Early life factors initiate a ‘vicious circle’ of affective and gastrointestinal symptoms: A longitudinal study

Abstract

Objective: Functional gastrointestinal disorders (FGID) have been shown to be associated with both comorbid mood disorders and traumatic events such as abuse earlier in life. In a longitudinal study, we tested a model that hypothesized: (i) childhood abuse was associated with subsequent mood disorder and pain or interference in life by bowel symptoms both directly and indirectly via neurotic personality; and (ii) an ongoing cycle of mood disorder impacts on bowel symptoms. Design: Subjects from the general population classified as irritable bowel syndrome and/or functional dyspepsia (IBS/FD, n ¼ 207) or free of FGID (n ¼ 100) were prospectively studied every 6 months over 18 months. In addition to bowel symptom interference and abdominal pain, measures of personality (neuroticism), childhood abuse history, depression, and anxiety were obtained. The hypothesized model was tested via Path Modelling. Results: Childhood abuse was found to be directly associated with neuroticism but only indirectly associated with baseline interference and mood disorders (via neuroticism). The data further supported an ongoing cycle of elevations in mood disorders and pain/interference by bowel symptoms. The data supported direct effects of interference at one time point on interference at the subsequent time point in addition to indirect effects of prior anxiety and depression. Repeating the model with pain frequency as the outcome yielded almost identical findings which suggests the findings are generalized across domains of symptoms and quality-of-life. Conclusion: Our data provide support for a model characterized by a 'vicious circle' between mood disorders and FGID symptoms in adulthood, with initial input from early life factors.

Brain-based Correlations Between Psychological Factors and Functional Dyspepsia

“…This model showed the maintenance of gastrointestinal symptoms relying on an ongoing interaction between mood disorders and abdominal symptoms. 29 In the present study, we found the correlations between anxiety/depression and dyspeptic symptoms based on glycometabolism in accordance with the model proposed by Jones et al 29 The insula, ACC, MCC and PFC may be crucial for both visceral condition and emotional situation, thus their abnormalities may modify the emotional response and visceral state, promoting gastrointestinal disorders. That is to say, psychological aspects or gastrointestinal tracts, facing uncertain threat, may lead to the triggering and exacerbation of dyspepsia symptoms.…”

Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population

“…Our data also link with population studies showing the association between socioeconomic factors, FGID incidence, and psychological morbidity, 9,24,32,33 suggesting that socioeconomic disadvantage may be partly responsible for driving the brain-to-gut pathway. However, the manifestation of FGIDs in patients with psychological disturbances and the manifestation of psychological disturbances in patients with FGID is not simply a coincidence.…”

“…8 Data from our own group are supportive of the directional hypothesis that abuse during childhood is associated with elevated neuroticism and FGIDs in adulthood. 9 FGIDs are strongly associated with anxiety and depression in cross-sectional studies. 10 Longitudinal studies to date have been inconclusive with some evidence suggesting a bidirectional pathway.…”

Functional dyspepsia

“…Known and presumed risk factors for developing func tional dyspepsia are gastrointestinal infections and traveller's diarrhoea 25 , antibiotic use 26 , intake of NSAIDs 27 , childhood abuse 28 , early environ mental microbial exposure 29 and other early life factors 30 , smoking 31 , overweight and obesity 32 and perceived stress 33 as well as psycho social states and traits (for example, anxiety and depression; see Psychosocial factors and brain mech anisms, below). Women have an overall higher prob ability of developing functional dyspepsia compared with men 34 , including post-infectious functional dys pepsia 35 .…”

“…The most widely used generic measure, the Short Form 36-Item Health Survey (SF-36) 222 , assesses eight dimensions of health: physical functioning, social functioning, Nature Reviews | Disease Primers Fatty foods , milk and dairy Alcohol , coffee Red meat Carbonated drinks Vegetables Spicy foods Carbohydrates and wheat (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) Citrus (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) Figure 5 | Foods and food groups frequently associated with symptom induction or exacerbation in functional dyspepsia. Offending foods reported by patients with functional dyspepsia include fatty food (for example, fried food [179][180][181]187,191 ), alcohol 179,180 , dairy products 179,181 , coffee [179]…”