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Title: Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome

item JARRETT, MONICA - University Of Washington
item HEITKEMPER, MARGARET - University Of Washington
item CZYZEWSKI, DANITA - Baylor College Of Medicine
item ZELTZER, LONNIE - Geffen School Of Medicine
item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: The Journal of Pain
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/21/2012
Publication Date: 5/1/2012
Citation: Jarrett, M., Heitkemper, M., Czyzewski, D., Zeltzer, L., Shulman, R.J. 2012. Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome. The Journal of Pain. 13(5):477-484.

Interpretive Summary: The autonomic nervous system (ANS) is responsible, in part, for regulating how our intestines work. Studies in adults suggest that the ANS can be affected by stress and other psychological pressures. In this study, we discovered that the ANS in children is less affected by psychological factors than in adults. However, young girls are more likely to have the ANS affected by psychological distress. Our observation underline the importance of brain/gut and emotional influence on intestinal pain.

Technical Abstract: Adults with irritable bowel syndrome (IBS) have been reported to have alterations in autonomic nervous system function as measured by vagal activity via heart rate variability. Whether the same is true for children is unknown. We compared young children 7 to 10 years of age with functional abdominal pain (FAP) or IBS to healthy children (HC) and explored the relationship of vagal activity and sympathovagal balance to psychological distress and stool type. Children completed questionnaires, kept a 2-week pain/stool diary, and wore a 24-hour Holter monitor to assess vagal activity. Group comparisons on vagal activity were controlled for age and body mass index. Indicators of vagal activity and sympathovagal balance did not differ between FAP/IBS children (70 girls, 30 boys) and HC (44 girls, 18 boys). Psychological distress measures were generally higher in FAP/IBS than HC, primarily in girls. Exploratory analyses suggest a potential negative correlation between vagal activity and psychological distress in FAP/IBS girls but not boys. In contrast to reports in women, no differences were found in vagal activity between FAP/IBS and HC. Preliminary findings suggest that in girls with FAP/IBS there is an inverse relationship between vagal activity and psychological distress. The results from this study suggest a possible relationship between emotional state and vagal activity in prepubertal girls (but not boys) with FAP/IBS. Age and/or duration of symptoms may explain our contrasting findings versus adults with IBS.