ASSOCIATION OF AUTONOMIC NERVOUS HYPERREFLEXIA AND SYSTEMIC INFLAMMATION IN PATIENTS WITH CROHNS-DISEASE AND ULCERATIVE-COLITIS

The autonomic nervous system modulates gastrointestinal motility, secr etion and mucosal immunity. Its dysfunction may be of pathogenetic imp ortance in inflammatory bowel disease (IBD). This study aimed at inves tigating the autonomic nervous function in patients with IBD. Forty-se ven patients with IBD, 28 with Crohn's disease (CD) and 19 with ulcera tive colitis (UC), were investigated by means of 5 cardiovascular and 2 pupillary standardized autonomic nervous function tests. In CD and U C, cardiovascular autonomic neuropathy was very rare (0%, 5%), whereas pupillary autonomic neuropathy was more prevalent (21%, 21%). In cont rast to autonomic neuropathy, overall cardiovascular (CD:29%, UC:26%) and pupillary autonomic hyperreflexia (46%, 37%) were found more often . Patients with CD and UC demonstrated elevated percentiles in the res piratory sinus arrhythmia test as compared to controls (RSA: 82.3 +/- 3.9%, 80.0 +/- 5.9%, controls: 50.0% +/- 1.5%, p < 0.0001). CD patient s with, as compared to patients without, RSA hypereflexia had signific antly higher CDAIs (p < 0.001), increased erythrocyte sedimentation ra tes (p < 0.005) and more often extraintestinal disease manifestations (p < 0.001). UC patients with, as compared to patients without, pupill ary latency time hyperreflexia had lower hemoglobin (p < 0.05), lower albumin (p < 0.01) and increased erythrocyte sedimentation rates (p < 0.05). Autonomic hyperreflexia was significantly associated with more severe inflammation and systemic disease in IBD. Hyperreflexia may be a response to inflammation or a pathogenetic element that drives mucos al inflammation. (C) 1997 Elsevier Science B.V.