title: Impact of autonomic dysfunction on inflammatory bowel disease.
abstract: Functional symptoms are common in patients with inflammatory bowel disease (IBD). The autonomic nervous system has been proposed to be involved in the pathogenesis of IBD. Autonomic dysfunction (AD) is associated with systemic manifestations and altered gut motility that may contributed to functional symptoms.
  
  
  OBJECTIVE
  To examine the impact of clinically manifest AD on patients with IBD.
  
  
  METHODS
  This was a retrospective case-control study from a single tertiary referral IBD center. The cases comprised 43 IBD patients with AD diagnosed using a standardized battery of tests. Three disease-matched controls were selected for each case. We performed multivariate regression to compare health-related quality of life (SIBDQ), disease activity scores, and healthcare utilization.
  
  
  RESULTS
  Female sex (83.7% vs. 53.5%, P<0.001) and psychiatric comorbidity (41.9% vs. 10.9%, P<0.001) were more common among IBD patients with AD than IBD controls. Small bowel transit times were significantly longer in cases (92.7 min) compared with controls (62.9 min, P=0.02). On multivariate analysis, AD was associated with a 7-point lower adjusted SIBDQ score compared with IBD controls [odds ratio (OR)-7.50; 95% confidence interval (CI), -12.0--3.03]. AD was also significantly associated with having more than 3 annual gastroenterology office visits (OR 2.84; 95% CI, 1.09-7.35), and 1 or more IBD-related medical hospitalizations (OR 2.49; 95% CI, 1.09-5.71).
  
  
  CONCLUSIONS
  Clinically manifest AD is associated with lower quality of life and higher healthcare utilization in IBD patients. They may represent a cohort at risk for worse outcomes.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.forename: Mazen
authors.initials: M
authors.lastname: Issa
authors.forename: Alexandru
authors.initials: A
authors.lastname: Barboi
authors.forename: Safwan
authors.initials: S
authors.lastname: Jaradeh
authors.forename: Yelena
authors.initials: Y
authors.lastname: Zadvornova
authors.forename: Sue
authors.initials: S
authors.lastname: Skaros
authors.forename: Kathryn
authors.initials: K
authors.lastname: Johnson
authors.forename: Mary F
authors.initials: MF
authors.lastname: Otterson
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires