Gender / Hormones
#13955 - 07/14/03 01:57 PM
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Heather
Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA
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All articles that are gender-specific or related to the role hormones in IBS should be posted here.
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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Gastroenterology June 2003 • Volume 124 • Number 7
Sex-related differences in IBS patients: Central processing of visceral stimuli
Bruce D. Naliboff*,‡ * [MEDLINE LOOKUP]
Steve Berman*,‡,§ [MEDLINE LOOKUP]
Lin Chang*, § [MEDLINE LOOKUP]
Stuart W.G. Derbyshire* [MEDLINE LOOKUP]
Brandall Suyenobu*,‡ [MEDLINE LOOKUP]
Brent A. Vogt'' [MEDLINE LOOKUP]
Mark Mandelkern¶ [MEDLINE LOOKUP]
Emeran A. Mayer*,‡,§,¶,# [MEDLINE LOOKUP]
Abstract
Background & Aims: Women have a higher prevalence of irritable bowel syndrome (IBS) and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.
Methods: Regional cerebral blood flow measurements using H215O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus (moderate rectal inflation) and a psychological stimulus (anticipation of a visceral stimulus).
Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.
Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.
Publishing and Reprint Information
*Center for Neurovisceral Sciences and Women's Health UCLA School of Medicine, Los Angeles, California, USA
§Department of Medicine, UCLA School of Medicine, Los Angeles, California, USA
‡Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, California, USA
#Department of Physiology, UCLA School of Medicine, Los Angeles, California, USA
''Brain Research Institute, UCLA School of Medicine, and VA GLAHS PET Center, Los Angeles, California, USA
''Cingulum NeuroSciences Institute, Syracuse, New York, USA
Supported by National Institutes of Health grants NR 04881 (to B.D.N.), DK 64539 (to E.A.M.), and AR 46122 (to L.C.). Lin Chang received research support from Astra Zeneca, participates in the Speaker's Bureau for GSK and Novartis, and is on the Advisory Board for GSK and Merck. Dr. Derbyshire's current address is: University of Pittsburgh Medical Center, MR Research Facility, PUH B-804, Pittsburgh, Pennsylvania 15213.
*Address requests for reprints to: Bruce D. Naliboff, Ph.D., GLAVAHS, CURE Building, 115/Room 223, 11301 Wilshire Boulevard, Los Angeles, California 90073, USA; fax: (310) 794-2864; Email: naliboff@ucla.edu
Submitted June 18, 2002.
Accepted on February 27, 2003.
Copyright © 2003 by American Gastroenterological Association
doi:10.1016/S0016-5085(03)00400-1
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Irritable Bowel Syndrome Worse During Periods
By Salynn Boyles
WebMD Medical News
March 14, 2002 -- Women who suffer from irritable bowel syndrome often experience a worsening in symptoms during their periods, suggesting that fluctuations in sex hormones may play a role in the condition, British researchers report.
The findings may help explain why more women than men are afflicted with irritable bowel syndrome (IBS), an intestinal condition characterized by gas, bloating, cramps, and changes in bowel habits. Some people with IBS experience constipation, some have diarrhea, and some have both.
"Women with IBS appear to respond differently to hormonal cycles than women without the syndrome," says lead author Lesley A. Houghton, PhD, of the University Hospital of South Manchester. "The potential role of sex hormones in [development] of IBS needs to be taken into consideration by those working on new medications for the disease."
In their research, Houghton and colleagues used balloon distention of the rectum -- a common tool for studying IBS -- to measure sensitivity changes among women with the disorder during different phases of their menstrual cycle. They showed, for the first time, that rectal sensitivity in women with IBS increases during their periods, compared with all other phases in the cycle. This was not true of women without IBS.
Periods were associated with a worsening of abdominal pain and bloating in those with IBS, and trips to the bathroom were more frequent. In addition, the women tended to report lower general well-being during their periods. The findings were reported in the latest issue of the journal Gut.
