Increased Auditory Startle Reflex in Children with Functional Abdominal Pain

doi:10.1016/j.jpeds.2009.08.045

The Journal of Pediatrics

Volume 156, Issue 2, February 2010, Pages 285-291.e1

https://doi.org/10.1016/j.jpeds.2009.08.045 Get rights and content

Objective

To test the hypothesis that children with abdominal pain–related functional gastrointestinal disorders have a general hypersensitivity for sensory stimuli.

Study design

Auditory startle reflexes were assessed in 20 children classified according to Rome III classifications of abdominal pain–related functional gastrointestinal disorders (13 irritable bowel syndrome [IBS], 7 functional abdominal pain syndrome; mean age, 12.4 years; 15 girls) and 23 control subjects (14 girls; mean age, 12.3 years) using a case-control design. The activity of 6 left-sided muscles and the sympathetic skin response were obtained by an electromyogram. We presented sudden loud noises to the subjects through headphones.

Results

Both the combined response of 6 muscles and the blink response proved to be significantly increased in patients with abdominal pain compared with control subjects. A significant increase of the sympathetic skin response was not found. Comorbid anxiety disorders (8 patients with abdominal pain) or Rome III subclassification did not significantly affect these results.

Conclusions

This study demonstrates an objective hyperresponsivity to nongastrointestinal stimuli. Children with abdominal pain–related functional gastrointestinal disorders may have a generalized hypersensitivity of the central nervous system.

Section snippets

Methods

Children with chronic abdominal pain were referred to a pediatrician specialized in childhood gastrointestinal disorders at the Pediatric Outpatient Clinic of the Academic Medical Center in Amsterdam between August and October 2006. All patients between 8 and 17 years old who fulfilled the childhood/adolescent Rome III criteria for either IBS or functional abdominal pain syndrome¹ were invited to participate in the study. No structural or biochemical abnormalities were found on physical

Results

A total of 13 patients with IBS and 7 patients with functional abdominal pain syndrome (15 girls; mean age, 12.4 years), 23 control subjects (15 girls; mean age, 12.3 years), and 25 patients with anxiety disorder (17 girls; mean age, 12.7 years) were included in the study. Of the 20 patients with abdominal pain, 8 (40 %) had a comorbid anxiety disorder (7 IBS, 1 functional abdominal pain syndrome) (Table I).

Discussion

This study demonstrated a general hypersensitivity for sensory stimuli in children with abdominal pain–related functional gastrointestinal disorders. We found that these patients have increased responses after sensory stimuli that are not presented to the viscera. All ASR quantifications used in this study showed a significant increase of this response in patients with abdominal pain compared with control subjects.

