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Autonomic nervous system function predicts the inflammatory response over three years in newly diagnosed ulcerative colitis patients

Journal article
Authors Veronica Gunterberg
Magnus Simrén
Lena Öhman
Peter Friberg
M. P. Jones
L. Van Oudenhove
Hans Strid
Published in Neurogastroenterology and Motility
Volume 28
Issue 11
Pages 1655-1662
ISSN 1350-1925
Publication year 2016
Published at Institute of Neuroscience and Physiology
Institute of Biomedicine, Department of Microbiology and Immunology
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 1655-1662
Language en
Links dx.doi.org/10.1111/nmo.12865
Keywords autonomic nervous system function, clinical course, inflammation, ulcerative colitis, heart-rate-variability, bowel-disease, crohns-disease, spectral-analysis, stimulation, innervation, remission, gut, Gastroenterology & Hepatology, Neurosciences & Neurology
Subject categories Clinical Medicine

Abstract

BackgroundThe autonomic nervous system (ANS) modulates intestinal inflammation in animal models. Human evidence confirming such modulating influence is limited. We aimed to investigate whether ANS function is associated with inflammatory parameters at disease onset, and whether it predicts the evolution of inflammation in patients with ulcerative colitis (UC). MethodsWe prospectively monitored 51 patients from onset of UC for 3 years. Upon remission of the onset flare, ANS activity was assessed by heart rate variability analysis and compared with healthy controls. Inflammatory parameters in blood, stool, and colonic biopsies obtained at onset and during follow-up visits were analyzed. Generalized linear models were used to test cross-sectional associations between ANS activity and inflammatory parameters at onset; linear mixed models were used to test whether ANS function at onset predicted the evolution of inflammation over the following 3 years. Key ResultsSympathovagal balance was different in UC patients compared to healthy controls, and cross-sectional associated with higher levels of systemic (erythrocyte sedimentation rate [ESR], CRP, TNF-, IFN-) and mucosal inflammation (interleukin-8, IFN-) at onset. Conversely, a negative cross-sectional association with parasympathetic activity was found for ESR & TNF-. Longitudinally, parasympathetic activity at onset predicted systemic (ESR, WBC), but not mucosal inflammation during follow-up. Conclusions & InferencesThis study further strengthens the association between the ANS system and intestinal inflammation previously found in animal models and recently in patients with inflammatory bowel disease. These results may have important implications for the pathogenesis and treatment of UC.

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