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Adult Patients Who Were Breastfed Are Less Anxious but Suffer More Bouchoucha et al. Int Arch Clin Physiol 2019, 1:005 DOI: 10.23937/iacph-2017/1710005 Volume 1 | Issue 1 International Archives of Open Access Clinical Physiology RESEARCH ARTICLE Adult Patients who were Breastfed are Less Anxious but Suffer More Frequently of Non-Diarrheic Functional Bowel Disorders Michel Bouchoucha1,2*, Ghislain Devroede3,4, Pierre Rompteaux2, Florence Mary2, Bakhtiar Bejou2 and Robert Benamouzig2 1Université Paris Descartes, 15 Rue de I’école de Médecine, France 2CEFRED (Centre d’Exploration Fonctionnelle et de Rééducation Digestive), Service de Gastroentérologie, Hôpital Avicenne, France 3 Check for Département de Chirurgie, Faculté de Médecine, Université de Sherbrooke, Quebec, Canada updates 4Hôpital Fleurimont (CHUS), 3001 12 Avenue Nord, Sherbrooke, Canada *Corresponding author: Dr. Michel Bouchoucha, Université Paris Descartes, 15 Rue de I’école de Médecine, 75270, Paris; CEFRED (Centre d’Exploration Fonctionnelle et de Rééducation Digestive), Service de Gastroentérologie, Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France, Tel: 33-148957432, Fax: 33-148957437 Abstract Keywords Introduction: Functional gastrointestinal disorders are Breastfeeding, Functional gastrointestinal disorders, Ir- pathologies of multifactorial origin. A shorter duration of ritable bowel syndrome, Depression, Anxiety, Constipa- breastfeeding has been found to enhance the prevalence tion, Bloating of irritable bowel syndrome (IBS) in adulthood. The pres- ent observational study aims mainly to evaluate if breast- Abbreviations feeding is associated with IBS only or with other function- FGID: Functional Gastrointestinal Disorders; BMI: Body al gastrointestinal disorders (FGIDs). Mass Index; IBS: Irritable Bowel Syndrome Patients and methods: 1106 consecutive FGID patients (70% female) aged 48.4 ± 16.6 years (M ± SD), (BMI Introduction 26.9 ± 11.0 kg/m²) filled both a Rome III questionnaire, a psychological evaluation and a questionnaire about Many patients have persistent and recurring GI breastfeeding. The backwards selection procedure was symptoms attributed to the digestive system. The used for model selection during multivariate logistic re- gression. Rome criteria [1], a classification of the function- al gastrointestinal disorders (FGIDs) has been pro- Results: Breastfed patients are older (P = 0.039), and have lower state anxiety (P = 0.004; HR = 0.986; 95% CI = posed, for FGIDS not associated to any structural [0.976-0.995]). They suffer more frequently of IBS with con- or biochemical abnormalities. These disorders can stipation (P = 0.028; HR = 1.866; 95% CI = [1.069-3.256]), affect any part of the GI tract (esophagus, stomach, mixed IBS (P = 0.006; HR = 2.181; 95% CI = [1.254-3.792]), colon, terminal intestine). FGIDs are not psychiatric functional constipation (P = 0.006; HR = 1.909; 95% CI = [1.199-3.040]), and bloating (P = 0.039; HR = 1.624; 95% CI disorders, although stress and psychological difficul- = [1.026-2.571]). In contrast to esophageal, gastroduodenal ties can make FGIDs worse. There are three prima- and anorectal disorders which were not associated to the ry features of FGIDs, namely motility, sensation and fact of having been breastfed or not. brain-gut dysfunction. Conclusion: Our results support the presence of an asso- ciation between breastfeeding and non-diarrheic function- The prevalence of FGIDs in the general population al bowel disorders (IBS, IBS with constipation, mixed IBS, is high: Functional dyspepsia 20 to 30%, Irritable Bowel functional constipation and bloating) in FGIDs patients, but Syndrome (IBS) 10 to 20%, functional constipation up it also demonstrates that these people are less acutely anx- to 27%, pelvic floor dysfunction 5 to 11% [2]. More than ious. Citation: Bouchoucha M, Devroede G, Rompteaux P, Mary F, Bejou B, et al. (2019) Adult Patients who were Breastfed are Less Anxious but Suffer More Frequently of Non-Diarrheic Functional Bowel Disorders. Int Arch Clin Physiol 1:005. doi.org/10.23937/iacph-2017/1710005 Accepted: December 02, 2019: Published: December 04, 2019 Copyright: © 2019 Bouchoucha M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Bouchoucha et al. Int Arch Clin Pharmacol 2019, 1:005 • Page 1 of 7 • DOI: 10.23937/iacph-2017/1710005 half of subjects with FGID symptoms do not consult diology). Metabolic, endocrinologic, neurologic and psy- a physician, and take over-the-counter medications. chiatric etiologies were excluded. Patients with drug ad- These subjects also report significantly more job absen- dictions or previous digestive surgery, except cholecys- teeism and disability than healthy people [3]. Thus