Association between vasomotor rhinitis and irritable bowel syndrome.

Background: Vasomotor rhinitis (VMR) and Irritable Bowel Syndrome (IBS) are two of the most widespread pathologies in industrialized countries and they have a substantial impact on health-related quality of life (HR-QoL). Moreover they constitute a public-health problem of enormous proportions, with an impact on both the individual sufferer and society. These two diseases seem so different from one another, but they have common aspects in physiopathology: they are both linked to neural hyper-responsiveness, neural and visceral hypersensitivity, implication of sensory nerves, imbalance of sympathetic and para-sympathetic systems, neurogenic inflammation, increased release of SP, CGRP, NO, neurokinin 1, cytokines IL-1, IL-6 and TNF-α, presence of mast cells, neutrophils, eosinophils, lymphocites B and T, increased expression of TRL9. Objective: The aims of this study were to investigate the relationship between VMR and IBS, studying the different types of NAR and checking the prevalence of mood disorders in these two pathologies. We are going to report further evidence with the aim of identifying a shared treatment for both diseases, hopefully thinking about VMR and IBS as an only disorder seen from two different points of view. Methods: In this study we checked the hyper-reactivity of both nasal and enteric mucosa, that is an increased sensitivity to various nonspecific stimuli, which usually do not evoke any answer. The study included 150 people (75 females and 75 males): 50 patients affected by vasomotor rhinitis were from Otolaryngology Department; other fifty people from Gastroenterology Department affected by irritable bowel syndrome and other 50 volunteers, otherwise healthy. After the diagnosis of VMR, each patient had to answer to examiner-guided questionnaires about IBS (according to Rome III criteria) to confirm or exclude the pathology. After the diagnosis of IBS, patients underwent nasal cytology and a questionnaires to make diagnosis of VMR, too. At last, healthy volunteers had to answer to both questionnaires and underwent nasal cytology to make diagnosis of VMR and/or IBS or to exclude both pathologies. All the 150 patients had to answer a psychological test to check the presence of mood disorders. Results: Our study pointed out a strong clinical association between NAR and IBS. In our study we have pointed out a predominance of NARNE compared to the other cytological types. A significant prevalence of depression mood was found in our study in patients with VMR and IBS symptoms. Conclusions: This study not only expands the knowledge about the link between NAR and IBS, but also about the correlations between typical NAR symptoms, like rhinorrhea and obstruction, andIBS, and about the correlations between typical IBS symptoms, like diarrhea and constipation, and NAR. The factors that are common across these syndromes are diagnosis of exclusion, high anxiety/depression, imbalance of Autonomic Nervous System, no alteration mucosa and a low grade of inflammation and neurogenic inflammation.