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Am J Gastroenterol. 2003 Feb;98(2):420-30.
Symptoms across the menstrual cycle in women with irritable bowel syndrome.
Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V, Bond EF.
Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle 98195, USA.
OBJECTIVE: The purpose of this study was to describe the patterns of GI, somatic, and psychological symptoms across the menstrual cycle in women with irritable bowel syndrome, and to determine whether symptoms differed by oral contraceptive use or predominant bowel pattern. METHODS: A daily diary was used to assess symptoms across one menstrual cycle. Repeated-measures analysis of covariance, controlling for age and body mass index, was used to compare patterns of symptoms across the menstrual cycle by oral contraceptive use and predominant bowel pattern (diarrhea, constipation, alternating). Data from control women are presented for comparison. RESULTS: For somatic and psychological as well as GI symptoms, women with irritable bowel syndrome had higher symptom severity than did controls. Women with irritable bowel syndrome using oral contraceptives had lower cognitive, anxiety, and depression symptoms (p < 0.05, but not significant after multiple comparison adjustment), but no differences were seen for most symptoms of irritable bowel syndrome. All symptoms except diarrhea were highest in the alternating group and lowest in the diarrhea group, with the constipation group either intermediate or close to the alternating group. This pattern was significant after multiple comparisons adjustment for GI symptoms, and trending toward significance (p < 0.05, but not significant after multiple comparison adjustment) for menstrual, sleep, and cognitive symptoms. The strongest menstrual cycle effect was seen in somatic and menstrual symptoms. The pattern of symptoms over the menstrual cycle did not differ by predominant bowel pattern or by oral contraceptive use. CONCLUSIONS: Many of the symptoms examined differed by predominant bowel pattern and menstrual cycle phase, not just the GI symptoms. The menstrual cycle variation was similar regardless of oral contraceptive use or predominant bowel pattern.
PMID: 12591063 [PubMed - indexed for MEDLINE]
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Dig Dis Sci. 2000 May;45(5):952-9.
Sleep disturbance influences gastrointestinal symptoms in women with irritable bowel syndrome.
Jarrett M, Heitkemper M, Cain KC, Burr RL, Hertig V.
Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle 98195-7266, USA.
This analysis evaluated the association between sleep disturbance and gastrointestinal symptoms in women with and without irritable bowel syndrome (IBS), and examined the role of psychological distress in this relationship. Women with IBS (N = 82) reported considerably higher levels of sleep disturbance compared to controls (N = 35), using both retrospective seven-day recall and daily diary recall for two menstrual cycles (P < 0.05 on 8 of 10 measures). We used daily diary data to estimate the association between sleep disturbance and gastrointestinal symptoms, both across women (ie, whether women with high average sleep disturbance have higher average gastrointestinal symptoms) and within woman (ie, whether poorer than average sleep on one night is associated with higher than average gastrointestinal symptoms the following day). The regression coefficients for the across-women effect are large and highly significant in both groups (IBS, beta +/- SE = 0.46 +/- 0.08, P < 0.001; controls, 0.57 +/- 0.13, P < 0.001). The regression coefficients for the within-woman effect are considerably smaller and statistically significant only in the IBS group (IBS, 0.06 +/- 0.02, P = 0.006; control, 0.01 +/- 0.03, P = 0.691). These regression coefficients showed little change when daily psychological distress or stress was controlled for, the one exception being the coefficient for the across-women effect in the IBS group, which decreased substantially but still remained highly significant. Because it is possible that gastrointestinal symptoms could, in fact, cause poor sleep, we also fitted the temporally reversed model to evaluate the association between gastrointestinal symptoms on one day and sleep disturbance that night. The within-woman regression coefficients were nonsignificant in both the IBS and control groups. In conclusion, these results are consistent with the hypothesis that poor sleep leads to higher gastrointestinal symptoms on the following day among women with IBS.
PMID: 10795760 [PubMed - indexed for MEDLINE]
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Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome?
Maturitas 2003 Feb 25;44(2):133-40 (ISSN: 0378-5122)
Ruigomez A; Garcia Rodriguez LA; Johansson S; Wallander MA
Centro Espanol de Investigacion Farmacoepidemiologica (CEIFE), Madrid, Spain.
OBJECTIVE: Hormonal status could be involved in the occurrence of irritable bowel syndrome (IBS).
The authors examined the risk of developing IBS in women using hormone replacement therapy (HRT).
