Relationship of Abuse History to Functional Gastrointestinal Disorders and Symptoms: Some Possible Mediating Mechanisms

• NCJ Number: 219169
• Journal: Trauma, Violence, & Abuse Volume: 8 Issue: 3 Dated: July 2007 Pages: 331-343
• Author(s): Jane Leserman; Douglas A. Drossman
• Date Published: July 2007
• Length: 13 pages
• Grant Number(s): R01 AT002035; R01 MH61687; R24 DK067674
• Sponsoring Agency: National Institutes of Health
• Publication Format: Article
• Publication Type: Literature Review
• Language: English
• Country: United States of America

Annotation

This research review examines the evidence that links sexual and physical abuse associated with intimate partner violence (IPV) to functional gastrointestinal (GI) symptoms and disorders, and it explores the physiological mechanisms that might mediate these health effects.

Abstract

Research has found that patients with functional GI disorders have more impaired quality of life, poor physical functioning, pain, numerous medical symptoms, and health care visits compared to patients with organic GI disorders and patients with other medical disorders. Functional GI disorders refer to disorders of the GI tract (e.g., diarrhea, constipation, and heartburn) with no known or identifiable structural abnormalities, infectious, biochemical, or metabolic causes. Organic GI disorders, on the other hand, have a diagnosable structural or biological cause. Large probability-based studies have shown that those victimized by sexual abuse, physical abuse, or IPV have one and one-half to two times the risk of reporting GI symptoms or having a functional GI disorder. Those with functional GI disorders tended to be at greater risk for sexual abuse compared to patients with organic GI disorders. Possible mediating mechanisms that account for the relationship of IPV with GI symptoms include greater autonomic reaction to physical and psychological stressors and increased visceral hypersensitivity that leads to lower sensation thresholds in the GI system. Other possible mediating mechanisms are altered cortico-limbic pain modulatory systems that link hypervigilance and emotions such as fear and anxiety with visceral pain, as well as greater stress reactivity through the hypothalamic-pituitary-adrenal (HPA) axis that leads to increased cortisol and inflammatory cytokines. The latter are factors that increase visceral hypersensitivity. More studies are needed to examine whether other childhood and adult adversities might explain some of the impact of sexual and physical abuse on GI symptoms and health status. 96 references