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Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction.
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A standardised inventory of stressful life events and a bowel symptom questionnaire were administered at three month intervals for one year to 383 women who were unselected with respect to bowel symptoms. A NEO Personality Inventory was given initially to assess neuroticism. Subjects who satisfied restrictive diagnostic criteria for irritable bowel syndrome were compared with those who complained of abdominal pain plus altered bowel habits but who did not meet restrictive diagnostic criteria (functional bowel disorder) and with controls without bowel dysfunction. The irritable bowel group showed significantly higher levels of stress than the other two groups even when the confounding effects of neuroticism were statistically controlled for. Time lagged correlations showed that stress in one three month interval was significantly correlated with bowel symptoms in the subsequent three month interval for all groups. The slope of the regression line relating stress to bowel symptoms was significantly steeper for the irritable bowel group than for the other two groups at three and six months, suggesting that subjects with irritable bowel syndrome show a greater reactivity to stress. Stress scores were also significantly correlated with the number of disability days and the number of medical clinic visits for bowel symptoms.
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“Recent investigations have found that mindfulness meditation induces changes in the activation of neural circuits implicated in interoception (awareness of stimuli originating inside the body (21)) and emotion regulation (22,23), while improving attentional control (24–27).”
From Mindfulness training reduces the severity of irritable bowel syndrome in women: Results of a randomized controlled trial (2011) · cites this paper as [26]
Experimental — accuracy not yet measuredIn the citing paper
“Early life experiences (e.g., abuse), adult stressors (e.g., divorce or bereavement), lack of social support, and other social learning experiences can affect both an individual’s physiological and psychological responses, and may precipitate abdominal distress, as well as psychiatric disorders (4,7–11).”
From Psychosocial Distress and Somatic Symptoms in Community Subjects With Irritable Bowel Syndrome: A Psychological Component Is the Rule (2009) · cites this paper as [10]
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“Although different types of psychological stressors, including early-life stress and sustained stress, have been recognized as risk factors or promoters of events that result in disease exacerbation in patients with ulcerative colitis2 and IBS,3”
From Principles and clinical implications of the brain-gut-enteric microbiota axis (2009) · cites this paper as [3]
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“Our group (22) and others (23, 24) have reported that subgroups of persons with IBS have a significant within-person relationship between stress the day before and gastrointestinal symptoms the following day, although Sul et al (25) did not find a significant within-person relationship.”
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Camilleri, M., Heading, R. C., & Thompson, W. (2002) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2002.01305.x · Cited by 134
Gender role and irritable bowel syndrome: literature review and hypothesis
Toner, B. B., & Akman, D. (2000) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.01698.x · Cited by 132
“(24) found that three of the six Manning symptoms formed a cluster in all subgroups, concluding that the Manning criteria have equal applicability to both men and women.”
BackgroundReview article: an integrated approach to the irritable bowel syndrome
Drossman, D. A. (1999) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.1999.0130s2003.x · Cited by 130
Levy, R. L., Cain, K. C., Jarrett, M. E., & Heitkemper, M. M. (1997) · Journal of Behavioral Medicine · doi:10.1023/a:1025582728271 · Cited by 131
“Whitehead et al (1992) found that stressful life events recalled for a 3-month period were significantly correlated with bowel symptoms recalled over the subsequent 3 moths, with IBS patients showing greater reactivity to stress than asymptomatic control subjects.”
BackgroundEpidemiology of Irritable Bowel Syndrome
Müller-Lissner, S. A. (2013) · Wiley eBooks · doi:10.1002/9781118444689.ch2 · Cited by 133
Choung, R. S., Locke, G. R., Zinsmeister, A. R., Schleck, C. D., & Talley, N. J. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.239 · Cited by 129
Yang, J., Lee, H.-R., Low, K., Chatterjee, S., & Pimentel, M. (2008) · Digestive Diseases and Sciences · doi:10.1007/s10620-007-9839-8 · Cited by 129
“There have been several hypotheses characterizing IBS, including altered gut motility [4], peripheral [5] and central [6] sensory dysfunction, and an abnormal response to stress [7].”
BackgroundStereotaxic delivery of corticosterone to the amygdala modulates colonic sensitivity in rats
Meerveld, B. G., Gibson, M. S., Gunter, W., Shepard, J. D., Foreman, R. D., & Myers, D. A. (2001) · Brain Research · doi:10.1016/s0006-8993(00)03305-9 · Cited by 125
Evidence for visceral hypersensitivity in high-anxiety rats
Gunter, W., Shepard, J. D., Foreman, R. D., Myers, D. A., & Beverley (2000) · Physiology & Behavior · doi:10.1016/s0031-9384(99)00254-1 · Cited by 121
Galley, J. D., Yu, Z., Kumar, P., Dowd, S. E., Lyte, M., & Bailey, M. T. (2014) · Gut Microbes · doi:10.4161/19490976.2014.972241 · Cited by 124
“Such differences include a reduction in overall diversity, and shifts in major phyla like the Firmicutes and Bacteroidetes, as well as commensals like Bifidobacterium, Faecalibacterium prausnitzii and Roseburia.63-67 It is not yet clear whether the changed microbiome is the cause or the effect of the increased inflamm…”
BackgroundInfluentialSlow transit constipation: a model of human gut dysmotility. Review of possible aetiologies
Knowles, C. H., & Martín, M. (2000) · Neurogastroenterology & Motility · doi:10.1046/j.1365-2982.2000.00198.x · Cited by 119
Fortnightly Review: Irritable bowel, irritable body, or irritable brain?