It is estimated that from 15-20% of the population suffers from irritable bowel syndrome. Symptoms can range from mildly annoying to disabling. Many people are able to control their symptoms through medications, stress management, and diet, but for some these treatments offer little relief.
Because the cause of IBS is not known, many doctors believe its origins are primarily psychological rather than physiological. Gastroenterologist Brenda Horwitz, MD, of Philadelphia's Temple University Health Sciences Center, says studies like this one add validity to the idea that IBS is truly a disease.
"Many doctors think that it is a psychological disease," she tells WebMD. Clearly it is not, and this is good scientific evidence to show that. These women experienced changes in sensitivity during their menstrual cycles that were different from the normal control population.'
Horwitz agrees that the findings could someday lead to better therapies to treat irritable bowel syndrome. Hopes for better treatments have been dampened over the past several years, as promising new drugs were withdrawn from the market due to unacceptable side effects.
"This is a field that is in desperate need of new treatment strategies," Horwitz says. "The standard treatments we are using have been out there for 15 to 20 years."
© 2002 WebMD Inc. All rights reserved.
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Women Health. 1998;27(4):55-66.
Bowel dysfunction in postmenopausal women.
Triadafilopoulos G, Finlayson M, Grellet C.
Gastroenterology Section, Palo Alto VA Health Care System (111-GI), CA 94304, USA. vagt@leland.stanford.edu
BACKGROUND/AIMS: The perimenopausal and postmenopausal states are frequently accompanied by a variety of symptoms of hormonal imbalance. Although vasomotor, vaginal and genitourinary symptoms prevail, gastrointestinal complaints such as abdominal bloating may occur. In this study, we investigated the nature and prevalence of gastrointestinal and irritable bowel syndrome (IBS)-type complaints in women going through their climacteric and postmenopausal periods. PATIENTS/METHODS: 228 women (170 postmenopausal and 58 premenopausal) who presented for evaluation at a primary care practice limited to women's health were evaluated prospectively by a previously validated gastrointestinal symptoms questionnaire designed to evaluate symptoms suggestive of IBS. At the time of their participation in the study, none of these women was presenting for evaluation of abdominal or genitourinary symptoms. RESULTS: Thirty-eight percent of postmenopausal women reported altered bowel function, in contrast to 14% of premenopausal ones (p < 0.001). Despite this, the two groups did not differ in regards to the occurrence of abdominal pain, diarrhea or constipation, suggestive of IBS. The prevalence of IBS-type complaints peaked to 36% during the climacteric period (40-49 years). Laxative usage (9.4% prevalence), gaseousness/excessive flatulence (48% prevalence) and heart-burn/acid regurgitation (34% prevalence) were also more common among postmenopausal women. Estrogen use did not affect gastrointestinal symptoms in any of the two groups. CONCLUSIONS: Although the possible role of aging on symptom perception-regardless of hormonal status-cannot be ruled out, these results suggest that peri- and postmenopausal women have a high prevalence of altered bowel function and IBS-like gastrointestinal complaints that should be carefully assessed. If the diagnosis of IBS is confirmed, appropriate treatment may improve patients' symptoms, although this approach requires further study.
PMID: 9796084 [PubMed - indexed for MEDLINE]
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Scand J Gastroenterol. 2003 Jan;38(1):36-42.
Gender differences in gut transit shown with a newly developed radiological procedure.
Sadik R, Abrahamsson H, Stotzer PO.
