J Neurogastroenterol Motil 2022; 28(3): 335-336  https://doi.org/10.5056/jnm22065
Irritable Bowel Syndrome or Psychiatric Disorders: Which Comes First?
Hong Sub Lee
Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
Correspondence to: *Hong Sub Lee, MD, PhD
Department of Internal Medicine, Inje University Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea
Tel: +82-51-890-6989, Fax: +82-51-892-0273, E-mail: hslee@paik.ac.kr

Article: Risk factors for self-reported irritable bowel syndrome with prior psychiatric disorder: the lifelines cohort study Creed F
(J Neurogastroenterol Motil 2022;28:442-453)
Received: May 9, 2022; Accepted: June 3, 2022; Published online: July 30, 2022
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Body

Patients with irritable bowel syndrome (IBS) frequently display psychological disorders involving depression and anxiety.1 Furthermore, sleep disturbances and stress may also be associated with a greater risk of IBS development.2,3 Previous studies have suggested a positive link between psychophysiological stress levels and IBS incidence although the etiology of IBS remains unknown.4-7 Psychological factors can influence pain perception. One plausible explanation is that changes in visceral hypersensitivity or unknown peripheral mechanisms may cause disturbance in the gastrointestinal motor and sensory systems.8 Thus, it is important to identify patients with mental disease because the early application of psychological therapy or the action of central neuromodulators could help improve IBS symptoms.9,10

In this issue of the Journal of Neurogastroenterology and Motility, Creed11 reported a prospective, sizable population-based study that assessed new predictors of IBS. Approximately 1% of participants reported new-onset IBS after a 2.4-year follow-up. There was a prior psychiatric disorder in 27% of this subgroup. According to the authors, prior psychiatric disorders may be a potential risk factor for IBS incidence. This study has the advantage of covering most of the recognized risk factors for IBS in a single large sample cohort. Earlier research has suggested that having severe anxiety but not depression at baseline was a significant independent predictor of new-onset functional gastrointestinal disorder (FGID) development 12 years later.12 A limitation of this study is the impossibility to confirm whether a psychiatric disease has occurred in the group of patients with previous confirmed IBS.

Would it be intestinal symptoms or psychiatric distress that comes first? That is to say, could psychosocial factors induce IBS or could psychological symptoms arise as a result of IBS? Clinical population studies have reported a link between IBS and mental problems in 38-100% of cases.13 Koloski et al14 have suggested that mood disorders preceded FGID in one-third of patients, whereas FGID preceded mood disorders in two-thirds. Although IBS is being recognized as a somatoform and somatic symptom condition, approximately half of all patients with IBS exhibit gastrointestinal symptoms with no mental comorbidities.15 While studies support a two-way brain-to-gut interaction, the hypothesis of a separate gut-to-brain syndrome, which may necessitate a different treatment strategy, is still debated.

Which biological mechanisms may explain the link between IBS and psychological disorders? First, an increased prevalence of psychiatric disorders has been previously reported among relatives of patients with IBS.16 Simultaneously, a genome-wide solid correlation between the risk of IBS and anxiety, ill feelings, and depression has also been identified.17 Neuroimaging psychological distress may trigger a change in the brain’s processing of incoming sensory information, resulting in IBS.18 In addition, the relevance of the microbiome as a possible link between IBS and psychological disorders is gaining ground.19 Finally, the lifelines cohort used in this study also began collecting fecal samples to investigate the impact of the microbiota.20 Such studies will be required in the future to explain the microbiome-brain-gut axis, which contributes to the two-way communication between the gut, its microbiome, and the nervous system.

In summary, mental disorders are a potential risk factor for IBS incidence. Although IBS develops sequentially following psychological distress, the mental elements of the condition have received little attention. Identifying the pathophysiological mechanism between psychological distress and IBS could provide clinical benefits for patients with IBS, bringing them one step closer to therapy.

Financial support

None.

Conflicts of interest

None.

Author contributions

Hong Sub Lee drafted and revised the manuscript.

