Heart Rate Variability and Somatization in Adolescents With Irritable Bowel Syndrome 2023 Semen et al

[Andy]

Background/Aims
Changes in autonomic regulation and psychological distress play an important role in the pathobiology of irritable bowel syndrome (IBS). The aim of the current study is to evaluate the autonomic function and to link it to the levels of somatization in adolescents with IBS.

Methods
We enrolled 30 adolescents with various types of IBS and 35 healthy controls. Time and frequency domain indexes of heart rate variability (HRV) were measured in supine (baseline) and standing (orthostasis) positions using short-term electrocardiographic recordings. The somatic symptoms index was assessed with the modified Screening for Somatoform Symptoms questionnaire.

Results
Adolescents with IBS showed no differences of HRV parameters in the supine position compared to healthy control. In orthostasis, a decrease in the standard deviation of normal RR intervals as well as main spectral index total power (TP) were observed. The reduction of TP was attributed to the reduced activities of the high- and low frequency components. Increased somatic symptoms index in IBS patients negatively correlated with TP in orthostasis (r = –0.485, P = 0.007). A subgroup analysis revealed that adolescents with IBS with TP values either < 2500 msec2 or > 5500 msec2 in the supine position demonstrated significantly reduced activity of the low frequency component.

Conclusions
Adolescents with IBS showed signs of autonomic dysfunction only during the orthostatic test, which were associated with increased somatization scores. Further research is needed to establish the links between emotional wellbeing and autonomic function in this population.

Open access, https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22019

 

[alktipping]

Changes in autonomic regulation and psychological distress play an important role in the pathobiology of irritable bowel syndrome. quite the statement so where is the evidence to back it up .

 

[SNT Gatchaman]

Added links.

In the adolescent population from China the prevalence of IBS was reported to be as high as 21%, which was attributed to the higher levels of psycho-emotional distress.

The Rome IV Consensus (2016) acknowledges the biopsychosocial model of IBS as the framework to understand its pathophysiology [paper's ref].

It has been suggested that the development of autonomic imbalance in IBS may be triggered by the disorders of intestinal motility and production of the pro-inflammatory cytokines within the intestinal mucosa as well as changes in the regulation within the hypothalamic-pituitary-adrenal axis.

Despite this paper being published in the Journal of Neurogastroenterology and Motility, we're not going to discuss this further or even mention the word 'motility' again.

The phenomenon of somatization denotes a tendency to experience personal psycho-emotional and social distress at a somatic level, namely, as increased perception, awareness, and/or pathological interpretation of unpleasant physiological sensations. Frequent complaints related to somatization include abdominal distension, pain or bloating, which significantly impair quality of life and may require use of medications.

The aim of current study is to evaluate autonomic dysfunction and to link it with the somatic symptoms index in adolescents with IBS.

Our study revealed that adolescents with IBS had high levels of somatization. [...] A possible connection between somatization and ANS dysfunction can be explained by alexithymia, which is usually characterized by difficulties in understanding own feelings and emotions and their verbal expression.

Mission accomplished.

Strangely no-one seems to discuss the possibility that (1) autonomic dysfunction and (2) psychoemotional distress might be linked, with 1 -> 2 or both independently following... oh I don't know... something like "triggered by the disorders of intestinal motility and production of the pro-inflammatory cytokines within the intestinal mucosa". It's always 2 -> 1.

 

[Sean]

It is the arbitrary assigning of causal direction, without adequate testing, that is the rotten heart of psychosomatics.

 

[Hutan]

None so blind...

I cannot understand how people can write this stuff and not see the holes in their assumptions.

 

[Sean]

I cannot understand how people can write this stuff and not see the holes in their assumptions.

The single most important and practically useful advice I have ever heard about assessing any study is identify and test the assumptions underlying it, because that is almost always where they will fail.

Go for the assumptions, and you will rarely be wrong, and will save yourself a lot of time and energy.

For example, the assumption of deconditioning (and its causal role) in the BPS view of ME.

 

[rvallee]

Changes in autonomic regulation and psychological distress play an important role in the pathobiology of irritable bowel syndrome. quite the statement so where is the evidence to back it up .

Gotta love how for years it was "you can't use wikipedia as a source, anyone can write anything in there and many statements aren't backed up by anything", and then you find that it's basically standard in medicine to do just that, pass one's own opinion as if it's some fact, as long as that opinion is popular.

It sure is true that in most contexts, this is not allowed. Certainly in every other profession. Outside of work hours? Sure, whatever. On the clock? Nope. Nopitty nope. Great way to have either a short career, or get stuck in entry-level positions. In medicine? Elected president of all medicine, or whatever. It's absurd how different the standards are, how arbitrary.