The Korean Journal of Medicine

  • 제82권2호
  • /
  • Pages.164-169
  • /
  • 2012
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

스트레스에 의한 소화 생리학적 변화: 과민성 장증후군 발생과 관련하여

The Effect of Stress on Gastrointestinal Physiology in Irritable Bowel Syndrome

  • 박정호 (성균관대학교 의과대학 강북삼성병원 소화기내과)
  • Park, Jung-Ho (Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 발행 : 2012.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Stress is an acute threat to the homeostasis of an organism by events in the outside world and evokes adaptive responses to preserve the stability of the internal environment. This adaptation can be carried out by means of alterations in HPA axis hormones, the autonomic nervous system, metabolic and immune systems. However, chronic stress can lead to changes in adaptation system and cause a functional disease such as irritable bowel syndrome (IBS). In fact, stress plays an important role in the development and exacerbations of IBS symptoms and it has been postulated that stress have an effect on the pathophysiology of IBS, including an increase in visceral perception, alterations in gastrointestinal motility and increased intestinal permeability. Therefore, Therapeutic approaches targeting stress management could be of great benefit for patients with irritable bowel syndrome.

키워드

참고문헌

  1. Hinkle LE Jr. The concept of "stress" in the biological and social sciences. Int J Psychiatry Med 1974;5:335-357. https://doi.org/10.2190/91DK-NKAD-1XP0-Y4RG
  2. Selye H. The Stress of Life. New York: McGraw-Hill Book Co., 1956.
  3. Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990;113:828-833 https://doi.org/10.7326/0003-4819-113-11-828
  4. Talley NJ, Fett SL, Zinsmeister AR. Self-reported abuse and gastrointestinal disease in outpatients: association with irritable bowel-type symptoms. Am J Gastroenterol 1995; 90:366-371.
  5. Chitkara DK, van Tilburg MA, Blois-Martin N, Whitehead WE. Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review. Am J Gastroenterol 2008;103:765-774. https://doi.org/10.1111/j.1572-0241.2007.01722.x
  6. Lightman SL. The neuroendocrinology of stress: a never ending story. J Neuroendocrinol 2008;20:880-884. https://doi.org/10.1111/j.1365-2826.2008.01711.x
  7. Chang L. The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology 2011;140:761-765. https://doi.org/10.1053/j.gastro.2011.01.032
  8. Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve: an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev 2000;52:595-638.
  9. Bockus HI, Bank J, Wilkinson SA. Neurogenic mucous colitis. Am J Med Sci 1928;176:813-829. https://doi.org/10.1097/00000441-192812000-00006
  10. Aggarwal A, Cutts TF, Abell TL, et al. Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology 1994;106:945-950. https://doi.org/10.1016/0016-5085(94)90753-6
  11. Burr RL, Heitkemper M, Jarrett M, Cain KC. Comparison of autonomic nervous system indices based on abdominal pain reports in women with irritable bowel syndrome. Biol Res Nurs 2000;2:97-106. https://doi.org/10.1177/109980040000200203
  12. Tillisch K, Mayer EA, Labus JS, Stains J, Chang L, Naliboff BD. Sex specific alterations in autonomic function among patients with irritable bowel syndrome. Gut 2005;54: 1396-1401. https://doi.org/10.1136/gut.2004.058685
  13. Heitkemper M, Jarrett M, Cain KC, et al. Autonomic nervous system function in women with irritable bowel syndrome. Dig Dis Sci 2001;46:1276-1284. https://doi.org/10.1023/A:1010671514618
