Abuse, trauma, and GI illness: is there a link?

Our understanding of the relationship of abuse and trauma history with gastrointestinal (GI) disorders has evolved over the last three decades. Although previously seen within a psychiatric context, ongoing studies continue to show that abuse can have multiple effects on GI symptoms, patient illness behaviors, and clinical outcomes. The prevalence of abuse history is greater among those who have more severe symptoms and who are seen in referral settings. Although abuse history may be present across all diagnostic categories, more severe abuse seems to occur in patients with functional GI disorders. The pathophysiological features that explain this association relate to stress-mediated brain-gut dysfunction and can range from altered stress-induced mucosal immune function to impaired ability of the central nervous system to downregulate incoming visceral or somatic afferent signals. For gastroenterologists and other health-care providers, it is important to understand when to inquire about an abuse history and what to do with that information. This is particularly relevant, as the data indicate that having a co-morbid abuse history leads to adverse health outcomes. Finally, there is growing evidence that centrally targeted interventions may have palliative effects on reducing symptoms, altering brain-gut dysregulation and structure, and improving the clinical outcome. This presentation tracks the history of our understanding of the effect of abuse and trauma on GI illness, provides the scientific rationale for this association, and offers guidelines as to when and how to inquire about this information and implement proper care for the patient.