Irritable Bowel Syndrome Message Boards | Stress, the Brain-Gut Axis, and IBS

Stress and the Emotional Motor System (EMS)
eCAM Advance Access published online on May 17, 2007
eCAM, doi:10.1093/ecam/nem046

Min/Body Psychological Treatments for Irritable Bowel Syndrome
Bruce D. Naliboff1,2,3, Michael P. Fres�1,2,3 and Lobsang Rapgay2
1UCLA Center for Neurovisceral Sciences and Women's Health, 2Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and 3Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA

A variety of experimental and clinical studies support the model described above. In general, IBS patients show altered perception of visceral events that is characterized by hypervigilance, hypersensitivity and increased autonomic arousal (16,17). While peripheral GI factors may play a role in subsets of patients with IBS (e.g. post-infectious IBS), there is converging clinical and neurobiologic research to suggest that enhanced central stress responsiveness involving anxiety may provide a specific mechanism for enhanced visceral sensitivity found in these disorders (11). GI symptom-specific anxiety may be an especially important variable leading to increased pain sensitivity, hypervigilance and poor coping (18,19). Mild psychologic stress increases visceral perception in IBS patients but not in healthy controls (20) and IBS symptoms are exacerbated following stressful life events (21). We have also recently shown that visceral-specific anxiety appears to be particularly important in IBS and may be the primary element in mediating the impact between changes in symptom severity and changes in quality of life in IBS sufferers (18). Recent brain imaging findings have now begun to show the central circuitry that may underlie many of the observations described above (22). For example, patients with IBS during visceral stimulation show increased activation in the anterior cingulate cortex, a brain region involved in vigilance and discomfort during physical and social situations (23).

http://ecam.oxfordjournals.org/cgi/content/full/nem046v1#SEC3

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