METHODS: Women 50-69 years old with at least one prescription for HRT during 1994-1999 were
identified from the General Practice Research Database in the UK (n=40, 119). An aged-matched cohort
of 50000 women who never used HRT was sampled from the source population where the HRT cohort
was ascertained. Women in the two cohorts were followed to assess the risk of development of IBS.
Authors performed a nested case-control analysis to assess the role of duration, route and regimen of
HRT use and other risk factors for IBS. The IBS diagnosis was validated by means of a questionnaire
sent to the general practitioners (n=660). RESULTS: The incidence rate of IBS per 1000 person-years
was 1.7 in the cohort of never HRT users and 3.8 among HRT users, respectively. Both current and past
users of HRT presented an increased risk of IBS compared to non-users, after adjusting for co-morbidity
and consultation patterns. This increased risk was observed irrespective of treatment duration, regimen
or route of administration of HRT.
CONCLUSION: The result suggests that HRT use is associated with an increased risk of IBS similar to the one observed among younger premenopausal women with endogenous oestrogenic activity.
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After Menopause, Women Have Same Severity of Irritable Bowel Syndrome As Men
By Maggie Schwarz
BALTIMORE, MD -- October 15, 2003 -- The higher severity of irritable bowel syndrome (IBS) that women experience in comparison with men diminishes after menopause, according to a study of over 800 patients.
Researchers compared severity of IBS symptoms and IBS-specific impairment of quality of life in 826 women and men with the syndrome. Olafur S. Palsson, PsyD, University of North Carolina, Chapel Hill, North Carolina, United States, reported their findings here October 12th at the 68th Annual Scientific Meeting of the American College of Gastroenterology.
Dr. Palsson explained that women have more severe symptoms of IBS, they need more medications, and they go to the doctor more than men with IBS.
To determine whether this greater severity changes with age, the investigators obtained responses to a questionnaire from 638 women and 188 men who were diagnosed with functional bowel disorders and met Rome II criteria for IBS. Their ages ranged from 18 to 76 years (mean 51.9 years). The questionnaires included the IBS Severity Index and the IBS and poorer quality of life (QoL) questionnaire.
Results showed that after the age of 50, the severity of IBS symptoms in women and men is identical. Women in postmenopausal age groups (50+ years of age) had significantly less severity overall for IBS (P<0.0001), abdominal pain (p<0.0001) and bloating (P<0.001), and had higher quality of life scores on the QOL (P<0.05), compared to younger women.
Women younger than 50 had higher IBS severity scores compared to same-age men, but these differences disappeared in older age groups.
Overall IBS-QOL scores were not significantly different between the genders in any age group. However, analysis of the eight content subscales of the IBS-QOL, controlling for IBS severity differences, showed that women differed from men on two scales, with more impaired scores on body image (P<0.05) and food avoidance (P<0.01).
Dr. Palsson said the reduced severity of IBS symptoms after menopause is due to the drop in sex hormones, which are known to make IBS symptoms worse. "Three-quarters of women with IBS say their IBS symptoms are worse during menses," he said.
The research should help physicians take the effect of the menstrual cycle into account when treating women with IBS, Dr. Palsson said.
The study was supported by Novartis Pharmaceuticals Corporation.
[Study title: IBS Severity and Health-Related Quality of Life Improve With Age in Women But Not in Men. Abstract 81]
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Gender Differences In Brain Response To Pain
Source: University Of California - Los Angeles
Date: 2003-11-05
A new UCLA study shows that different parts of the brain are stimulated in reaction to pain depending on gender. The research, which represents the largest gender-comparison study of its kind, focused on people with irritable bowel syndrome (IBS), one of the nation's most common chronic medical conditions. The findings may help develop and target better treatments for IBS and other illnesses.
"We are finding more scientific differences between men and women as we improve research methods and broaden study populations," said study co-author Dr. Emeran Mayer, UCLA professor of bio-behavioral sciences, and medicine, physiology and psychiatry. "This growing base of research will help us develop more effective treatments based on a new criteria: gender."
Dr. Mayer is the director of the new Center for Neurovisceral Sciences & Women's Health (CNS) at UCLA, which conducted the study.
Published in the June 2003 issue of the journal Gastroenterology, the study examined 26 women and 24 men with IBS. UCLA researchers took positron emission tomography (PET) brain scans of patients during mild pain stimuli.
