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Basal and Stimulated Hypothalamic-Pituitary-Adrenal Axis Activity in Patients With Functional Gastrointestinal Disorders and Healthy Controls

From the Center for Psychobiological and Psychosomatic Research, University of Trier, Trier, Germany (A.H.B., S.F., D.H.H.); and Institute of Psychology, Clinical Psychology and Psychotherapy, University of Zürich, Zürich, Switzerland (U.M.N., U.E.).

Address correspondence and reprint requests to Ulrike Ehlert, PhD, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Zürich, Zürichbergstr. 43, CH-8044 Zürich, Switzerland. E-mail: u.ehlert{at}psychologie.unizh.ch

Objective: The aim of this study was to investigate alterations of pituitary-adrenal activity under both stimulated and unstimulated conditions in patients with functional gastrointestinal disorders.

Methods: Thirty subjects who fulfilled the Rome Diagnostic Criteria for either irritable bowel syndrome or nonulcer dyspepsia and 24 healthy controls took part in the study. Free salivary morning cortisol and diurnal cortisol profiles were obtained for all subjects. On a second day, a low-dose dexamethasone suppression test was applied. Additionally, in all subjects a corticotropin-releasing hormone (CRH) challenge test was performed.

Results: The results show attenuated unstimulated cortisol levels in patients compared with controls. After CRH challenge, blunted adrenocorticotropic hormone and cortisol responses were observed. These findings suggest lower pituitary and adrenocortical activity in patients with functional gastrointestinal disorders.

Conclusion: The observed pituitary-adrenal reactivity in these patients is discussed as a possible consequence of lower adrenocortical activity, possibly resulting in a disinhibition of CRH in the brain.

Key Words: irritable bowel syndrome • nonulcer dyspepsia • HPA axis • corticotropin-releasing hormone • cortisol • dexamethasone suppression test

Abbreviations: CRH = corticotropin-releasing hormone; NUD = nonulcer dyspepsia; IBS = irritable bowel syndrome; ACTH = adrenocorticotropic hormone; HPA = hypothalamic-pituitary-adrenal; ANOVA = analysis of variance; AUCtot = area under the curve total.

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