Somatization in patients with predominant diarrhoea irritable bowel syndrome: the role of the intestinal barrier function and integrity

Laura Prospero, Giuseppe Riezzo, Michele Linsalata, Antonella Orlando, Benedetta D'Attoma, Marta Di Masi, Manuela Martulli, Francesco Russo, Laura Prospero, Giuseppe Riezzo, Michele Linsalata, Antonella Orlando, Benedetta D'Attoma, Marta Di Masi, Manuela Martulli, Francesco Russo

Abstract

Background: Irritable bowel syndrome (IBS) is characterised by gastrointestinal (GI) and psychological symptoms (e.g., depression, anxiety, and somatization). Depression and anxiety, but not somatization, have already been associated with altered intestinal barrier function, increased LPS, and dysbiosis. The study aimed to investigate the possible link between somatization and intestinal barrier in IBS with diarrhoea (IBS-D) patients.

Methods: Forty-seven IBS-D patients were classified as having low somatization (LS = 19) or high somatization (HS = 28) according to the Symptom Checklist-90-Revised (SCL-90-R), (cut-off score = 63). The IBS Severity Scoring System (IBS-SSS) and the Gastrointestinal Symptom Rating Scale (GSRS) questionnaires were administered to evaluate GI symptoms. The intestinal barrier function was studied by the lactulose/mannitol absorption test, faecal and serum zonulin, serum intestinal fatty-acid binding protein, and diamine oxidase. Inflammation was assessed by assaying serum Interleukins (IL-6, IL-8, IL-10), and tumour necrosis factor-α. Dysbiosis was assessed by the urinary concentrations of indole and skatole and serum lipopolysaccharide (LPS). All data were analysed using a non-parametric test.

Results: The GI symptoms profiles were significantly more severe, both as a single symptom and as clusters of IBS-SSS and GSRS, in HS than LS patients. This finding was associated with impaired small intestinal permeability and increased faecal zonulin levels. Besides, HS patients showed significantly higher IL-8 and lowered IL-10 concentrations than LS patients. Lastly, circulating LPS levels and the urinary concentrations of indole were higher in HS than LS ones, suggesting a more pronounced imbalance of the small intestine in the former patients.

Conclusions: IBS is a multifactorial disorder needing complete clinical, psychological, and biochemical evaluations.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT03423069 .

Keywords: Dysbiosis; Inflammation; Intestinal permeability; Irritable bowel syndrome; Somatization; Symptom questionnaire.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of the patients
Fig. 2
Fig. 2
Urinary markers of gastrointestinal permeabilityin IBS-D with low (LS) and high (HS) somatization. Panel A = %Lactulose (La). Panel B = %Mannitol (Ma). Panel C = La/Ma ratio. Panel D = %Sucrose (Su). The La/Ma ratio was significantly higher in HS patients than in LS ones (P = 0.0358). The red dot line indicates the cut-off level. Data are expressed as means ± SD and evaluated by the Mann-Whitney rank-sum test

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