Relationship between psychological state and level of activity of extrinsic gut innervation in patients with a functional gut disorder

Abstract

Background: Anxiety and depression are known to be associated with alterations in central autonomic activity, and this may manifest as a functional gut disturbance. However, the final expression of motility disturbance is non-specific and non-quantifiable. This study examines the relationship between psychological state and psychosocial functioning with a new direct measure of the level of activity of extrinsic autonomic gut innervation, rectal mucosal Doppler blood flow.

Materials and methods: Thirty four female patients (mean age 36 years, range 19--45) with constipation for greater than five years and 19 healthy women (mean age 38 years, range 21--60) were studied. They completed the general health questionnaire-28 point scale (GHQ-28; psychosocial functioning) and the Bem sex role inventory (BSRI; an index of women's psychological feelings about their own femininity). On the same day they underwent measurement of rectal mucosal Doppler blood flow, a new validated measure of the activity of gut extrinsic nerve innervation. Measurements were made during the follicular phase and in the fasted state.

Results: Women with constipation scored higher on the total GHQ-28 score and the somatisation (p=0.05) and anxiety (p=0.05) subscales of the GHQ-28. There was a negative correlation between mucosal blood flow and GHQ somatisation subscale (r=-0.45, p<0.005), anxiety (r=-0.38, p<0.05), and depression (r=-0.40, p<0.01) scores in women with constipation. Although constipated women scored no higher than controls on the BSRI, there was a significant negative correlation between blood flow and BSRI score (r=-0.49, p<0.005) for constipated women.

Conclusions: General psychosocial function, somatisation, anxiety, depression, and feelings about female role are impaired in women with constipation and associated with altered rectal mucosal blood flow, a measure of extrinsic gut innervation. These findings suggest that psychological factors are likely to influence gut function via autonomic efferent neural pathways.

Figure 1

Scattergram showing statistically significant correlation of rectal mucosal blood flow with general health questionnaire (GHQ) anxiety subscale in patients with constipation (r=−0.38, p=0.017). High anxiety subscale scores (range 0-7) represent high levels of anxiety.

Figure 2

Scattergram showing lack of statistically significant correlation of rectal mucosal blood flow with general health questionnaire (GHQ) anxiety subscale in healthy volunteers (r=−0.17, p=0.488).

Figure 3

Relationship of measurement of rectal mucosal blood flow with Bem sex role inventory (BSRI) score. The higher the BSRI score the lower the psychological morbidity, and lower flow correlated with poorer psychological score (r=−0.50, p=0.003).