Division of Gastroenterology, Institute of Internal Medicine, Sahlgrenska University Hospital, University of Goteborg, Goteborg, Sweden. riadhsadik@hotmail.com
BACKGROUND: Gut transit measurements are essential for understanding the pathophysiology of many gastrointestinal disorders. The ideal bowel transit test should be easy to perform, widely accessible, reproducible, non-invasive and inexpensive and the risks should be minimal. These requirements prompted us to develop a procedure for simultaneous measurement of gastric emptying, small-bowel transit and colonic transit at one visit. We assessed the influence of gender, body mass index, age, menopause and smoking on gastrointestinal transit in healthy subjects. METHODS: Eighty-three healthy subjects (43 women) were included. Colonic transit was based on 10 radiopaque rings given daily for 6 days with fluoroscopy on day 7. Then, the subjects had a test meal containing 20 radiopaque markers. Using fluoroscopy, gastric emptying and small-bowel transit of the markers were followed until they reached the colon. RESULTS: Gastric emptying, small-bowel transit and colonic transit were significantly slower in female healthy subjects compared to males (2.9 (1.6-4.9) h, median and percentile 10-90, versus 2.4 (0.7-3.7) h, P=0.005; 4.4 (2.1-11.1) h versus 3.2 (1.5-6.0) h, P=0.001; 1.5 (1.0-3.7) days versus 1.3 (0.8-1.9) days P=0.002), respectively. Small-bowel transit was significantly faster in women with overweight and in postmenopausal women compared to lean and premenopausal women, respectively. CONCLUSION: This procedure meets most of the requirements of the ideal bowel transit test and is easily performed at one visit. Small-bowel transit as well as gastric emptying and colonic transit were significantly slower for women.
PMID: 12608462 [PubMed - indexed for MEDLINE]
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Int J Fertil Womens Med. 2002 May-Jun;47(3):136-42.
Gender issues in the management of inflammatory bowel disease and irritable bowel syndrome.
Kane S.
Section of Gastroenterology, University of Chicago, Illinois 60637, USA.
Crohn's disease and ulcerative colitis are two chronic inflammatory diseases involving the gastrointestinal tract. While many aspects of the management of these diseases are identical for all patients, there are some issues that are specific to women that are not necessarily part of routine care. Such gender-specific issues as menses, fertility, pregnancy and menopause are often overlooked and mismanaged. Women have different psychological concerns as compared with men with regard to their self-image and impact of disease. Health care providers, regardless of their primary focus, should be aware of these differences and be familiar with general information. Irritable bowel syndrome is a prevalent condition that affects more women than men. Theories as to its underlying pathophysiology are still evolving, but what does appear clear is that women pose specific challenges to the management of this condition.
Publication Types:
Review
Review, Tutorial
PMID: 12081259 [PubMed - indexed for MEDLINE]
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Dig Dis Sci. 2002 Jan;47(1):236-7.
Physician perception of IBS management in women and men.
Borum ML.
Division of Gastroenterology, The George Washington University Medical Center, Washington, DC 20037, USA.
Irritable bowel syndrome is a common gastrointestinal disorder that is manifested by abdominal pain and an alteration in bowel habits. It is estimated to occur in approximately 20% of the US population and is diagnosed more frequently in women compared to men. The principles of management do not differ based upon gender. However, there is not data that has evaluated physician perception of IBS diagnosis and management. This study evaluated internal medicine physicians' perception of IBS in women and men. Sixty internal medicine physicians (30 men, 30 women) completed anonymous surveys evaluating their perception of the ease of diagnosis and management of IBS. A database was created and analyzed using Epi Info. Statistical significance was determined with chi-square tables that generated P values. IBS was more frequently diagnosed in women. There was a statistically significant difference in women with IBS being not easy to diagnose when compared to men with IBS (P = 0.0003). There was also a statistically significant difference in men with IBS being reported to be not easy to manage when compared to women with IBS (P = 0.0014). This study revealed that physicians perceive a difference in the ease of diagnosis and management of IBS based upon gender. Further research is necessary to gain insight into the influence of patient gender upon this disorder.
PMID: 11837728 [PubMed - indexed for MEDL web page INE]
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Gastroenterol Clin North Am. 1992 Dec;21(4):793-802. Related Articles, Links
Diagnosis and management of irritable bowel syndrome, constipation, and diarrhea in pregnancy.
West L, Warren J, Cutts T.
Department of Internal Medicine, University of Tennessee, Memphis.
