Inflammatory Reaction In Irritable Bowel Syndrome With Depressive Symptoms

BackgroundIBS is a worldwide disease,the prevalence rate is about 7-21%,the medical burden is heavy year by year,the quality of life of some patients is affected,and even lose social mobility,and it has important research value.The pathogenesis of IBS is complicated.At present,consensus is based on genetic susceptibility to infection,trauma and acute&chronic stress events to induce and aggravate,but a single mechanism can explain all the pathogenesis of IBS.In addition to digestive symptoms,IBS often combines anxiety,depression and other psychiatric symptoms.It also includes headache,palpitations and fatigue and other somatic symptoms.Each individual has different clinical manifestations,and even some patients suffer from mental symptoms more severe than IBS symptoms,which bring great difficulties to the treatment and make it difficult for the patient to recover from the disease.Therefore,it is of important clinical value to treat psychiatric symptoms in IBS patients.Although clinicians have paid great attention to the impact of psychiatric symptoms on the clinical prognosis of IBS,it is not easy to identify IBS patients with psychiatric symptoms,and early identification is more difficult.The psychiatric department offers a variety of anxiety and depression scales,and although there are differences in measurement methods,they all have good reliability.But the clinical use of scale to judge the existence of anxiety and depression,even using the Zung checklist is still time-consuming,and sometimes it is difficult to obtain accurate evaluation,but not suitable for outpatient timely diagnosis of patients with psychiatric symptoms.Therefore,we sought to re analyze the gastrointestinal symptoms and somatic symptoms in patients with IBS,combined Hamilton depression scale score,using backstepping method to improve the ability of early identification of mental and psychological abnormalities in IBS patients.ObjectiveBy analyzing somatic and digestive tract symptoms in IBS patient’s with depression state,Compared with the Hamilton Depression Scale,to primary discussion on interrogation of recognition IBS with abnormal psychological value.MethodsFrom Anhui provincial hospital Gastroenterology Clinic from May 2014 to October 2014,to investigate and follow-up medical history records and questionnaire of 102 cases of IBS,including data of patient clinic information,21 item Hamilton Depression Scale(HAMD),14 item Hamilton rating Anxiety Scale(HAMA),gastrointestinal symptoms questionnaire,self-made physical symptoms questionnaire and irritable bowel syndrome-symptom severity score(IBS-SSS)table to be collected,compiled and statistical.Statistical count data using t test,measurement data using Chi square test.Results1.General information:A total of 102 IBS patients and 102 healthy controls entered the present study.Of the 102 IBS patients,male 39 cases,female 63 cases.average age(48.1 ±26.9)years age,the average course of(23.4 ± 21.2)months;In patients with IBS,43.13%(n=44)were diagnosed with diarrhea-predominant(IBS-D)IBS.,29.41%(n=30)were constipation-predominant(IBS-C)IBS,15.69%(n=16)were IBS-M(mixed diarrhea and constipation)and 11.76%(n=12)were IBS-A(alternating stool pattern).Of the 102 healthy controls,there were 43 males and 59 females with an average age of(42.3 ± 33.5)years.2.Comparison of HAMD and HAMA scores in 102 patients with IBS and control group.The HAMD score of IBS group was 19.19 ± 17.00 which was higher than that in healthy control group(3.20± 2.90)(t=8.966,P<0.01).The HAMA score of IBS group was 17.25 ± 14.30,which was also higher than that in healthy control group(5.86±3.16)(t=7.837,P<0.01).Of the 102 IBS patients,58 had depressive symptoms(56.9%),and 44 had no depressi-ve symptoms(43.1%).Of the 102 IBS patients,67 had anxiety symptoms(65.7%),and 35 had no anxiety symptoms(34.3%).3.Comparison of gastrointestinal symptoms in DP-IBS patients and NDP-IBS patients.The 102 IBS patients,the first diagnosed with IBS symptoms in 43 cases(42.2%),with functional dyspepsia(functional dyspepsia,FD)28 cases(27.5%),15 cases of patients with GERD(14.7%),6 cases(5.9%)with FD and GRED,10(9.8%)cases of difficult to classify.Of the 58 DP-IBS patients.44(75.9%)had digestive tract overlapping symptoms,and 15 of the 44 NDP-patients had digestive tract overlap(34.1%);There was significant difference between two groups(X2＝17.902,P<0.01).Of the 44 patients with NDP-IBS.only 1(2.3%)of the 3 symptoms overlapped.4.Comparison of