Location: Children's Nutrition Research CenterTitle: Gastrointestinal (GI) permeability correlates with trait anxiety and urinary norepinephrine/creatinine (CR)ratio in children with functional abdominal pain (FAP)and irritable bowel syndrome (IBS) but not in controls Author
Submitted to: Neurogastroenterology & Motility
Publication Type: Abstract Only
Publication Acceptance Date: 8/1/2008
Publication Date: 10/1/2008
Citation: Shulman, R.J., Czyzewski, D., Lane, M., Jarrett, M., Burr, R., Heitkemper, M. 2008. Gastrointestinal (GI) permeability correlates with trait anxiety and urinary norepinephrine/creatinine (CR)ratio in children with functional abdominal pain (FAP)and irritable bowel syndrome (IBS) but not in controls [abstract]. Neurogastroenterology & Motility. 20(Supple.1):137-138. Interpretive Summary:
Technical Abstract: FAP and IBS affect 10–15% of school age children and bear many 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/anxiety and increased GI permeability later in life. We hypothesized that psychological and physiological measures related to the experience of stress/anxiety, would predict GI permeability more strongly than in children with FAP/IBS vs Control children without GI complaints. Children (age 7–10 years) were identified by chart review in pediatrician’s or pediatric gastroenterologist’s offices. FAP/IBS children (n = 98) met Rome II criteria and Controls were healthy children without GI complaints (n = 64). 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 small intestinal permeability (lactulose/mannitol ratio). A first morning urine collection was obtained to measure norepinephrine (Norepi), epinephrine (Epi), cortisol (Cort), and Cr excretion. Mean age in FAP/IBS group was 8.5 ± 1.1 years and 70.2% were female vs. 8.7 ± 1.1 years and 70.2% in controls, respectively (mean ± SD). The mean score/value on STAIC-State and Trait Anxiety Score, lactulose/mannitol ratio, or urinary norepi/Cr, epi/Cr, cort/Cr ratios was similar between groups (Table). The effect of Anxiety Score, norepi/epi/cort, and group membership on permeability was assessed with general linear modeling techniques. There was a significant interaction between STAICTrait Anxiety Score and group (P = 0.044). Permeability increased with increasing anxiety in the FAP/IBS group but not in controls. There also was a significant interaction between norepi/Cr and group (P = 0.005). Permeability decreased with increasing norepi/Cr in the FAP/IBS group but not in controls. There is a positive relationship between the stable tendency to experience anxiety states and small intestinal permeability in children with FAP/IBS, but not in controls. These data lend support to the hypothesis that stress/anxiety may affect GI permeability in FAP/IBS. Whether this is related to perinatal stress in children needs to be determined. We speculate that the inverse relationship between permeability and norepi/Cr may relate to the ability of this hormone to reduce GI permeability.