Irritable bowel syndrome, constipation, and diarrhea may complicate a pregnancy. Complaints of IBS and constipation may be managed by nonpharmaceutical methods. A careful history should be conducted to determine whether these complaints are of an acute or a long-standing nature. Conservative treatment of IBS is recommended and may include stool-bulking agents, a high-fiber diet, elimination of offensive foods, and the behavioral treatment of passive muscle relaxation, biofeedback or supportive psychotherapy. Constipation is generally self-limiting. It also may be treated conservatively with stool-bulking agents, increases in dietary fiber, and the addition of pelvic muscle exercises, preferably using electromyographic biofeedback. Laxatives should be used judiciously (Table 1). Diarrhea is caused most often by infectious agents in pregnancy but may also be from food poisoning or a viral disease. Infectious diarrhea may be treated by mild antidiarrheal agents and safe antibiotics. Fluid replacement is the mainstay of treatment, and care should be taken, remembering that the treatment involves two patients. These complaints can generally be managed conservatively, but persistent cases should be investigated as in a nonpregnant patient.
Publication Types:
Review
Review, Tutorial
PMID: 1478735 [PubMed - indexed for MEDLINE]
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Gut. 1992 Jun;33(6):814-7.
Relation between hysterectomy and the irritable bowel: a prospective study.
Prior A, Stanley KM, Smith AR, Read NW.
Department of Gastrointestinal Physiology and Nutrition, Royal Hallamshire Hospital, Sheffield.
Some women with irritable bowel syndrome date the onset of symptoms to previous hysterectomy. To assess prospectively the incidence of gastrointestinal symptomatology arising de novo after hysterectomy, and to study the effect of surgery on pre-existing symptoms, 205 women completed a symptom questionnaire before and six weeks and six months after surgery. Beforehand, symptoms suggestive of irritable bowel syndrome occurred in 22% of patients. At six months after operation, 60% of these had improved or were symptom free while 20% had increased symptomatology. New gastrointestinal symptoms were present more than once per week in 10% of previously asymptomatic women. Constipation predominant irritable bowel syndrome was the commonest symptom complex seen de novo, occurring more than once per week in 5% of the group. No relation was found between new symptomatology and the type of hysterectomy, oophorectomy, or the administration of perioperative antibiotics. This study suggests that many women with pre-existing gastrointestinal symptomatology improve after hysterectomy. However, symptoms suggestive of irritable bowel syndrome do arise de novo in 10%. As hysterectomy is common, gastroenterologists can expect to see women presenting with post-hysterectomy problems.
PMID: 1624165 [PubMed - indexed for MEDLINE]
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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Gastroenterol Nurs. 2001 May-Jun;24(3):129-37.
Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome?
Lustyk MK, Jarrett ME, Bennett JC, Heitkemper MM.
Department of Psychology, Seattle Pacific University, WA 98119, USA. klustyk@spu.edu
It has been proposed that physical activity moderates physiological or psychological responses to chronic conditions. The purpose of this study was to determine if women with a chronic functional gastrointestinal (GI) disorder, irritable bowel syndrome, had less active lifestyles than healthy controls and to test whether active women with irritable bowel syndrome had less severe recalled or daily reports of GI, psychological, and somatic symptoms than inactive women with irritable bowel syndrome. Questionnaires were used to measure GI and psychological distress and somatic symptoms in 89 women who participated in this study. A daily symptom and activity diary was kept for one menstrual cycle. Women with irritable bowel syndrome were significantly less likely to be active (48%) than control women (71%) (X2 = 3.4, p = .05). Within the irritable bowel syndrome group, active women were less likely to report a feeling of incomplete evacuation following a bowel movement than inactive women (p < .04), yet active women did not have less severe recalled psychological or somatic symptoms than inactive women. Active women with irritable bowel syndrome reported less severe daily somatic symptoms, which were accounted for by a lower level of fatigue (p = .003), but not daily GI or psychological symptoms. These results suggest that physical activity may produce select symptom improvement in women with irritable bowel syndrome.
PMID: 11847862 [PubMed - indexed for MEDL web page INE]
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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
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