Women with diarrhoea-predominant irritable bowel syndrome show an increased pressure response to 35% carbon dioxide stress challenge

Abstract

The responses to inhalation of 35% carbon dioxide (CO₂) as a stressor were compared in female irritable bowel syndrome (IBS) patients and healthy controls to assess potential differences in cardiovascular, neuroendocrine and behavioural responses to stress. A total of 22 women (12 patients with ROME II defined diarrhoea-predominant IBS and 10 aged-matched controls) were challenged with a single vital capacity breath of 35% CO₂ (with 65% oxygen). Beat-to-beat blood pressure and heart rate were recorded prior to, during and after the inhalation. Serum cortisol concentration and behavioural ratings were measured pre- and post-inhalation. A typical pattern of responses to CO₂ was observed, characterised by a reduction in heart rate and increases in serum cortisol and anxiogenic symptoms; however, these responses did not differ between groups. Both groups also demonstrated an increase in systolic blood pressure; however, this response was significantly enhanced in IBS patients compared to healthy controls (P < 0.05). These findings demonstrate that females with diarrhoea-predominant IBS have an exaggerated pressor response to 35% CO₂ stress challenge, suggesting a more stress-responsive sympathetic nervous system.

• Irritable bowel syndrome
• stress
• autonomic dysfunction
• carbon dioxide
• inhalation
• mood

Additional information

Notes on contributors

Jonathan Shufflebotham

Contributors J Shufflebotham instigated the study. J Shufflebotham, M Wetherell, and J Potokar designed the study. J Shufflebotham recruited patients from C Probert's clinic. J Shufflebotham, M Wetherell ran the study days and collected data. J Shufflebotham, M Wetherell, D Hince, S Hood, S Lightman, J Potokar, D Nutt, and C Probert contributed to the analysis. J Shufflebotham, M Wetherell, J Potokar, D Hince S, Hood, S Lightman, D Nutt, and C Probert contributed to the final manuscript, which was approved by all authors.