specialty clinic between DP-IBS patients and NDP-IBS patients.58 DP-IBS patients,first diagnosed 23 cases of digestive diseases(39.7%).10 cases of neurology(17.2%),8 cases of cardiovascular disease(13.8%),5 cases(8.6%);4 cases of Department of respiration department of Endocrinology(6.9%),3 cases of psychological department(5.2%),5 cases of other specialties(8.8%).Visit 2 specialties 43 cases(74.1%),3 specialties(31%),18 cases of more than 4 Specialties(6.8%).Of the 44 NDP-IBS patients,13(29.5%)visited other specialties except gastroenterology.Among the IBS patients with depression,one or more specialties were found on the same day except for gastroenterology.5.Comparison of somatic symptoms in DP-IBS patients and NDP-IBS patients.DP-IBS patients with headache,dizziness or nausea,throat discomfort,chest pain,chest tightness and palpitation,palpitations,backache and lumbago,muscle aches,fever or chills,body numbness,body weakness,panic,insomnia,fuzzy rates are higher than NDP-IBS patients(all P<0.01).The symptoms of IBS in patients with depressive symptoms are headache,dizziness,insomnia,palpitation and palpitation,chest pain and chest tightness.6.Comparison of IBS-SSS and abdominal pain characteristics between DP-IBS patients and NDP-IBS patients.Comparison the abdominal pain,abdominal distension,and quality of life with score of IBS-SSS in IBS patients with depressive symptoms were higher than those in NDP-IBS patients(all P<0.05),The satisfaction of defecation was lower than that of NDP-IBS patients(all P<0.05).There was no significant difference in the severity of abdominal pain between the two groups(P>0.05).The abdominal pain of the DP-IBS and NDP-IBS patients mainly locate in lower abdominal region,but the former is often manifested by the coexistence of multiple regions,and more obscure in pain syndrome.Conclusion1.The incidence of anxiety and depression in patients with IBS is higher.2.The digestive tract overlap symptoms and somatization symptoms of IBS patients with depressive symptoms are obvious,and they are generalized and changeable.3.When IBS combined with depressive symptoms,it may affect the main symptoms of IBS,reduce the severity of abdominal pain,while the degree of abdominal distension is serious and the quality of life drops.4.If IBS patients have digestive tract overlapping symptoms and somatization symptoms,and the symptoms are more disordered,suggesting that IBS patients suffer from depression and anxiety and other mental and psychological disorders.It is helpful to identify the mental symptoms of IBS in the early clinical practice,and give the appropriate intervention to improve the patient’s condition.BackgroundIrritable bowel syndrome with abdominal pain and(or)abdominal discomfort associated with altered bowel habit was a clinical syndrome,the prevalence rate is higher,and has the tendency to rise year by year,partial patient quality of life has been affected,even can lose the social activity ability.bring huge economic burden to society and family,is still the medical research key point in the world.At present,the pathogenesis of IBS has not been fully clarified,and there is no single mechanism to explain the whole picture of IBS.The clinical manifestations of IBS patients are complicated.In addition to the symptoms of IBS,most patients also suffer from anxiety,depression and other psychiatric symptoms.These psychiatric symptoms make IBS patients’complex,protracted,refractory,but the pathophysiology of IBS associated with psychiatric symptoms is poorly understood.The study of its pathogenesis may provide theoretical support for the treatment of IBS patients with psychiatric symptoms,it has important research value.Chronic stress is an important cause of IBS and the main cause of depression.Therefore,there may be a common pathway between IBS and depression in pathogenesis.In recent years,the study found that immune activation and low levels of inflammatory reaction in patients with IBS,the study also found that immune activation and inflammation in patients with depression,suggesting that low levels of inflammation may be the key point of IBS with depression symptoms.The present results show that the neuro-endocrine-immune pathway is involved in the pathogenesis of IBS.Under stress,the HPA axis changes,leading to inflammation and alterations in the central nervous system and intestinal mucosa,where CRF plays a major role.Innate immunity plays an important role in regulating immune homeostasis.Toll like receptor(TLR)is one of the important pattern recognition