Childhood Trauma Is Associated With Hypothalamic-Pituitary-Adrenal Axis Responsiveness in Irritable Bowel Syndrome

Background & Aims

A history of early adverse life events (EALs) is associated with a poorer outcome and higher levels of distress in adult patients with functional gastrointestinal disorders. An EAL is thought to predispose individuals to develop a range of chronic illnesses by inducing persistent changes in the central stress response systems, including the hypothalamic-pituitary-adrenal (HPA) axis. We sought to determine if EALs affect the HPA axis response to a visceral stressor in irritable bowel syndrome (IBS) patients and healthy controls, and to determine if this is affected by sex or related to symptoms or quality of life.

Methods

Forty-four IBS patients (25 women, 19 men) and 39 healthy controls (21 women, 18 men) were assessed for gastrointestinal and psychological symptoms and EALs by validated questionnaires and interview. All subjects underwent a visceral stressor (sigmoidoscopy). Salivary cortisol was collected at baseline and serially for 1 hour poststressor.

Results

Twenty-one IBS patients and 18 controls had EALs. In subjects with and without IBS, an EAL was associated with higher mean (±SD) cortisol levels (0.32 ± 0.2 vs 0.20 ± 0.1 μg/dL; P = .003) and higher area under the curve (28.1 ± 17 vs 18.6 ± 13 μg × min/dL; P = .005) after the stressor compared with subjects without EALs. In IBS, a faster resolution of cortisol to basal values corresponded to lower symptom severity (r = −0.36, P < .05) and better disease-specific quality of life (r = 0.33, P < .05).

Conclusions

HPA axis hyperresponsiveness to a visceral stressor is related more to a history of EALs than to the presence of IBS. However, HPA axis reactivity has a moderating effect on IBS symptoms.

Abbreviations used in this paper: AUC, area under the curve, EALs, early adverse life events, GR, glucocorticoid receptor, HAD, Hospital Anxiety and Depression scale, HPA, hypothalamic-pituitary-adrenal, IBS, irritable bowel syndrome, QOL, quality of life