Increased abdominal pain during final examinations

A. Harris, B. J. Martin

Research output: Contribution to journalArticle

14 Scopus citations


Anecdotes and animal experiments alike suggest that physiological and psychological stress can profoundly alter gastrointestinal function. However, few studies have examined, in humans, real-world stress to see if free-living persons exhibit gut alterations similar to those produced in the laboratory. To investigate this possibility, we studied 16 medical and premedical students during final written examinations. As compared to a control day, the examination created a classic stress response: elevated serum cortisol (16±1 to 21±3 μg/dl;P<0.05), ACTH (31±1 to 33±1 pg/ml;P<0.05), heart rate (72±3 to 79±3 beats/min;P<0.05), arterial blood pressure (systolic pressure 106±2 to 120±2 torr;P<0.05; diastolic pressure 72±2 to 77±1 torr;P<0.05), and subjective anxiety (raw score 28±2 to 47±3;P<0.0001). In contrast, subjects displayed identical orocecal liquid transit time (of 0.36 g/kg lactulose in a 240-ml, 250-kcal liquid meal) under control (103±8 min) and examination conditions (106±8 min;P=NS). Mean subjective reports of gas, diarrhea, and borborygmi were unchanged on the day of the experiment, although the examination did increase reported abdominal pain (from 0.5±0.4 to 2.1±0.5 on a 0-5 analog scale;P<0.05). We conclude that examination stress in humans can increase gastrointestinal symptoms without altering orocecal transit.

Original languageEnglish (US)
Pages (from-to)104-108
Number of pages5
JournalDigestive diseases and sciences
Issue number1
StatePublished - Jan 1 1994


  • ACTH
  • cortisol
  • gastrointestinal motility
  • psychological stress
  • stress

ASJC Scopus subject areas

  • Gastroenterology

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