Farthing, M. J. G. (1995) · BMJ · doi:10.1136/bmj.310.6973.171 · Cited by 119
Ringel, Y., Sperber, A. D., & Drossman, D. A. (2001) · Annual Review of Medicine · doi:10.1146/annurev.med.52.1.319 · Cited by 117
Miwa, H. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2011.01872.x · Cited by 113
Herschbach, P., Henrich, G., & von Rad, M. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00005 · Cited by 110
Sweetser, S. R., Camilleri, M., Nord, S. L., Burton, D. D., Castenada, L., Croop, R. S., Tong, G., Dockens, R. C., & Zinsmeister, A. R. (2009) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00011.2009 · Cited by 114
“There is an association of IBS with increased response to stress (51), and concomitant anxiety or depression is frequent in IBS.”
BackgroundCorticosteroid receptor-mediated mechanisms in the amygdala regulate anxiety and colonic sensitivity
Myers, B., & Meerveld, B. G. (2007) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00080.2007 · Cited by 113
“Furthermore, there is a statistically significant correlation between stress, bowel symptoms, illness-related absenteeism, and medical clinic visits (44).”
BackgroundSecond Asian Consensus on Irritable Bowel Syndrome
Gwee, K., Gonlachanvit, S., Ghoshal, U. C., Chua, A. S. B., Miwa, H., Wu, J. C. Y., Bak, Y., Lee, O. Y., Lu, C., Park, H., et al. (2019) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm19041 · Cited by 112
“symptoms in IBS patients show higher correlation than that in healthy individuals.(49) IBS patients show more exaggerated colonic motility in response to experimental stress than healthy subjects.”
BackgroundKoloski, N. A., Talley, N. J., & Boyce, P. M. (2003) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2003.07388.x · Cited by 111
“Others have observed that psychological vulnerability (6) and life-event stress (12) are associated with a poorer outcome for people with chronic GI symptoms (6, 13, 14, 33), although these studies have relied on retrospective data or have used volunteers, which may potentially bias the results.”
BackgroundResultMeerveld, B. G., Johnson, A. C., Cochrane, S. W., Schulkin, J. A., & Myers, D. A. (2005) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2005.00648.x · Cited by 111
Quality of Life in Irritable Bowel Syndrome
Lea, R., & Whorwell, P. J. (2001) · PharmacoEconomics · doi:10.2165/00019053-200119060-00003 · Cited by 106
Does endoscopy have a positive impact on quality of life in dyspepsia?
Wiklund, I. E., Glise, H., Jerndal, P., Carlsson, J., & Talley, N. J. (1998) · Gastrointestinal Endoscopy · doi:10.1016/s0016-5107(98)70243-3 · Cited by 104
Dehhaghi, M., Panahi, H. K. S., Heng, B., & Guillemin, G. J. (2020) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2020.562812 · Cited by 101
Abnormal Propagation Pattern of Duodenal Pressure Waves in the Irritable Bowel Syndrome (IBS)
Simrén, M., Castedal, M., Svedlund, J., Abrahamsson, H., & Björnsson, E. S. (2000) · Digestive Diseases and Sciences · doi:10.1023/a:1010770302403 · Cited by 101
“Since the IBS patients who consult a doctor exhibit higher levels of stress than healthy controls (27), the increased frequency of cluster activity in IBS patients participating in clinical studies may reflect their state of anxiety, rather than a primary motor dysfunction.”
BackgroundPalsson, O. S., & Drossman, D. A. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.004 · Cited by 99
“Detailed analyses of changes in symptoms and life experiences of IBS patients over time demonstrate that increases in stressful life events are associated with greater bowel symptoms [21,30].”
BackgroundWinston, J. H., Xu, G., & Sarna, S. K. (2009) · Gastroenterology · doi:10.1053/j.gastro.2009.09.054 · Cited by 102
Metadata
- Authors
- Whitehead, W. E., Crowell, M. D., Robinson, J. C., Heller, B. R., & Schuster, M. M.
- Affiliations
- Johns Hopkins University (US)
- Venue
- Gut
- Publisher
- BMJ
- Published
- 1992-06
- Volume
- 33
- Issue
- 6
- Pages
- 825-830
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1379344
- OpenAlex
- W2091075637
- Cited by
- 432
- References
- 21
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 16 · 2019: 13 · 2018: 14 · 2017: 7 · 2016: 16 · 2015: 18 · 2014: 12 · 2013: 14 · 2012: 17
- FWCI
- 6.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2k05mh000133-17, 5r01nr001369-03)
- National Institute of Mental Health (KO5 MH00133)
- National Institute of Nursing Research (R01 NR01369)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Health and Development
- Keywords
- irritable bowel syndrome, life events, bowel symptoms, functional bowel disorders, stress reactivity, neuroticism, abdominal pain, altered bowel habits, disability days, women
- MeSH terms
- Adult, Colonic Diseases, Functional, Constipation, Diarrhea, Female, Humans, Life Change Events, Neurotic Disorders, Personality Inventory, Prospective Studies, Stress, Psychological
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