References
  1. Fond G, Loundou A, Hamdani N, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2014;264:651-660.
    Pubmed CrossRef
  2. Tu Q, Heitkemper MM, Jarrett ME, Buchanan DT. Sleep disturbances in irritable bowel syndrome: a systematic review. J Neurogastroenterol Motil 2017;29:e12946.
    Pubmed CrossRef
  3. Koloski NA, Jones M, Walker MM, Keely S, Holtmann G, Talley NJ. Sleep disturbances in the irritable bowel syndrome and functional dyspepsia are independent of psychological distress: a population-based study of 1322 Australians. Aliment Pharmacol Ther 2021;54:627-636.
    Pubmed CrossRef
  4. Elhosseiny D, Mahmoud NE, Manzour AF. Factors associated with irritable bowel syndrome among medical students at Ain Shams University. J Egypt Public Health Assoc 2019;94:23.
    Pubmed KoreaMed CrossRef
  5. Koh SJ, Kim M, Oh DY, Kim BG, Lee KL, Kim JW. Psychosocial stress in nurses with shift work schedule is associated with functional gastrointestinal disorders. J Neurogastroenterol Motil 2014;20:516-522.
    Pubmed KoreaMed CrossRef
  6. Wells M, Roth L, McWilliam M, Thompson K, Chande N. A cross-sectional study of the association between overnight call and irritable bowel syndrome in medical students. Can J Gastroenterol 2012;26:281-284.
    Pubmed KoreaMed CrossRef
  7. Park DW, Lee OY, Shim SG, et al. The differences in prevalence and sociodemographic characteristics of irritable bowel syndrome according to Rome II and Rome III. J Neurogastroenterol Motil 2010;16:186-193.
    Pubmed KoreaMed CrossRef
  8. Camilleri M. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med 2012;367:1626-1635.
    Pubmed CrossRef
  9. Staudacher HM, Mikocka-Walus A, Ford AC. Common mental disorders in irritable bowel syndrome: pathophysiology, management, and considerations for future randomised controlled trials. Lancet Gastroenterol Hepatol 2021;6:401-410.
    Pubmed CrossRef
  10. Midenfjord I, Borg A, Törnblom H, Simrén M. Cumulative effect of psychological alterations on gastrointestinal symptom severity in irritable bowel syndrome. Am J Gastroenterol 2021;116:769-779.
    Pubmed CrossRef
  11. Creed F. Risk factors for self-reported irritable bowel syndrome with prior psychiatric disorder: the lifelines cohort study. J Neurogastroenterol Motil 2022;28:442-453.
    Pubmed CrossRef
  12. Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain--gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut 2012;61:1284-1290.
    Pubmed CrossRef
  13. Woodman CL, Breen K, Noyes R Jr, et al. The relationship between irritable bowel syndrome and psychiatric illness. A family study. Psychosomatics 1998;39:45-54.
    Pubmed CrossRef
  14. Koloski NA, Jones M, Talley NJ. 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. Aliment Pharmacol Ther 2016;44:592-600.
    Pubmed CrossRef
  15. Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol 2014;20:6024-6030.
    Pubmed KoreaMed CrossRef
  16. Sullivan G, Jenkins PL, Blewett AE. Irritable bowel syndrome and family history of psychiatric disorder: a preliminary study. Gen Hosp Psychiatry 1995;17:43-46.
    Pubmed CrossRef
  17. Eijsbouts C, Zheng T, Kennedy NA, et al. Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nat Genet 2021;53:1543-1552.
    Pubmed KoreaMed CrossRef
  18. Qi R, Liu C, Ke J, et al. Intrinsic brain abnormalities in irritable bowel syndrome and effect of anxiety and depression. Brain Imaging Behav 2016;10:1127-1134.
    Pubmed CrossRef
  19. Simpson CA, Mu A, Haslam N, Schwartz OS, Simmons JG. Feeling down? A systematic review of the gut microbiota in anxiety/depression and irritable bowel syndrome. J Affect Disord 2020;266:429-446.
    Pubmed CrossRef
  20. Sijtsma A, Rienks J, van der Harst P, Navis G, Rosmalen JGM, Dotinga A. Cohort profile update: lifelines, a three-generation cohort study and biobank. Int J Epidemiol Published Online First: 13 Dec 2021. doi: 10.1093/ije/dyab257.
    Pubmed CrossRef


This Article

e-submission

Archives

Aims and Scope