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World J Gastroenterol. Jun 28, 2014; 20(24): 7570-7586
Published online Jun 28, 2014. doi: 10.3748/wjg.v20.i24.7570
Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome
Maria Rosaria A Muscatello, Antonio Bruno, Giuseppe Scimeca, Gianluca Pandolfo, Rocco A Zoccali
Maria Rosaria A Muscatello, Antonio Bruno, Giuseppe Scimeca, Gianluca Pandolfo, Rocco A Zoccali, Psychiatry Unit, Department of Neurosciences, University of Messina, 98125 Messina, Italy
Author contributions: Muscatello MRA contributed to the literature search, manuscript writing, and final revision; Bruno A suggested topics to be included and contributed to the writing of the manuscript; Scimeca G managed the literature search and contributed to the writing; Pandolfo G contributed to the literature search and writing of the manuscript; Zoccali RA contributed to the study idea, manuscript writing and final revision of the article.
Correspondence to: Rocco A Zoccali, Professor, Psychiatry Unit, Department of Neurosciences, University of Messina, Via Consolare Pompea, 1, 98125 Messina, Italy. rocco.zoccali@unime.it
Telephone: +39-90-2212092 Fax: +39-90-695136
Received: September 28, 2013
Revised: January 18, 2014
Accepted: April 2, 2014
Published online: June 28, 2014
Abstract

Irritable bowel syndrome (IBS) is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role. The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors, interacting with peripheral/central neuroendocrine and immune changes, may induce symptoms of IBS, modulate symptom severity, influence illness experience and quality of life, and affect outcome. The present review focuses on the role of negative affects, including depression, anxiety, and anger, on pathogenesis and clinical expression of IBS. The potential role of the autonomic nervous system, stress-hormone system, and immune system in the pathophysiology of both negative affects and IBS are taken into account. Psychiatric comorbidity and subclinical variations in levels of depression, anxiety, and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS, such as sensorimotor functions, gut microbiota, inflammation/immunity, and symptom reporting.

Keywords: Depression, Anxiety, Anger, Mood disorders, Irritable bowel syndrome, Neuroticism, Stress, Brain-gut axis, Microbiota, Hypothalamic-pituitary-adrenal axis

Core tip: This review deals with the role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome (IBS). Depression, anxiety, and anger play a key role in dysregulation of the brain-gut axis, contributing to the majority of pathophysiological and symptomatic correlates of IBS. Research efforts to integrate different knowledge provide further insight into the pathways linking negative psychological states to health and disease, leading to identification of individual vulnerability and susceptibility factors, including subsyndromal conditions, which should be addressed to promote better health in the population and more effective and efficient prevention and treatment of IBS.