Although researchers found some overlapping areas of brain activation in men and women, several areas of male and female brains reacted differently when given the same pain stimulus. The female brain showed greater activity in limbic regions, which are emotion-based centers. In men, the cognitive regions, or analytical centers, showed greater activity.
"The reason for the two different brain responses may date back to primitive days, when the roles of men and women were more distinct," said study co-author Dr. Bruce Naliboff, UCLA clinical professor of psychiatry and biobehavioral sciences, and co-director of CNS.
According to Naliboff, these gender differences in brain responses to pain may have evolved as part of a more general difference in stress responses between men and women. Men's cognitive areas may be more highly triggered because of the early male role in defending the homestead, where in response to stress and pain, the brain launched a calculated fight-or-flight reaction.
The female limbic regions may be more responsive under threat because of their importance in triggering a nurturing and protecting response for the young, leading to a more emotion-based response in facing pain and stress.
Naliboff noted that both responses have advantages and neither is better. In fact, under conditions of external threat, the different responses may lead to complementary behaviors between men and women.
In addition, researchers found that the anticipation of pain generated the same brain responses from study volunteers as the actual pain stimulus. "The brain is a powerful force in dictating how the body responds to pain and stress," said study co-author Dr. Lin Chang, UCLA associate professor of medicine and co-director of CNS.
The next step, according to Mayer, is to look at how the results of the study may impact treatment for IBS and other disorders. Mayer adds that one current drug for IBS, Lotronex, affects the limbic system and has worked more successfully in women than men.
UCLA's Center for Neurovisceral Sciences and Women's Health studies how the brain, stress and emotions impact the development of disorders that affect mainly women.
Irritable bowel syndrome affects 15 to 20 percent of Americans and causes discomfort in the abdomen, along with diarrhea and/or constipation.
The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Nursing Research, both part of the National Institutes of Health, funded the study.
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This story has been adapted from a news release issued by University Of California - Los Angeles.
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Women More Sensitive to Pain Than Men
But study didn't find any racial differences in pain thresholds
THURSDAY, April 1 (HealthDayNews) -- Blacks and whites have about the same sensitivity to pain, but women appear to be more sensitive to it than men.
That's what Duke University researchers report in the April issue of the Journal of Pain.
"Many pain medications are addictive and have unpleasant side effects, so it's important for physicians to be able to understand exactly how much pain their patients are experiencing," lead researcher and psychologist Dr. Tavis Campbell said in a prepared statement.
He conducted the study while at Duke; he's now at the University of Calgary in Canada.
"This research supports well-established findings of slightly higher sensitivity to pain among women compared to men, but revealed no difference between whites and African-Americans," Campbell said.
Previous research and anecdotal evidence have suggested blacks are more sensitive to pain than whites. Campbell suggested pain assessment procedures may be responsible for such racial differences in pain sensitivity.
His study included 76 men and 59 women aged 25 to 45; 72 were black, the rest white. A blood pressure cuff was inflated on the arm of each study participant and left inflated for several minutes. That created an aching sensation. The participants rated their pain according to standard pain rating scales, which gauge both the intensity and the unpleasantness of the pain.
--Robert Preidt
SOURCE: University of Calgary, news release, March 29, 2004
Copyright © 2004 ScoutNews, LLC. All rights reserved.
http://www.healthday.com/view.cfm?id=518151
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Catching Colon Cancer in Women Can Be Tough
They're twice as likely as men to get inadequate sigmoidoscopy, study shows
TUESDAY, Jan. 27 (HealthDayNews) -- Women are up to twice as likely as men to have inadequate sigmoidoscopy exams due to inadequate depth of insertion.
That concern is raised by researchers at the San Francisco VA Medical Center (SFVAMC), who report their finding in the Feb. 1 issue of the American Journal of Medicine.
The study also found that failure to achieve adequate depth of insertion during sigmoidoscopy increases as patients, both men and women, age. The findings suggest a patient's age and sex are important factors when doctors are considering which colorectal cancer screening method to use.
Flexible sigmoidoscopy is one of the most common colorectal cancer screening tools. A sigmoidoscope -- a 60-centimeter-long flexible tube about the thickness of a finger -- is threaded into the patient's rectum and lower third of the colon. The sigmoidoscope has a tiny video camera that lets the doctor to examine the wall of the colon for any abnormalities, such as cancer or polyps.
This study included a review of more than 15,000 sigmoidoscopies. It found the percentage of sigmoidoscopies examinations that failed to reach 50 centimeters into the colon increased from 19 percent in women aged 50 to 59, to 32 percent in women aged 80 or older.
