Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study

N. A. Koloski, M. Jones, N. J. Talley

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Traditionally, functional gastrointestinal disorders (FGIDs) are conceptualised as originating in the brain via stress pathways (brain-to-gut). It is uncertain how many with irritable bowel syndrome (IBS) and functional dyspepsia (FD) have a gut origin of symptoms (gut-to-brain pathway). Aims: To determine if there is a distinct brain-to-gut FGID (where psychological symptoms begin first) and separately a distinct gut-to-brain FGID (where gut symptoms start first). Methods: A prospective random population sample from Newcastle, Australia who responded to a validated survey in 2012 and completed a 1-year follow-up survey (n = 1900). The surveys contained questions on Rome III IBS and FD and the Hospital Anxiety and Depression Scale. Results: We found that higher levels of anxiety and depression at baseline were significant predictors of developing IBS (OR = 1.31; 95% CI 1.06–1.61, P = 0.01; OR = 1.54; 95% CI 1.29–1.83, P < 0.001) and FD (OR = 1.28; 95% CI 1.05–1.55, P = 0.01; OR = 1.55, 95% CI 1.32–1.83, P < 0.001), respectively, at the 1-year follow-up. Among those people who did not have elevated levels of anxiety and depression at baseline, subjects at baseline with documented IBS (mean difference 0.34; 95% CI 0.13–0.55, P = 0.002; 0.81; 95% CI 0.47–1.15, P < 0.001) and FD (0.38; 95% CI 0.14–0.63, P = 0.002; 0.92; 95% CI 0.57–1.27, P < 0.001), reported significantly higher levels of anxiety and depression at the 1-year follow-up. We calculated in one-third of individuals a mood disorder precedes FGID but in two-thirds an FGID precedes the mood disorder. Conclusion: While brain–gut pathways are bidirectional, a major subset begin with gut symptoms first and only then psychological distress develops, implicating primary gut mechanisms as drivers of the gut and extra-intestinal features in many cases.

LanguageEnglish
Pages592-600
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume44
Issue number6
DOIs
Publication statusPublished - 1 Sep 2016

Fingerprint

Irritable Bowel Syndrome
Dyspepsia
Gastrointestinal Diseases
Prospective Studies
Brain
Anxiety
Depression
Population
Mood Disorders
Psychology
Surveys and Questionnaires

Cite this

@article{e1a7b09141234c2c91fea7819a08610a,
title = "Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study",
abstract = "Background: Traditionally, functional gastrointestinal disorders (FGIDs) are conceptualised as originating in the brain via stress pathways (brain-to-gut). It is uncertain how many with irritable bowel syndrome (IBS) and functional dyspepsia (FD) have a gut origin of symptoms (gut-to-brain pathway). Aims: To determine if there is a distinct brain-to-gut FGID (where psychological symptoms begin first) and separately a distinct gut-to-brain FGID (where gut symptoms start first). Methods: A prospective random population sample from Newcastle, Australia who responded to a validated survey in 2012 and completed a 1-year follow-up survey (n = 1900). The surveys contained questions on Rome III IBS and FD and the Hospital Anxiety and Depression Scale. Results: We found that higher levels of anxiety and depression at baseline were significant predictors of developing IBS (OR = 1.31; 95{\%} CI 1.06–1.61, P = 0.01; OR = 1.54; 95{\%} CI 1.29–1.83, P < 0.001) and FD (OR = 1.28; 95{\%} CI 1.05–1.55, P = 0.01; OR = 1.55, 95{\%} CI 1.32–1.83, P < 0.001), respectively, at the 1-year follow-up. Among those people who did not have elevated levels of anxiety and depression at baseline, subjects at baseline with documented IBS (mean difference 0.34; 95{\%} CI 0.13–0.55, P = 0.002; 0.81; 95{\%} CI 0.47–1.15, P < 0.001) and FD (0.38; 95{\%} CI 0.14–0.63, P = 0.002; 0.92; 95{\%} CI 0.57–1.27, P < 0.001), reported significantly higher levels of anxiety and depression at the 1-year follow-up. We calculated in one-third of individuals a mood disorder precedes FGID but in two-thirds an FGID precedes the mood disorder. Conclusion: While brain–gut pathways are bidirectional, a major subset begin with gut symptoms first and only then psychological distress develops, implicating primary gut mechanisms as drivers of the gut and extra-intestinal features in many cases.",
author = "Koloski, {N. A.} and M. Jones and Talley, {N. J.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1111/apt.13738",
language = "English",
volume = "44",
pages = "592--600",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell, Wiley",
number = "6",

}

Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia : a 1-year population-based prospective study. / Koloski, N. A.; Jones, M.; Talley, N. J.