  14. Park JH, Rhee PL, Kim HS, et al. Increased beta-adrenergic sensitivity correlates with visceral hypersensitivity in patients with constipation-predominant irritable bowel syndrome. Dig Dis Sci 2005;50:1454-1460. https://doi.org/10.1007/s10620-005-2860-x
  15. Posserud I, Agerforz P, Ekman R, Björnsson ES, Abrahamsson H, Simrén M. Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. Gut 2004;53:1102-1108. https://doi.org/10.1136/gut.2003.017962
  16. Dickhaus B, Mayer EA, Firooz N, et al. Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress. Am J Gastroenterol 2003; 98:135-143. https://doi.org/10.1111/j.1572-0241.2003.07156.x
  17. Elsenbruch S, Lucas A, Holtmann G, et al. Public speaking stress-induced neuroendocrine responses and circulating immune cell redistribution in irritable bowel syndrome. Am J Gastroenterol 2006;101:2300-2307. https://doi.org/10.1111/j.1572-0241.2006.00837.x
  18. Chang L, Sundaresh S, Elliott J, et al. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome. Neurogastroenterol Motil 2009;21:149-159. https://doi.org/10.1111/j.1365-2982.2008.01171.x
  19. Patacchioli FR, Angelucci L, Dellerba G, Monnazzi P, Leri O. Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS). J Endocrinol Invest 2001;24:173-177. https://doi.org/10.1007/BF03343838
  20. Fukudo S, Nomura T, Hongo M. Impact of corticotropinreleasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut 1998;42:845-849. https://doi.org/10.1136/gut.42.6.845
  21. Videlock EJ, Adeyemo M, Licudine A, et al. Childhood trauma is associated with hypothalamic-pituitary-adrenal axis responsiveness in irritable bowel syndrome. Gastroenterology 2009;137:1954-1962. https://doi.org/10.1053/j.gastro.2009.08.058
  22. Heim C, Newport DJ, Bonsall R, Miller AH, Nemeroff CB. Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. Am J Psychiatry 2001;158:575-581. https://doi.org/10.1176/appi.ajp.158.4.575
  23. Tyrka AR, Wier L, Price LH, et al. Childhood parental loss and adult hypothalamic-pituitary-adrenal function. Biol Psychiatry 2008;63:1147-1154. https://doi.org/10.1016/j.biopsych.2008.01.011
  24. Mizoguchi K, Ishige A, Aburada M, Tabira T. Chronic stress attenuates glucocorticoid negative feedback: involvement of the prefrontal cortex and hippocampus. Neuroscience 2003;119:887-897. https://doi.org/10.1016/S0306-4522(03)00105-2
  25. Taché Y. Stress-induced alterations of gastric emptying. In: Bueno L, Collins S, Junien JL, eds. Stress and Digestive Motility. Montrouge: John Libbey Eurotext, 1989:123-132.
  26. Rao SS, Hatfield RA, Suls JM, Chamberlain MJ. Psychological and physical stress induce differential effects on human colonic motility. Am J Gastroenterol 1998;93: 985-990. https://doi.org/10.1111/j.1572-0241.1998.00293.x
  27. Masere C, Nakade Y, Zheng J, Babygirija R, Ludwig K, Takahashi T. Chronic restraint stress has no more stimulatory effects on colonic motility in rats. Neurosci Lett 2009; 453:147-150. https://doi.org/10.1016/j.neulet.2009.02.042
  28. Grundy D, Al-Chaer ED, Aziz Q, et al. Fundamentals of neurogastroenterology: basic science. Gastroenterology 2006;130:1391-1411. https://doi.org/10.1053/j.gastro.2005.11.060
  29. Lee C, Sarna SK. Central regulation of gastric emptying of solid nutrient meals by corticotropin releasing factor. Neurogastroenterol Motil 1997;9:221-229. https://doi.org/10.1046/j.1365-2982.1997.d01-58.x