For men, those percentages were 10 percent in the younger group and 22 percent in the older group.
"I had been finding that a lot of my older patients were not getting adequate exams, and I wanted to know whether this was a widespread problem," researcher Dr. Louise Walter, a SFVAMC staff physician in geriatrics and assistant professor of medicine at the University of California, San Francisco, says in a prepared statement.
"I was initially approaching this as an age issue. But then the gender differences popped up. The most disturbing thing this study shows is that women are twice as likely as men to have an inadequate exam," Walter says.
More information
Here's where you can learn more about screening for colorectal cancer. http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_colon_and_rectum_cancer_be_found_early.asp?sitearea=
--Robert Preidt
SOURCE: University of California, San Francisco, news release, Jan. 26, 2004
Copyright © 2004 ScoutNews, LLC. All rights reserved.
http://www.healthday.com/view.cfm?id=517118
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Abdominal Bloating: Relation to Rectal Hypersensitivity and Menstrual Cycle
Lin Chang, MD
Abdominal bloating and visible abdominal distension are commonly reported by patients with IBS.[17] Despite the introduction of tegaserod, which has been shown to relieve symptoms of bloating in female patients with IBS-C,[18] bloating can still be challenging to treat because of the lack of understanding of the pathophysiologic mechanisms underlying these common symptoms.[19] While some patients with bloating have associated abdominal distension, others do not. Although patients with IBS with abdominal bloating, with and without associated visible abdominal distension, are quite similar in the majority of parameters, eg, those with both bloating and distension are more likely to be female, are more likely to report a greater perceived symptom severity, and are more likely to have less diurnal variation in symptoms.[20] In addition, abdominal bloating is reportedly worse in women during the late luteal and early menses phases of the menstrual cycle.[21]
Lea and colleagues[22] performed several studies to further evaluate the impact of these associated factors (ie, diurnal variation, abdominal distension, and menstrual cycle) in patients with IBS with bloating. In one study, they evaluated the diurnal variation of abdominal girth in 16 patients with IBS-C, 21 with IBS-D, and in 20 healthy control subjects. Abdominal distension was measured using a recently validated objective technique of Ambulatory Abdominal Inductance Plethysmography.[23] Abdominal girth was greatest in the early evening in approximately 60% of both IBS-C and IBS-D patients, but only correlated with worsening bloating symptoms in the IBS-C patients.
In a second study,[24] these investigators assessed whether rectal sensitivity differed between female patients with IBS with abdominal bloating, with and without increased abdominal distension (total n = 37). Those patients who did not exhibit physical abdominal distension (compared with healthy controls) had significantly lower rectal pain thresholds than both patients with IBS who were distended and healthy controls. The investigators concluded that the symptom of bloating in the absence of visible abdominal distension may be due to increased visceral sensitivity to gastrointestinal events.
In their third study, Lea and colleagues[25] sought to determine whether perimenstrual bloating is associated with abdominal distension. Abdominal girth was recorded for 24 hours in 12 women with IBS and in 10 healthy female volunteers during the various menstrual cycle phases. Both women with IBS and control females reported more bloating during menses and the premenstrual phase, although bloating was rated as more severe in the patients than in the controls. However, abdominal girth was not different between the different phases of the menstrual cycle in IBS patients or in controls. Taken in conjunction with the results from the first study and with the previous finding that rectal perception is increased during menses compared with the other menstrual cycle phases in women with IBS,[26] these results lend support to the hypothesis that abdominal bloating is related to visceral hypersensitivity in IBS.
Summary. Abdominal bloating is a common symptom reported by patients with IBS, although its pathophysiology is not well understood. Several findings suggest that abdominal bloating may be related to visceral hypersensitivity: (1) bloating without distension is associated with lowered rectal pain thresholds; (2) bloating is reported as worse in the premenstrual and early menses phases of the menstrual cycle; and (3) rectal sensitivity is increased during menses compared with the other phases in women with IBS. If abdominal bloating is related to visceral hypersensitivity, it is not clear whether this is due primarily to visceral hyperalgesia (ie, increased pain perception to noxious visceral events) or to a hypervigilance towards expected aversive events arising from the viscera.
http://www.medscape.com/viewarticle/480232
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Autonomic Cardiovascular Responses Are Impaired in Women With Irritable Bowel Syndrome.
Journal of Clinical Gastroenterology. 38(8):658-663, September 2004.
