Think about how many people you know who suffer with their gut. The bloating, the cramping, the urgent dashes to the loo, the miserable mornings spent doubled over in pain.
Irritable bowel syndrome (IBS) alone affects around one in five people in the UK, yet for most the reason they suffer remains frustratingly out of reach.
They have been scoped and scanned, poked and prodded. They have cut out gluten, dairy and everything else a well-meaning friend once read might help. And still nobody has ever thought to ask them about their childhood. Yet new research suggests that this might be exactly the right place to start.
As a psychiatrist, I have seen this pattern more times than I can count. Patients with IBS are often referred to specialists like me because they’ve developed depression, anxiety or disordered eating as a consequence of their gut problems. They arrive with a long and fruitless medical history – years of gut problems that nobody has been able to explain – and we go through it together.
And then, almost as an aside, a different kind of story starts to emerge: a difficult start; a parent who struggled; a home that felt, for a young child, unsafe or unpredictable; parents who argued a lot; abuse; neglect.
Most people with IBS know that stress makes their symptoms worse – but what medicine has paid far less attention to is not the stress of today, but the stress of 30 or 40 years ago. It turns out there may be good scientific reasons why that early history matters so much.
A new study from New York University, published in the journal Gastroenterology, has findings that should stop every gastroenterologist in their tracks.
We know that stress in early life can raise the chances of anxiety and depression in adulthood.
Irritable bowel syndrome (IBS) affects around one in five people in the UK, yet for most the reason they suffer remains frustratingly out of reach
But what this latest research showed is the effects of childhood stress reach beyond the brain.
The researchers found that stress in early life – from birth to the first years of school – may fundamentally alter the way the gut and the brain communicate with each other, increasing the risk of digestive problems that can persist for decades. And we’re not talking about minor tummy troubles. We are talking about chronic abdominal pain, constipation and IBS.
To understand why, you need to know that the gut and the brain are in constant, two-way conversation, known as the ‘gut-brain axis’.
The two are talking to each other every hour of every day (via a complex system of receptors and nerve signals, and even our gut microbiome, the vast community of bacteria, viruses and fungi).
When something disturbs that relationship early in life, the consequences can be profound.
Digestion slows or speeds up erratically. Pain signals are amplified. Research also suggests that early stress alters the gut microbiome – another pathway through which a difficult childhood can leave its mark. The gut becomes in effect exquisitely, miserably sensitive.
To test this, the New York University team separated young mice from their mothers for periods every day, mimicking the kind of disruption and insecurity that early adversity can produce.
By the time these animals reached adulthood, they displayed heightened anxiety and were significantly more prone to gut pain and disordered bowel function than young mice that hadn’t been subjected to the same stress.
The way that disruption expressed itself differed between the sexes too, with females more likely to develop looser stools and males more prone to constipation – a pattern that will feel familiar to any clinician who sees a lot of patients with gut problems.
The researchers also found that different symptoms appeared to be driven by different biological pathways. Gut pain and motility problems, it seems, are not simply two sides of the same coin – as is often assumed.
This matters enormously, suggesting that the same drug or intervention is unlikely to help everyone with a gut-brain disorder, and that we will need more personalised approaches.
The mice findings were then supported by two large studies of children, carried out by the same research group. The first tracked more than 40,000 Danish children over 15 years, comparing those born to mothers whose depression during or after pregnancy went untreated with those born to mothers who had no depression at all, or whose depression had been treated.
The children whose mothers had depression yet received no treatment were considerably more likely to be diagnosed with digestive disorders, such as constipation, colic and IBS. The worse the mother’s mental health, the greater the risk to the child’s gut.
A second study, involving children aged nine and ten in the US, looked at the full range of adverse childhood experiences, from neglect and abuse to having a parent with mental illness.
Any form of early stress was linked to a greater likelihood of gastrointestinal problems. It did not matter what kind of stress.
The lead researcher, Professor Kara Margolis, a paediatric gasteroenterologist, put it plainly.
When a patient comes in with gut problems, she said, doctors should not only be asking about their current stress levels – what happened in childhood is equally important, and something medicine needs to take far more seriously.
Professor Kara Margolis, a paediatric gasteroenterologist, says when a patient comes in with gut problems, doctors should be asking them what happened in childhood
And yet, IBS is still all too often dismissed as a neurotic complaint, as though being partly psychological makes it somehow less deserving of proper care. Patients are handed a leaflet and sent away.
I’ve seen too many of them spiral into serious depression, or starve themselves to a dangerous weight after years of cutting out food groups in desperation, simply because nobody took their symptoms seriously enough to offer proper support.
Just because something has a psychological component does not make it any less of an illness. This is what stigma around mental health looks like when it is hiding in a gastroenterology clinic.
None of this means that gut problems are inevitable for anyone who had a difficult start in life, or that they cannot be helped.
Psychological interventions, such as CBT, can have dramatic and lasting benefits for people with IBS, for example.
But this new research raises the possibility that for those whose gut problems are rooted in early adversity, more targeted approaches may prove more effective, ones that address the original trauma directly.
What this means is that the next time a patient sits down across from a doctor and describes years of unexplained gut problems, the most important question might not be about what they are eating, but what happened to them, a very long time ago.
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