  30. Monnikes H, Schmidt BG, Tebbe J, Bauer C, Tache Y. Microinfusion of corticotropin releasing factor into the locus coeruleus/subcoeruleus nuclei stimulates colonic motor function in rats. Brain Res 1994;644:101-108. https://doi.org/10.1016/0006-8993(94)90352-2
  31. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil 2011;17:131-139. https://doi.org/10.5056/jnm.2011.17.2.131
  32. Mayer EA, Naliboff BD, Chang L, Coutinho SV. V. Stress and irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2001;280:G519-G524. https://doi.org/10.1152/ajpgi.2001.280.4.G519
  33. Welgan P, Meshkinpour H, Beeler M. Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology 1988;94(5 Pt 1):1150-1156. https://doi.org/10.1016/0016-5085(88)90006-6
  34. Saunders PR, Kosecka U, McKay DM, Perdue MH. Acute stressors stimulate ion secretion and increase epithelial permeability in rat intestine. Am J Physiol 1994;267(5 Pt 1):G794-G799.
  35. Santos J, Yang PC, Soderholm JD, Benjamin M, Perdue MH. Role of mast cells in chronic stress induced colonic epithelial barrier dysfunction in the rat. Gut 2001;48: 630-636. https://doi.org/10.1136/gut.48.5.630
  36. Teitelbaum AA, Gareau MG, Jury J, Yang PC, Perdue MH. Chronic peripheral administration of corticotropin-releasing factor causes colonic barrier dysfunction similar to psychological stress. Am J Physiol Gastrointest Liver Physiol 2008;295:G452-G459. https://doi.org/10.1152/ajpgi.90210.2008
  37. D'Incà R, Di Leo V, Corrao G, et al. Intestinal permeability test as a predictor of clinical course in Crohn's disease. Am J Gastroenterol 1999;94:2956-2960. https://doi.org/10.1111/j.1572-0241.1999.01444.x
  38. Madara JL, Trier JS. Structural abnormalities of jejunal epithelial cell membranes in celiac sprue. Lab Invest 1980; 43:254-261.
  39. Clayburgh DR, Barrett TA, Tang Y, et al. Epithelial myosin light chain kinase-dependent barrier dysfunction mediates T cell activation-induced diarrhea in vivo. J Clin Invest 2005;115:2702-2715. https://doi.org/10.1172/JCI24970
  40. Marshall JK, Thabane M, Garg AX, Clark W, Meddings J, Collins SM. Intestinal permeability in patients with irritable bowel syndrome after a waterborne outbreak of acute gastroenteritis in Walkerton, Ontario. Aliment Pharmacol Ther 2004;20:1317-1322. https://doi.org/10.1111/j.1365-2036.2004.02284.x
  41. Dunlop SP, Hebden J, Campbell E, et al. Abnormal intestinal permeability in subgroups of diarrhea-predominant irritable bowel syndromes. Am J Gastroenterol 2006;101: 1288-1294. https://doi.org/10.1111/j.1572-0241.2006.00672.x
  42. Lee JW, Park JH, Park DI, et al. Subjects with diarrheapredominant IBS have increased rectal permeability responsive to tryptase. Dig Dis Sci 2010;55:2922-2928. https://doi.org/10.1007/s10620-009-1094-8
  43. Piche T, Barbara G, Aubert P, et al. Impaired intestinal barrier integrity in the colon of patients with irritable bowel syndrome: involvement of soluble mediators. Gut 2009;58: 196-201. https://doi.org/10.1136/gut.2007.140806
  44. Fukudo S. Role of corticotropin-releasing hormone in irritable bowel syndrome and intestinal inflammation. J Gastroenterol 2007;42(Suppl 17):S48-S51. https://doi.org/10.1007/s00535-006-1942-7
  45. Larauche M, Kiank C, Tache Y. Corticotropin releasing factor signaling in colon and ileum: regulation by stress and pathophysiological implications. J Physiol Pharmacol 2009; 60(Suppl 7):S33-S46.
  46. Erckenbrecht JF. Noise and intestinal motor alterations. In: Bueno L, Collins S, Junien JL, eds. Stress and Digestive Motility. London: John Libbey Eurotext, 1989:93-96.
