Autonomic nervous system abnormalities in children with inflammatory bowel disease and irritable bowel syndrome: a
Paola Ruška1, Antonella Jerković1, Sara Sila1
1Department of Pediatrics, Children's Hospital Zagreb, Zagreb, Croatia.
Insights
Children with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) exhibit autonomic nervous system (ANS) abnormalities. IBS patients show higher symptom burden, while IBD patients have greater sudomotor dysfunction, impacting quality of life.
Area of Science:
- Pediatric Gastroenterology
- Autonomic Neuroscience
- Clinical Medicine
Background:
- Autonomic nervous system (ANS) dysfunction is increasingly recognized in pediatric gastrointestinal disorders.
- Understanding ANS involvement in pediatric inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) is crucial for comprehensive patient care.
Purpose of the Study:
- To investigate and compare subjective and objective autonomic nervous system (ANS) abnormalities in children with IBD and IBS versus healthy children (HC).
- To assess the impact of ANS dysfunction on health-related quality of life (HRQoL) in these pediatric populations.
Main Methods:
- A cohort of 69 children (23 IBD, 28 IBS, 18 HC) was evaluated.
- Autonomic symptoms were measured using the Composite Autonomic Symptom Score (COMPASS-31).
- Autonomic function severity was assessed via the Composite Autonomic Severity Scale (CASS), including adrenergic, cardiovagal, and sudomotor indices. Pediatric Quality of Life Inventory (PedsQL) measured HRQoL.
Main Results:
- Children with IBS reported the highest autonomic symptom burden (COMPASS-31 scores), followed by IBD patients and HC.
- While overall CASS scores did not differ significantly, children with IBD showed greater sudomotor dysfunction.
- Symptomatic autonomic dysfunction was significantly more prevalent in children with IBS (61.5%) and IBD (42.1%) compared to HC (7.1%).
Conclusions:
- The autonomic nervous system (ANS) is frequently impacted in pediatric IBD and IBS.
- Children with IBS experience a greater burden of autonomic symptoms, whereas those with IBD exhibit more pronounced sudomotor dysfunction.
- Observed ANS changes significantly influence health-related quality of life (HRQoL) in children with IBD and IBS.
Objectives:
This study aimed to investigate the subjective and objective autonomic nervous system (ANS) abnormalities in children with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) compared with healthy children (HC).
Methods:
In total, 69 children were enrolled: 23 in the IBD, 28 in the IBS, and 18 HC group. ANS symptoms were evaluated using the Composite Autonomic Symptom Score (COMPASS-31). The severity and distribution of ANS function were quantitated using adrenergic, cardiovagal, and sudomotor indices of the Composite Autonomic Severity Scale (CASS). Health-related quality of life (HRQoL) was assessed with the Pediatric Quality of Life Inventory (PedsQL).
Results:
Children with IBS scored highest on the COMPASS-31, followed by patients with IBD and HC (median 11.5, 6.3, and 1.7, respectively; p = 0.001). There was no significant difference between groups in CASS (p = 0.09); however, children with IBD had a higher score on the sudomotor index (p = 0.012). There was a significant difference in symptomatic autonomic dysfunction (defined as COMPASS-31 > 7.913 and CASS > 0) between children with IBS (61.5%) compared with children with IBD (42.1%) and HC (7.1%), p = 0.004. In multivariable logistic regression, the number of squats decreased the probability of special health care needs by 17.2%, and the presence of symptomatic autonomic dysfunction increased the probability by 515.4%.
Conclusions:
The ANS is frequently affected in children with IBD and IBS; children with IBS show greater autonomic symptom burden, while children with IBD have greater sudomotor dysfunction. HRQoL is significantly influenced by observed ANS changes in both groups.
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