The enlarged ASRs provide objective evidence, independent of the subjective

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Abdominal Symptom Complexes
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Orienting reaction may help recognition of patients with psychogenic nonepileptic seizures
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Citation Excerpt :
These findings suggest normal ASRs with normal pattern of muscle recruitment in PNES. Conversely, a previous study showed that children with functional abdominal pain had exaggerated ASRs [2]. In addition, affective modulation of eye blink reflex was found to be abnormal in patients with functional movement disorders, while there was no correlation with depression or anxiety symptomatology [27].
Psychogenic nonepileptic seizures (PNES) are abrupt, paroxysmal changes in behavior or consciousness that may phenomenologically resemble epileptic seizures. Given the known association between anxiety and PNES, we hypothesized that in these subjects there may be evidence that the nervous system is hypersensitive to external stimuli. We aimed to test our hypothesis by means of the auditory startle reaction (ASR). By investigating ASR, we also had the opportunity to test presence of orienting reaction, which is generally defined as the second phase of response after the auditory stimulus, with longer latency.
We included 22 patients diagnosed as PNES and 25 age- and gender-matched healthy subjects. Clinical assessments and ASR recordings were performed. Electrophysiological findings were compared between patients with PNES and healthy subjects, including the presence of an orienting reaction. Orienting reaction was defined as a late response with latency between 100–1000 ms.
The mean ages of patients with PNES and healthy subjects were 34.9 ± 12.3 years and 33.3 ± 10.9 years, respectively (P = 0.709). All patients were diagnosed as having conversion disorder. Additionally, 19 patients had depressive disorder and four had anxiety. The recruitment pattern of muscles and probability were similar between patients with PNES and healthy subjects. Orienting reaction was solely observed in patients with PNES (n = 13, 59.1% of the patients vs. no healthy subject). The sequence and contribution of muscles in the orienting reaction changed almost in all patients. The duration of these responses was long, sometimes more than 200 ms.
PNES is associated with orienting reaction. This provides a possible electrophysiological marker of altered nervous system function in patients with PNES and may also reflect the distorted emotional processing in these patients.
Les crises psychogènes non épileptiques (CPNE) sont des changements abrupts et paroxystiques de comportement ou de conscience qui peuvent ressembler phénoménologiquement à des crises épileptiques. Étant donné l’association connue entre l’anxiété et les CPNE, nous avons émis l’hypothèse que, chez ces sujets, il peut y avoir des preuves que le système nerveux est hypersensible aux stimuli externes. Nous avons cherché à tester notre hypothèse au moyen de la réaction de sursaut auditif (RSA). En étudiant la RSA, nous avons également eu l’occasion de tester la présence d’une réaction d’orientation, qui est généralement définie comme la seconde phase de la réponse, survenant après le stimulus auditif avec une latence plus longue que la RSA.
Nous avons inclus 22 patients diagnostiqués comme ayant des CPNE et 25 sujets sains, appariés en âge et en sexe aux patients. Des évaluations cliniques et l’enregistrement des RSA ont été effectués. Les résultats électrophysiologiques ont été comparés entre les patients atteints de CPNE et les sujets sains, incluant la présence d’une réaction d’orientation. La réaction d’orientation était définie comme une réponse tardive avec une latence comprise entre 100 et 1000 ms.
L’âge moyen des patients avec CPNE et des sujets sains étaient respectivement de 34,9 ans ± 12,3 et de 33,3 ans ± 10,9 (p = 0,709). Tous les patients ont été diagnostiqués comme ayant un syndrome de conversion. En outre, 19 patients présentaient un trouble dépressif et quatre avaient un trouble anxieux. Le profil et la probabilité de recrutement des muscles étaient semblables chez les patients avec CPNE et les sujets sains. La réaction d’orientation n’a été observée que chez les patients atteints de CPNE (n = 13, 59,1 % des patients vs aucun sujet sain). La séquence d’activation et la contribution des muscles dans la réaction d’orientation étaient différentes entre presque tous les patients. La durée de ces réponses était longue, parfois plus de 200 ms.
Les CPNE sont associées à une réaction d’orientation qui n’est pas observée chez les sujets sains. Ceci témoigne d’un possible marqueur électrophysiologique d’une altération fonctionnelle du système nerveux chez les sujets présentant des CPNE et peut également refléter la déformation du traitement des émotions présente chez ces patients.
One-year course and predictors of abdominal pain in children with autism spectrum disorders: The role of anxiety and sensory over-responsivity
2014, Research in Autism Spectrum Disorders
Citation Excerpt :
Individuals with functional GI problems show greater activation in the emotional arousal network, including the amygdala and hypothalamus, following visceral stimulation (Tillisch, Mayer, & Labus, 2011). In addition, others have found evidence of autonomic dysfunction (Mazurak, Seredyuk, Sauer, Teufel, & Enck, 2012), increased stress response (Dufton et al., 2011), and increased startle reflex (Bakker et al., 2010) among individuals with functional abdominal pain. Startle response is used as a measure of central nervous system reactivity, and has been widely used to study sensory reactivity and anxiety in both human and animal studies (Bakker, van Dijk, van den Maagdenberg, & Tijssen, 2006; Davis, 1980, 1984).
To examine the one-year course of parent-reported abdominal pain in children with autism spectrum disorder (ASD), and to determine whether anxiety and sensory over-responsivity (SOR) contribute to the onset or remission of abdominal pain.
Participants included 225 children (ages 2–17) with ASD enrolled in the Autism Speaks Autism Treatment Network. Primary measures included the parent-reported GI Symptom Inventory Questionnaire, Child Behavior Checklist, and Short Sensory Profile.
One-fourth (25.8%) experienced chronic abdominal pain (duration ≥3 months) at baseline, persisting at one-year follow-up for 86.7%. New onset pain occurred for 23.8% of those without baseline pain. Anxiety, SOR, and chronic abdominal pain were associated at baseline. SOR significantly predicted new onset pain, but neither anxiety nor SOR were predictors of pain remission.
Abdominal pain appears to be common and persistent among children with ASD. The relations among SOR, anxiety and abdominal pain offer information about potential underlying mechanisms.
Recurring Abdominal Pain in Pediatrics
2012, Integrative Medicine, Third Edition
Abdominal Symptom Complexes
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth Edition

View all citing articles on Scopus

: The authors declare no conflicts of interest.

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Original ArticleIncreased Auditory Startle Reflex in Children with Functional Abdominal Pain

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Gastroenterology

J Pediatr

J Pediatr

J Pediatr

Behav Res Ther

Gastroenterology

J Psychosom Res

Am J Gastroenterol

Gastroenterology

Pain

Pain

Pain

Gastroenterology

Gastroenterology

Gastroenterology

Lancet Neurol

Biol Psychol

Suppl Clin Neurophysiol

Clin Neurophysiol

Gastroenterology

Pain

J Am Acad Child Adolesc Psychiatry

Behav Res Ther

Neurosci Lett

Clin Neurophysiol

Am J Gastroenterol

Pain

Best Pract Res Clin Gastroenterol

Clin Neurophysiol

Eur J Pain

Gastroenterology

Behav Brain Res

Original Article
Increased Auditory Startle Reflex in Children with Functional Abdominal Pain