Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: 1/1/2008
Publication Date: 4/1/2008
Citation: Shulman, R.J., Czyzewski, D.I., Lane, M., Jarrett, M., Burr, R.L. 2008. Gastrointestinal (GI) permeability is associated with trait anxiety in children with functional abdominal pain (FAP) and Irritable Bowel Syndrome (IBS) [abstract]. Gastroenterology. 134(Suppl.1):A-188 Interpretive Summary:
Technical Abstract: FAP and IBS affect 10-15% of school age children and bear many physiological similarities to irritable bowel syndrome (IBS) in adults (e.g., functional pain, visceral hyperalgesia). Animal models of IBS have suggested a relationship between neonatal stress and increased GI permeability later in life (Pediatr Res 2007;62: 240). We hypothesized that psychological and physiological measures related to the experience of stress would predict GI permeability in children with FAP/IBS. Children (age 7-10 yr) were identified by chart review in pediatrician's or pediatric gastroenterologist's offices. Children (n=99) met Rome II criteria for FAP or IBS. Phone screening confirmed current symptoms. After instruction in the home by research assistants the children completed the State-Trait Anxiety Inventory for Children (STAIC) which measures both stable tendencies to experience anxiety (Trait) and current level of anxiety (State). They then underwent measurement of GI permeability to measure gastric (sucrose), small intestinal (lactulose/mannitol ratio), and colonic (sucralose/lactulose ratio) permeability. A first morning urine collection was obtained to measure norepinephrine, cortisol, and creatinine excretion. The mean age of the children was 8.5 +/- 0.1 yr (mean +/- SEM). Mean percent recovery for sucrose was 0.023 +/- 0.002. The lactulose/mannitol and sucralose/lactulose ratios (per m2) were 0.064 +/- 0.004 and 1.134 +/- 0.104, respectively. Mean urinary norepinephrine/creatinine ratio was 22.5 +/- 0.0 and cortisol/creatinine ratio was 34.3 +/- 0.0. A series of regression equations were performed. In the first, the lactulose/mannitol ratio (i.e., small intestinal permeability) was predicted by the Trait anxiety score: F(1, 91) = 5.23; P = 0.025, r = 0.21). When urinary norepinephrine/creatinine ratio and cortisol/creatinine ratio were included in the model the prediction of permeability was stronger: F(3, 73) = 4.73; P = 0.005, r = 0.37. There was no relationship between Trait anxiety score and gastric or colonic permeability or between State anxiety score and GI permeability. There is a positive relationship between the stable tendency to experience anxiety states and small intestinal permeability in children with FAP/IBS. Catecholamine and cortisol excretion magnify the relationship. These data lend support to the hypothesis that stress (anxiety, norepinephrine and cortisol levels) may affect GI permeability. Whether this is related to pre-and/or perinatal stress in children needs to be determined.