The role of psychological and biological factors in postinfective gut dysfunction
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BACKGROUND: Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS). AIMS: To investigate how the psychological factors act, and the involvement of infective and physiological factors. METHODS: Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and past illness experiences on standardised questionnaires. They also completed psychometric questionnaires for anxiety, neuroticism, somatisation, and hypochondriasis. In some patients, rectal biopsy specimens were obtained during the acute illness and at three months postinfection. RESULTS: Ninety four patients completed all questionnaires: 22 patients were diagnosed with IBS after their gastroenteritis (IBS+), and 72 patients returned to normal bowel habits (IBS−). IBS+ patients reported more life events and had higher hypochondriasis scores than IBS− patients. The predictive value of the life event and hypochondriasis measures was highly significant and independent of anxiety, neuroticism, and somatisation scores, which were also elevated in IBS+ patients. Rectal biopsy specimens from 29 patients showed a chronic inflammatory response in both IBS+ and IBS− patients. Three months later, specimens from IBS+ patients continued to show increased chronic inflammatory cell counts but those from IBS− patients had returned to normal levels. IBS+ and IBS− patients exhibited rectal hypersensitivity and hyper-reactivity and rapid colonic transit compared with normal controls, but there were no significant differences between IBS+ and IBS− patients for these physiological measurements. CONCLUSION: Psychological factors most clearly predict the development of IBS symptoms after gastroenteritis but biological mechanisms also contribute towards the expression of symptoms.
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Other studies have shown the importance of increased 5HT containing cells in irritable bowel syndrome with diarrhoea and increased sensitivity in irritable bowel syndrome with diarrhoea with increased enterochromaffin cell counts, accelerated gut transit and visceral hypersensitivity.
“Other studies have shown the importance of increased 5HT containing cells in IBS-D130 and increased sensitivity in IBS-D with increased EC cell counts,131 accelerated gut transit and visceral hypersensitivity.132”
From Intestinal microbiota in functional bowel disorders: a Rome foundation report (2013) · cites this paper as [132]
In postinfectious IBS, major psychological stress around the time of gastroenteritis, trait anxiety, as well as extended duration of the infection, have been identified as risk factors for the persistence of symptoms.
“In postinfectious IBS, major psychological stress around the time of gastroenteritis, trait anxiety, as well as extended duration of the infection, have been identified as risk factors for the persistence of symptoms.81”
From Principles and clinical implications of the brain-gut-enteric microbiota axis (2009) · cites this paper as [81]
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- Authors
- Gwee, K.-A., Leong, Y.-L., Graham, C., McKendrick, M. W., Collins, S. M., Walters, S. J., Underwood, J. E., & Read, N. W.
- Affiliations
- aGastrointestinal Motility Unit, University of Sheffield, Northern General Hospital, Sheffield S5 7AU, UK, bDepartment of Infectious Diseases, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, cSheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK, dDepartment of Pathology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK, eIntestinal Diseases Research Unit, McMaster University, Hamilton, Canada
- Royal Hallamshire Hospital (GB)
- Corresponding author
- Read, N W
- Venue
- Gut
- Publisher
- BMJ
- Published
- 1999-03-01
- Volume
- 44
- Issue
- 3
- Pages
- 400-406
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1727402
- OpenAlex
- W2030727832
- Cited by
- 764
- References
- 49
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 15 · 2018: 16 · 2017: 15 · 2016: 24 · 2015: 20 · 2014: 29 · 2013: 26 · 2012: 41
- FWCI
- 26.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Keywords
- irritable bowel syndrome, gastroenteritis, psychological factors, health anxiety, life events, rectal hypersensitivity, colonic transit, anxiety, neuroticism, somatization
- MeSH terms
- Adolescent, Adult, Aged, Biopsy, Colon, Colonic Diseases, Functional, Humans, Hypochondriasis, Life Change Events, Middle Aged, Psychometrics, Psychophysiologic Disorders, Rectum, Case-Control Studies
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