In: Alimentary Pharmacology and Therapeutics, Vol. 44, No. 6, 01.09.2016, p. 592-600.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia

T2 - Alimentary Pharmacology and Therapeutics

AU - Koloski, N. A.

AU - Jones, M.

AU - Talley, N. J.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background: Traditionally, functional gastrointestinal disorders (FGIDs) are conceptualised as originating in the brain via stress pathways (brain-to-gut). It is uncertain how many with irritable bowel syndrome (IBS) and functional dyspepsia (FD) have a gut origin of symptoms (gut-to-brain pathway). Aims: To determine if there is a distinct brain-to-gut FGID (where psychological symptoms begin first) and separately a distinct gut-to-brain FGID (where gut symptoms start first). Methods: A prospective random population sample from Newcastle, Australia who responded to a validated survey in 2012 and completed a 1-year follow-up survey (n = 1900). The surveys contained questions on Rome III IBS and FD and the Hospital Anxiety and Depression Scale. Results: We found that higher levels of anxiety and depression at baseline were significant predictors of developing IBS (OR = 1.31; 95% CI 1.06–1.61, P = 0.01; OR = 1.54; 95% CI 1.29–1.83, P < 0.001) and FD (OR = 1.28; 95% CI 1.05–1.55, P = 0.01; OR = 1.55, 95% CI 1.32–1.83, P < 0.001), respectively, at the 1-year follow-up. Among those people who did not have elevated levels of anxiety and depression at baseline, subjects at baseline with documented IBS (mean difference 0.34; 95% CI 0.13–0.55, P = 0.002; 0.81; 95% CI 0.47–1.15, P < 0.001) and FD (0.38; 95% CI 0.14–0.63, P = 0.002; 0.92; 95% CI 0.57–1.27, P < 0.001), reported significantly higher levels of anxiety and depression at the 1-year follow-up. We calculated in one-third of individuals a mood disorder precedes FGID but in two-thirds an FGID precedes the mood disorder. Conclusion: While brain–gut pathways are bidirectional, a major subset begin with gut symptoms first and only then psychological distress develops, implicating primary gut mechanisms as drivers of the gut and extra-intestinal features in many cases.

AB - Background: Traditionally, functional gastrointestinal disorders (FGIDs) are conceptualised as originating in the brain via stress pathways (brain-to-gut). It is uncertain how many with irritable bowel syndrome (IBS) and functional dyspepsia (FD) have a gut origin of symptoms (gut-to-brain pathway). Aims: To determine if there is a distinct brain-to-gut FGID (where psychological symptoms begin first) and separately a distinct gut-to-brain FGID (where gut symptoms start first). Methods: A prospective random population sample from Newcastle, Australia who responded to a validated survey in 2012 and completed a 1-year follow-up survey (n = 1900). The surveys contained questions on Rome III IBS and FD and the Hospital Anxiety and Depression Scale. Results: We found that higher levels of anxiety and depression at baseline were significant predictors of developing IBS (OR = 1.31; 95% CI 1.06–1.61, P = 0.01; OR = 1.54; 95% CI 1.29–1.83, P < 0.001) and FD (OR = 1.28; 95% CI 1.05–1.55, P = 0.01; OR = 1.55, 95% CI 1.32–1.83, P < 0.001), respectively, at the 1-year follow-up. Among those people who did not have elevated levels of anxiety and depression at baseline, subjects at baseline with documented IBS (mean difference 0.34; 95% CI 0.13–0.55, P = 0.002; 0.81; 95% CI 0.47–1.15, P < 0.001) and FD (0.38; 95% CI 0.14–0.63, P = 0.002; 0.92; 95% CI 0.57–1.27, P < 0.001), reported significantly higher levels of anxiety and depression at the 1-year follow-up. We calculated in one-third of individuals a mood disorder precedes FGID but in two-thirds an FGID precedes the mood disorder. Conclusion: While brain–gut pathways are bidirectional, a major subset begin with gut symptoms first and only then psychological distress develops, implicating primary gut mechanisms as drivers of the gut and extra-intestinal features in many cases.

UR - http://www.scopus.com/inward/record.url?scp=84981164813&partnerID=8YFLogxK

U2 - 10.1111/apt.13738

DO - 10.1111/apt.13738

M3 - Article

VL - 44

SP - 592

EP - 600

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 6

ER -