Evaluation of Autonomic Functions in Patients with Inflammatory Bowel Disease by using Electro Diagnostic Study and Composite Autonomic Symptom Score-31
DOI:
https://doi.org/10.32792/jmed.2025.29.30Keywords:
Autonomic nervous system, Inflammatory bowel disease, Sympatho-vagal imbalanceAbstract
The autonomic nervous system may be involved in inflammatory bowel disease(IBD). Autonomic dysfunction is linked to systemic issues and altered gut
motility, possibly contributing to symptoms. This study evaluates autonomic
function using electrodiagnostic measures and examines its relationship to factors
such as age, sex, disease duration, treatment type, and the Composite Autonomic
Symptom Score-31. A case–control design included 75 individuals, consisting of
45 patients diagnosed with Crohn’s disease or Ulcerative colitis and 30 healthy
controls, aged 18 to 60 years, of either sex. Subjects fasted overnight and did not
take any medications for IBD or those that might affect heart rate from noon the
day before testing. Smokers were asked to abstain on the morning of testing.
Patients exhibited lower heart rate variability during normal breathing and
Valsalva maneuvers, with a prolonged palmar sympathetic skin response latency
compared to controls. 22 (48.9%) showed early dysfunction, 3 (6.7%) had definite
dysfunction, and 3 (6.7%) had severe dysfunction. Eleven (50%) early autonomic
dysfunction patients showed parasympathetic involvement (7 Ulcerative colitis, 4
Crohn’s disease), 5 (22.7%) had sympathetic involvement (3 Crohn’s, 2
Ulcerative colitis), and 6 (27.3%) had both (3 Ulcerative colitis, 3 Crohn’s). The
Composite Autonomic Symptom Score-31 was negatively linked to heart rate
responses to deep breathing, Valsalva, and standing. Patients with IBD have
lower autonomic functions. Patients with ulcerative colitis have significantly
lower parasympathetic function in comparison to those with Crohn’s disease and
healthy controls.
References
Colombel JF, Shin A, Gibson PR. AGA Clinical Practice Update on Functional Gastrointestinal Symptoms in Patients With
Inflammatory Bowel Disease: Expert Review. Clin Gastroenterol Hepatol. 2019 Feb;17(3):380-390.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr. 2015; 169:105360.
Kuenzig ME, Fung SG, Marderfeld L, Mak JW, Kaplan GG, Ng SC, Wilson DC, Cameron F, Henderson P, Kotze PG, Bhatti
J. Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review.
Gastroenterology. 2022 Apr 1;162(4):1147-59.
Ferro JM, Oliveira Santos M. Neurology of inflammatory bowel disease. J Neurol Sci. 2021; 424:117426.
Benavente L, Morís G. Neurologic disorders associated with inflammatory bowel disease. Eur J Neurol. 2011; 18(1):138
Ferro JM, Oliveira SN, Correia L. Neurologic manifestations of inflammatory bowel diseases. Handb Clin Neurol. 2014;
:595-605.
Zois CD, Katsanos KH, Kosmidou M, Tsianos EV. Neurologic manifestations in inflammatory bowel diseases: current
knowledge and novel insights. Journal of Crohn's and Colitis. 2010 Jun 1;4(2):115-24.
Babali A, Terzoudi A, Vadikolias K, et al. Peripheral neuropathy electrophysiological screening in inflammatory bowel
disease. Eur J Gastroenterol Hepatol. 2013; 25(5):539- 542.
Finnie IA, Shields R, Sutton R, Donnelly R, Morris AI. Crohn's disease and myasthenia gravis: a possible role for
thymectomy. Gut. 1994 Feb 1;35(2):278-9.
Rana A, Musto AE. The role of inflammation in the development of epilepsy. Journal of neuroinflammation. 2018 May
;15(1):144.
Musto AE, Rosencrans RF, Walker CP, Bhattacharjee S, Raulji CM, Belayev L, Fang Z, Gordon WC, Bazan NG.
Dysfunctional epileptic neuronal circuits and dysmorphic dendritic spines are mitigated by platelet-activating factor receptor
antagonism. Scientific reports. 2016 Jul 22;6(1):30298.
Casella G, Tontini GE, Bassotti G, Pastorelli L, Villanacci V, Spina L, Baldini V, Vecchi M. Neurological disorders and
inflammatory bowel diseases. World Journal of Gastroenterology: WJG. 2014 Jul 21;20(27):8764.
De Caro C, Leo A, Nesci V, Ghelardini C, di Cesare Mannelli L, Striano P, Avagliano C, Calignano A, Mainardi P, Constanti
A, Citraro R. Intestinal inflammation increases convulsant activity and reduces antiepileptic drug efficacy in a mouse model of epilepsy.
Scientific reports. 2019 Sep 27;9(1):13983.
Mogilevski T, Burgell R, Aziz Q, Gibson PR. the role of the autonomic nervous system in the pathogenesis and therapy of
IBD. Alimentary pharmacology & therapeutics. 2019 Oct;50(7):720-37.
Lindgren S, Lilja B, Rosen I, Sundkvist G. Disturbed autonomic nerve function in patients with Crohn's disease. Scandinavian
journal of gastroenterology. 1991 Jan 1;26(4):361-6.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of
Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The lancet. 2007 Oct
;370(9596):1453-7.
Preston DC & Shapiro BE. Routine Upper Extremity, Facial, and Phrenic Nerve Conduction Techniques. In:
Electromyography and Neuromuscular Disorders: Clinical–Electrophysiologic Correlations. Basic Nerve Conduction Studies.
SECTION IV. Detailed Nerve Conduction Studies. 3rd edition, Chapter 10, Elsevier Inc. 2021; p. 105, 119.
Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent.
Gastroenterology. 2006; 130(5):1527-1537.
Ott C, Obermeier F, Thieler S, Kemptner D, Bauer A, Schölmerich J, Rogler G, Timmer A. The incidence of inflammatory
bowel disease in a rural region of Southern Germany: a prospective population-based study. European journal of gastroenterology &
hepatology. 2008 Sep 1;20(9):917-23.
Sadowski A, Dunlap C, Lacombe A, Hanes D. Alterations in heart rate variability associated with irritable bowel syndrome
or inflammatory bowel disease: a systematic review and meta-analysis. Clinical and translational gastroenterology. 2021 Jan
;12(1):e00275.
Zhang Z, Ma Y, Fu L, Li L, Liu J, Peng H, Jiang H. Combination of composite autonomic symptom score 31 and heart rate
variability for diagnosis of cardiovascular autonomic neuropathy in people with type 2 diabetes. Journal of Diabetes Research.
;2020(1):5316769.
D’Ippolito I, Menduni M, D’Amato C, Andreadi A, Lauro D, Spallone V. Does the relationship of the autonomic symptoms
questionnaire COMPASS 31 with cardiovascular autonomic tests differ between type 1 and type 2 diabetes mellitus?. Diabetes &
Metabolism Journal. 2024 Nov 1;48(6):1114-25.
Maghraby GG, Khalil AS, Fawzi MM, Hegazy MT. Heart rate variability stands up to bedside tests and composite autonomic
symptom score-31 (COMPASS-31) questionnaire: Diagnostic tools for autonomic dysfunction in systemic sclerosis patients. The
Egyptian Rheumatologist. 2025 Jan 1;47(1):41-5.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Noor Jawad Kadhim, Farqad Bader Hamdan, Raghad J. Hussain
This work is licensed under a Creative Commons Attribution 4.0 International License.