Waring, W Stephen BMedSci, MB MRCP(UK) *; Chui, Michelle BSc MB ChB +; Japp, Alan BSc, MB ChB +; Nicol, E Fiona BSc, MB FRCP ++; Ford, Mike J MD FRCP +
Abstract:
Goals: This study characterizes cardiovascular autonomic function in women with irritable bowel syndrome (IBS), using standardized techniques.
Background: Autonomic dysfunction is believed to contribute to abnormal gastrointestinal motility and visceral hypersensitivity in IBS. There is mounting evidence of generalized impairment of autonomic activity in patients with IBS.
Study: Thirty women aged 39 years (95% C.I. 25-53 years) diagnosed with IBS, and 30 age-matched healthy women were studied. The ratio of low frequency to high frequency heart rate variability domains (LF:HF ratio) was used to represent cardiac sympathovagal activity, and orthostatic testing and sustained isometric handgrip exercise were used as sympathetic stimuli. Parasympathetic activity was represented by the expiratory to inspiratory R-R interval (E:I) ratio during deep breathing at 6 minutes-1.
Results: LF:HF responses to handgrip exercise (316%, C.I. 134% to 498% vs. 107%, C.I. 15% to 153%; P < 0.05) and orthostatic testing (648%, C.I. 520% to 904% vs. 330%, C.I. 140% to 520%; P < 0.05) were higher in IBS patients than controls, and the E:I ratio was significantly lower (1.47, C.I. 1.33-1.61 vs. 1.20, C.I. 1.14-1.26; P < 0.01).
Conclusions: Autonomic cardiovascular function is impaired in IBS, manifest as attenuated cardio-vagal tone, and relative sympathetic excess during stimulated conditions.
(C) 2004 Lippincott Williams & Wilkins, Inc.
http://www.mdlinx.com/GILinx/thearts.cfm?artid=1041738&specid=13&ok=yes
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Gut 2004;53:1452-1458
© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology
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IRRITABLE BOWEL SYNDROME
Association between a functional polymorphism in the serotonin transporter gene and diarrhoea predominant irritable bowel syndrome in women
A Yeo1, P Boyd2, S Lumsden2, T Saunders2, A Handley1, M Stubbins1, A Knaggs2, S Asquith1, I Taylor2, B Bahari2, N Crocker2, R Rallan2, S Varsani2, D Montgomery2, D H Alpers3, G E Dukes3, I Purvis1 and G A Hicks3
1 Department of Discovery Genetics, GlaxoSmithKline, New Frontiers Science Park, Harlow, Essex, UK
2 Department of Discovery Genetics, GlaxoSmithKline, Stevenage, Hertfordshire, UK
3 Neurology and GI Centre of Excellence for Drug Discovery, GlaxoSmithKline, New Frontiers Science Park, Harlow, Essex, UK
ABSTRACT
Background and aims: Serotonin (5-hydroxtryptamine, 5-HT) is an important factor in gut function, playing key roles in intestinal peristalsis and secretion, and in sensory signalling in the brain-gut axis. Removal from its sites of action is mediated by a specific protein called the serotonin reuptake transporter (SERT or 5-HTT). Polymorphisms in the promoter region of the SERT gene have effects on transcriptional activity, resulting in altered 5-HT reuptake efficiency. It has been speculated that such functional polymorphisms may underlie disturbance in gut function in individuals suffering with disorders such as irritable bowel syndrome (IBS). The aim of this study was to assess the potential association between SERT polymorphisms and the diarrhoea predominant IBS (dIBS) phenotype.
Subjects: A total of 194 North American Caucasian female dIBS patients and 448 female Caucasian controls were subjected to genotyping.
Methods: Leucocyte DNA of all subjects was analysed by polymerase chain reaction based technologies for nine SERT polymorphisms, including the insertion/deletion polymorphism in the promoter (SERT-P) and the variable tandem repeat in intron 2. Statistical analysis was performed to assess association of any SERT polymorphism allele with the dIBS phenotype.
Results: A strong genotypic association was observed between the SERT-P deletion/deletion genotype and the dIBS phenotype (p = 3.07x10–5; n = 194). None of the other polymorphisms analysed was significantly associated with the presence of disease.
Conclusions: Significant association was observed between dIBS and the SERT-P deletion/deletion genotype, suggesting that the serotonin transporter is a potential candidate gene for dIBS in women.
http://gut.bmjjournals.com/cgi/content/abstract/53/10/1452
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