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Motility and visceral sensation
The role of psychological and biological factors in postinfective gut dysfunction
  1. K-A Gweea,
  2. Y-L Leonga,
  3. C Grahamb,
  4. M W McKendrickb,
  5. S M Collinse,
  6. S J Waltersc,
  7. J E Underwoodd,
  8. N W Reada
  1. aGastrointestinal Motility Unit, University of Sheffield, Northern General Hospital, Sheffield S5 7AU, UK, bDepartment of Infectious Diseases, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, cSheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK, dDepartment of Pathology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, eIntestinal Diseases Research Unit, McMaster University, Hamilton, Canada
  1. Professor Read.

Abstract

BACKGROUND Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS).

AIMS To investigate how the psychological factors act, and the involvement of infective and physiological factors.

METHODS Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and past illness experiences on standardised questionnaires. They also completed psychometric questionnaires for anxiety, neuroticism, somatisation, and hypochondriasis. In some patients, rectal biopsy specimens were obtained during the acute illness and at three months postinfection.

RESULTS Ninety four patients completed all questionnaires: 22 patients were diagnosed with IBS after their gastroenteritis (IBS+), and 72 patients returned to normal bowel habits (IBS−). IBS+ patients reported more life events and had higher hypochondriasis scores than IBS− patients. The predictive value of the life event and hypochondriasis measures was highly significant and independent of anxiety, neuroticism, and somatisation scores, which were also elevated in IBS+ patients. Rectal biopsy specimens from 29 patients showed a chronic inflammatory response in both IBS+ and IBS− patients. Three months later, specimens from IBS+ patients continued to show increased chronic inflammatory cell counts but those from IBS− patients had returned to normal levels. IBS+ and IBS− patients exhibited rectal hypersensitivity and hyper-reactivity and rapid colonic transit compared with normal controls, but there were no significant differences between IBS+ and IBS− patients for these physiological measurements.

CONCLUSION Psychological factors most clearly predict the development of IBS symptoms after gastroenteritis but biological mechanisms also contribute towards the expression of symptoms.

  • irritable bowel syndrome
  • gastroenteritis
  • chronic inflammation
  • rectal sensitivity
  • intestinal transit
  • psychosomatic

  • Abbreviations

    IBS
    irritable bowel syndrome
    NC
    normal controls
    WIH
    Whiteley Index of Hypochondriasis
    WGTT
    whole gut transit time
    CI
    confidence interval
    IQR
    interquartile range

    • https://doi.org/10.1136/gut.44.3.400

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    • Abbreviations

      IBS
      irritable bowel syndrome
      NC
      normal controls
      WIH
      Whiteley Index of Hypochondriasis
      WGTT
      whole gut transit time
      CI
      confidence interval
      IQR
      interquartile range
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