-traumatic stress disorder. [12][13][14][15] In support of IBS being a stress-sensitive disorder, there is experimental evidence showing abnormal hypothalamicpituitary-adrenal (HPA) axis reactivity in IBS patients as shown by a heightened HPA response to a corticotropin-releasing hormone (CRH) challenge, and an overall increase in hourly cortisol secretion in IBS compared to controls.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Stress-induced Visceral Pain

Meerveld

Johnson

2018

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Evidence suggests that long-term stress facilitates visceral pain through sensitization of pain pathways and promotes chronic visceral pain disorders such as the irritable bowel syndrome (IBS). This review will describe the importance of stress in exacerbating IBS-induced abdominal pain. Additionally, we will briefly review our understanding of the activation of the hypothalamic-pituitary-adrenal axis by both chronic adult stress and following early life stress in the pathogenesis of IBS. The review will focus on the glucocorticoid receptor and corticotropin-releasing hormone-mediated mechanisms in the amygdala involved in stress-induced visceral hypersensitivity. One potential mechanism underlying persistent effects of stress on visceral sensitivity could be epigenetic modulation of gene expression. While there are relatively few studies examining epigenetically mediated mechanisms involved in stress-induced visceral nociception, alterations in DNA methylation and histone acetylation patterns within the brain, have been linked to alterations in nociceptive signaling via increased expression of pro-nociceptive neurotransmitters. This review will discuss the latest studies investigating the long-term effects of stress on visceral sensitivity. Additionally, we will critically review the importance of experimental models of adult stress and early life stress in enhancing our understanding of the basic molecular mechanisms of nociceptive processing. Taken together, the complex clinical phenotype makes recapitulating IBS in rodent models extremely challenging. However, an aim of this review will be to describe how the use of rodent models of adult stress, early life stress (ELS), and a dysregulated HPA axis has improved our understanding of stress in the pathophysiology of IBS. Pathophysiology of Irritable Bowel Syndrome: Activation of the Brain-Gut AxisEvidence from clinical and basic research points to dysregulation of the bidirectional communication between the brain-gut axis in IBS. 21 The brain-gut axis represents a dynamic interplay between central circuits and peripheral mechanisms. The messengers of this complex circuit include neural, endocrine, metabolic, and immune mediators that are activated by central factors such as stress (Fig. 1). Although IBS is not an inflammatory disorder, the immune system plays a role in the pathogenesis of IBS in at least a subset of patients and likely contributes to the etiology of IBS symptoms. 22,23 A subset of IBS patients display a low grade chronic inflammation, and there is also evidence that following an enteric infection and combined with stressful life events, there is an increased risk of developed post-infectious IBS. [24][25][26][27] Clearly, the immune system and inflammatory processes are modulated by the HPA and autonomic nervous systems. In support, IBS patients also show increased number and reactivity of mast cells. 28,29 Data from peripheral blood mononuclear cells, as well as in mucosal biopsies, from IBS patients show that cytokines levels including TNF-α...

show abstract

“…IBS prevalence estimates in North America for adults and adolescents are between 10 -15% [1,2]. Boys and girls appear to be equally affected until late adolescence [3], when sex differences emerge and women are twice as likely to be affected as men [4]. Direct costs of IBS to the U.S. health system are in the region of $10 billion, with indirect costs contributing a further $20 billion [5].…”

Section: Introductionmentioning

confidence: 99%

Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome

Evans

Cousins

Tsao

et al. 2011

Trials

View full text Add to dashboard Cite

IntroductionIrritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements.Methods/DesignSixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol.Trial registrationClinicalTrials.gov NCT01107977.

show abstract

Contribution of Gender to Pathophysiology and Clinical Presentation of IBS: Should Management Be Different in Women?

Cited by 55 publications

References 68 publications

Irritable bowel syndrome: Does gender matter?

Irritable bowel syndrome: Does gender matter?

Mechanisms of Stress-induced Visceral Pain

Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome

Contact Info

Product

Resources

About