the tectomy and appendectomy, were causes of exclusion high prevalence of a relatively benign problem is costly from the study. A single investigator (MB) confirmed [4], those afflicted report power quality of life [5] and independently, during the medical visit, the validity of the search of a basic reason to these common dysfunc- the initial diagnosis of FGID, and of all data mentioned tions remains very much in order [6,7]. above. It has long been known that breastfed children are The study was declared in the French National Agen- more resistant to infections (gastroenteritis, ear infec- cy for drug safety (ANSM, Agence Nationale de Sécurité tions,etc .) than others [8]. This effect is linked to sever- du Médicament et des produits de santé, decision num- al immunological and non-immunological mechanisms. ber: 2015-A00954-45) and conducted according to the Secretory immunoglobulin (IgA, IgG and IgM), absent Declaration of Helsinki and Good Clinical Practice (GCP) from the intestinal cells of newborn infants [9,10], intact guidelines. immune cells (B and T lymphocytes, macrophages, leu- cocytes) as well as immunity-stimulating factors [11,12] Experimental Procedure and non-immunological factors [13] can be found in the Study design mother’s milk. Recent studies have shown that nutrition The comparison of the groups of FGID patients was has a major impact on early microbiota composition un- performed within the framework of an observational til cessation of breast-feeding, and is necessary for their study. maturation into adult-like microbiota [14]. A recent study concluded that early environmental Rome III questionnaire factors may play a role in the subsequent genesis of IBS Patients in the gastroenterologist’s office (MB) filled [15]. The authors investigated 767 Australian subjects, out a standard clinical questionnaire based on Rome III and searched for the presence or not of IBS excluding questionnaire [16]. The diagnostic process was previ- organic diseases simply on the basis of self-reported ously described in published studies [17-19]. Function- rather than clinical investigation. They found that de- al esophageal disorders (heartburn, chest pain of pre- velopment of IBS was associated with childhood factors sumed esophageal origin, dysphagia and globus) [20], namely a shorter duration of breastfeeding, sharing a functional gastroduodenal disorders (dyspepsia, post- bedroom, exposure to herbivore pets and hygiene fac- prandial distress syndrome, epigastric pain syndrome, tors. Overall, they were extremely careful in their con- belching disorders, aerophagia, unspecified excessive clusion, wishing to rule out a type I error. They also in- belching, nausea with or without, vomiting disorders, vestigated patients with functional dyspepsia, but they and rumination syndrome) [21], functional bowel dis- found no association with breastfeeding. orders (Irritable bowel syndrome (IBS) and its subtypes The aim of the present study was to evaluate if breast- (IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), feeding is associated with mood disorders and specific mixed IBS (IBS-M) and unsubtyped IBS (IBS-U), bloating, functional gastrointestinal disorders. constipation, diarrhea, and unspecified) [1], abdominal pain syndrome [22], and anorectal disorders (fecal in- Patients and Methods continence, functional anorectal pain, including levator Subjects ani syndrome and Proctalgia fugax, difficult defecation) [23], were diagnosed according to Rome III criteria. In From January 1, 2011 to December 31, 2014, 1205 addition regurgitation, soiling, and stool description us- outpatients were consecutively referred by gastroen- ing Bristol Stool Form Scale [1] were also recorded. terologists to our Center for Functional GI and Motility Finally, a question about breastfeeding (“Were you Disorders (CEFRED) (Centre d’Exploration Fonctionnelle breastfed?” Answer “Yes” or “No”; not otherwise spec- et de Rééducation Digestive, Gastroenterology Clinic of ified) was asked to all patients. This question has been the Avicenne Hospital), a tertiary center for FGID ma- asked all along because of the long known debate nagement. Among them, only 99 (9%) were unable to among pediatricians on a possible relationship between specify whether or not they were breastfed, and exclu- breastfeeding and constipation in babies [24,25]. ded for this reason. The 1106 remaining patients with a full data set are included in the present study. Psychometric evaluation Before inclusion, a full evaluation had failed to yield Psychometric evaluation was focused on anxiety and any organic cause for the patients’ complaint, although depression. The level of depression was assessed by
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