molecules.It is expressed on the surface of most immune cells and is involved in the inflammatory response.The study found that TLR is involved in the pathogenesis of IBS and depression,but whether TLR is a common pathway for the inflammatory response of IBS and depression is rarely studied.This study focused on CRF receptors and TLR in patients with IBS with depressive symptoms,understanding the relationship between CRF receptors and TLR and low levels of inflammation in IBS associated with depressive symptoms,and exploring the mechanisms of IBS inflammation in CRF-TLR pathways associated with depressive symptoms.ObjectiveThe mechanism of low-grade inflammation in irritable bowel syndrome(IBS)is unclear.We investigated the involvement of the Corticotropin-releasing factor(CRF)and Toll-like receptor(TLR)gene expression in the process of low-grade inflammation in IBS patients with depression.Methods102 IBS patients and healthy controls were enrolled from in the outpatient department of the Anhui Provincial Hospital.The psychological status of all subjects were evaluated using the Hamilton depression scale(HAMD)and the Hamilton anxiety Scale(HAMA).The mRNA levels of CRF.TLR,interleukin-6(IL-6)and interleukin-10(IL-10)in peripheral blood were examined using real time quantitative PCR(RT-PCR).Results1.General information:The HAMD score of IBS group was 19.19 ± 17.00,which was higher than that in healthy control group(3.20 ± 2.90)(t=8.966,P<0.11).The HAMA score of IBS group was 17.25 ±14.30,which was also higher than that in healthy control group(5.86 ± 3.16)(t=7.837,P<0.01).A total of 58 cases(56.9%)got a HAMD score>7 for depressive IBS(DP-IBS),and 44 cases(43.1%)got a HAMD score<7 for no depressive IBS(NDP-IBS).IBS patients living in urban setting,married,or with a higher education were more likely to express depressive symptoms,respectively(X2=5.904,P<0.01,x2=3.938,P<0.05 and x2=6.795,P<0.01),there was significant difference.2.Comparison of IL-6 mRNA and IL-10 mRNA expression between DP-IBS,NDP-IBS and the control group.IL-6 mRNA expressions in DP-IBS and NDP-IBS patients were significantly higher than those in the control group(0.026 ± 0.004,0.023±0.005,and 0.017±0.006 respectively,F=53.077,P<0.01),and DP-IBS patients had a higher IL-6 mRNA level than that of NDP-IBS patients,p<0.05.IL-10 mRNA expressions in DP-IBS and NDP-IBS patients were significantly lower than those in the control group(0.0092±0.0019,0.0059± 0.0015,and 0.0052±0.0014 respectively,F=58.249,p<0.05),Although IL-10 mRNA level in DP-IBS is lower than NDP-IBS,but without statistical significance(p>0.05).3.Correlation between HAMD score and expression of IL-6,mRNA,IL-10mRNA in IBS patients.HAMD scores of 102 IBS patients were positively correlated with IL-6 mRNA expression(r=0.455,P<0.01),and no correlated with with IL-10 mRNA expression(r=0.028,p=0.667).4.Comparison of expressions of CRF1 mRNA and CRF2 mRNA between DP-IBS,NDP-IBS and the control group.CRF1 mRNA and CRF2 mRNA levels in DP-IBS and NDP-IBS patients were significantly higher than those in the control group(CRF1:0.070 ±0.004,0.054 ± 0.002,and 0.041 ± 0.008 respectively,F=12.047,P<0.01;CRF2:0.0031 ± 0.0005,0.0027 ± 0.0004,and 0.0018 ± 0.004 respectively,F＝83.726,P<0.01).CRF1 mRNA and CRF2 mRNA levels in DP-IBS patients were significantly higher than those of NDP-IBS patients,p<0.05.5 Comparison of TLR2 mRNA and TLR4 mRNA expression levels between DP-IBS,NDP-IBS and the control group.TLR2 mRNA and TLR4 mRNA levels in DP-IBS,NDP-IBS patients were significantly higher than those in the control group(0.013 ±0.002,0.009 ± 0.0035 and 0.006 ± 0.002 respectively,F=5.018,P<0.01;0.012 ±0.002,0.009 ±0.001,and 0.005 ±0.001 respectively,F=12.015,P<0.01),and those in DP-IBS patients were significantly higher than those in NDP-IBS patients(p<0.05).Conclusion1.The majority of IBS patients have symptoms of anxiety and depression,work pressure and other chronic mental stress may be the main reason IBS patients with depression,and IBS patients with depressive symptoms have both inflammatory cytokines and imbalance.2.IBS patients with depressive symptoms had elevated expression of CRF1 and CRF2 receptors.4.CRF-TLR pathw-ay may be involved in the low level of inflammatory response in IBS associated depressive symptoms.5.Effect of inflammatory factors on central nervous system and gut,produce corresponding gastrointestinal and psychiatric symptoms,play an important role in IBS associated with depressive symptoms.It provides a new therapeutic approach for clinical treatment.