  47. Schwetz I, Bradesi S, McRoberts JA, et al. Delayed stress-induced colonic hypersensitivity in male Wistar rats: role of neurokinin-1 and corticotropin-releasing factor-1 receptors. Am J Physiol Gastrointest Liver Physiol 2004; 286:G683-G691. https://doi.org/10.1152/ajpgi.00358.2003
  48. Gue M, Del Rio-Lacheze C, Eutamene H, Théodorou V, Fioramonti J, Bueno L. Stress-induced visceral hypersensitivity to rectal distension in rats: role of CRF and mast cells. Neurogastroenterol Motil 1997;9:271-279. https://doi.org/10.1046/j.1365-2982.1997.d01-63.x
  49. Rosztoczy A, Fioramonti J, Jarmay K, Barreau F, Wittmann T, Bueno L. Influence of sex and experimental protocol on the effect of maternal deprivation on rectal sensitivity to distension in the adult rat. Neurogastroenterol Motil 2003; 15:679-686. https://doi.org/10.1046/j.1350-1925.2003.00451.x
  50. Bradesi S, Schwetz I, Ennes HS, et al. Repeated exposure to water avoidance stress in rats: a new model for sustained visceral hyperalgesia. Am J Physiol Gastrointest Liver Physiol 2005;289:G42-G53. https://doi.org/10.1152/ajpgi.00500.2004
  51. Hong S, Fan J, Kemmerer ES, Evans S, Li Y, Wiley JW. Reciprocal changes in vanilloid (TRPV1) and endocannabinoid (CB1) receptors contribute to visceral hyperalgesia in the water avoidance stressed rat. Gut 2009;58:202-210. https://doi.org/10.1136/gut.2008.157594
  52. La JH, Sung TS, Kim HJ, Kim TW, Kang TM, Yang IS. Peripheral corticotropin releasing hormone mediates post-inflammatory visceral hypersensitivity in rats. World J Gastroenterol 2008;14:731-736. https://doi.org/10.3748/wjg.14.731
  53. Larauche M, Gourcerol G, Wang L, et al. Cortagine, a CRF1 agonist, induces stresslike alterations of colonic function and visceral hypersensitivity in rodents primarily through peripheral pathways. Am J Physiol Gastrointest Liver Physiol 2009;297:G215-G227. https://doi.org/10.1152/ajpgi.00072.2009
  54. Barreau F, Cartier C, Leveque M, et al. Pathways involved in gut mucosal barrier dysfunction induced in adult rats by maternal deprivation: corticotrophin-releasing factor and nerve growth factor interplay. J Physiol 2007;580(Pt 1):347-356. https://doi.org/10.1113/jphysiol.2006.120907
  55. Park JH, Rhee PL, Kim HS, et al. Mucosal mast cell counts correlate with visceral hypersensitivity in patients with diarrhea predominant irritable bowel syndrome. J Gastroenterol Hepatol 2006;21(1 Pt 1):71-78. https://doi.org/10.1111/j.1440-1746.2005.04143.x
  56. Cenac N, Andrews CN, Holzhausen M, et al. Role for protease activity in visceral pain in irritable bowel syndrome. J Clin Invest 2007;117:636-647. https://doi.org/10.1172/JCI29255
  57. Gold MS, Zhang L, Wrigley DL, Traub RJ. Prostaglandin E(2) modulates TTX-R I(Na) in rat colonic sensory neurons. J Neurophysiol 2002;88:1512-1522. https://doi.org/10.1152/jn.2002.88.3.1512
  58. Bouin M, Plourde V, Boivin M, et al. Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology 2002;122:1771-1777. https://doi.org/10.1053/gast.2002.33601
  59. Kanazawa M, Palsson OS, Thiwan SI, et al. Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits. Am J Gastroenterol 2008;103:2550-2561. https://doi.org/10.1111/j.1572-0241.2008.02066.x
  60. Murray CD, Flynn J, Ratcliffe L, Jacyna MR, Kamm MA, Emmanuel AV. Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome. Gastroenterology 2004;127:1695-1703. https://doi.org/10.1053/j.gastro.2004.08.057