{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T21:29:12Z","timestamp":1790544552421,"version":"4.1.0"},"reference-count":106,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["R01 AT011665"],"award-info":[{"award-number":["R01 AT011665"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Functional gastrointestinal disorders (FGID) and gastroesophageal reflux (GERD) disease affect a large global population and incur substantial health care costs. Impairment in gut-brain communication is one of the main causes of these disorders. The central nervous system (CNS) provides its inputs to the enteric nervous system (ENS) by modulating the autonomic nervous system (ANS) to control the gastrointestinal functions. Therefore, GERD and FGID\u2019s might be associated with autonomic dysfunction, which can be identified via heart rate variability (HRV). FGIDs may be treated by restoring the autonomic dysfunction via neuromodulation. This article reviews the roles of HRV in the assessment of autonomic function and dysfunction in (i) gastroesophageal reflux (GERD), and the following FGIDs: (ii) functional dyspepsia (FD) and gastroparesis, (iii) irritable bowel syndrome (IBS) and (iv) constipation. The roles of HRV in the assessment of autonomic responses to various interventions were also reviewed. We used PUBMED, Web of Science, Elsevier\/Science direct and Scopus to search the eligible studies for each disorder, which also included the keyword \u2018heart rate variability\u2019. The retrieved studies were screened and filtered to identify the most suitable studies using HRV parameters to associate the autonomic function with any of the above disorders. Studies involving both human and animal models were included. Based on analyses of HRV, GERD as well as the FGIDs were found to be associated with decreased parasympathetic activity and increased sympathetic nervous system activity with the autonomic balance shifted towards the sympathetic nervous system. In addition, the HRV methods were also reported to be able to assess the autonomic responses to various interventions (mostly neuromodulation), typically the enhancement of parasympathetic activity. In summary, GERD and FGIDs are associated with impaired autonomic dysfunction, mainly due to suppressed vagal and overactive sympathetic tone, which can be assessed noninvasively using HRV.<\/jats:p>","DOI":"10.3390\/diagnostics13020293","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T02:05:52Z","timestamp":1673575552000},"page":"293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Roles of Heart Rate Variability in Assessing Autonomic Nervous System in Functional Gastrointestinal Disorders: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8120-3218","authenticated-orcid":false,"given":"M. Khawar","family":"Ali","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-5697","authenticated-orcid":false,"given":"Jiande D. Z.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"G32","DOI":"10.1152\/ajpgi.00067.2016","article-title":"Enhanced sympathetic nerve activity induced by neonatal colon inflammation induces gastric hypersensitivity and anxiety-like behavior in adult rats","volume":"311","author":"Winston","year":"2016","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/MED.0000000000000449","article-title":"Central control of gastrointestinal motility","volume":"26","author":"Browning","year":"2019","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_3","unstructured":"Terjung, R. (2014). Central Nervous System Control of Gastrointestinal Motility and Secretion and Modulation of Gastrointestinal Functions. Comprehensive Physiology, Wiley."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/BF01303162","article-title":"Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact","volume":"38","author":"Drossman","year":"1993","journal-title":"Dig. Dis. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"44","DOI":"10.7861\/clinmed.2020-0980","article-title":"Management of functional gastrointestinal disorders","volume":"21","author":"Fikree","year":"2021","journal-title":"Clin. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1053\/j.gastro.2020.04.014","article-title":"Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study","volume":"160","author":"Sperber","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_7","unstructured":"(2022, October 12). Available online: https:\/\/www.worldgastroenterology.org."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.bpg.2004.04.012","article-title":"Definition and epidemiology of functional gastrointestinal disorders","volume":"18","author":"Corazziari","year":"2004","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Djeddi, D.-D., Kongolo, G., St\u00e9phan-Blanchard, E., Ammari, M., L\u00e9k\u00e9, A., Delanaud, S., Bach, V., and Telliez, F. (2013). Involvement of Autonomic Nervous Activity Changes in Gastroesophageal Reflux in Neonates during Sleep and Wakefulness. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0083464"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6982","DOI":"10.3748\/wjg.v21.i22.6982","article-title":"Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease","volume":"21","author":"Milovanovic","year":"2015","journal-title":"WJG"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/ner.13021","article-title":"Ameliorating Effects of Transcutaneous Electrical Acustimulation Combined With Deep Breathing Training on Refractory Gastroesophageal Reflux Disease Mediated via the Autonomic Pathway","volume":"22","author":"Yu","year":"2019","journal-title":"Neuromodul. Technol. Neural Interface"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/j.1365-2982.2009.01434.x","article-title":"Gastroparesis and Functional Dyspepsia: Excerpts from the AGA\/ANMS Meeting","volume":"22","author":"Parkman","year":"2010","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3164\/jcbn.15-140","article-title":"Disorder of autonomic nervous system and its vulnerability to external stimulation in functional dyspepsia","volume":"58","author":"Tominaga","year":"2016","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.5056\/jnm19101","article-title":"A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines","volume":"26","author":"Tu","year":"2020","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"435","DOI":"10.5056\/jnm17017","article-title":"Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial","volume":"23","author":"Jang","year":"2017","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7358","DOI":"10.1038\/s41598-019-43455-5","article-title":"Parasympathetic activity correlates with subjective and brain responses to rectal distension in healthy subjects but not in non-constipated patients with irritable bowel syndrome","volume":"9","author":"Kano","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"87","DOI":"10.5056\/jnm16216","article-title":"Increased Postprandial Colonic Motility and Autonomic Nervous System Activity in Patients With Irritable Bowel Syndrome: A Prospective Study","volume":"24","author":"Tanaka","year":"2018","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"700129","DOI":"10.3389\/fphys.2021.700129","article-title":"Regulation of the Autonomic Nervous System on Intestine","volume":"12","author":"Duan","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.autneu.2007.04.005","article-title":"Innervation of the gastrointestinal tract: Patterns of aging","volume":"136","author":"Phillips","year":"2007","journal-title":"Auton. Neurosci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3389\/fnins.2018.00155","article-title":"Interplay Between the Gut-Brain Axis, Obesity and Cognitive Function","volume":"12","author":"Campillo","year":"2018","journal-title":"Front. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1038\/s41393-017-0026-2","article-title":"Neural pathways for colorectal control, relevance to spinal cord injury and treatment: A narrative review","volume":"56","author":"Callaghan","year":"2018","journal-title":"Spinal Cord"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1038\/nrgastro.2016.107","article-title":"The bowel and beyond: The enteric nervous system in neurological disorders","volume":"13","author":"Rao","year":"2016","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_23","first-page":"203","article-title":"The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems","volume":"28","author":"Carabotti","year":"2015","journal-title":"Ann. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"882602","DOI":"10.3389\/fnins.2022.882602","article-title":"Modulation of the autonomic nervous system by one session of spinal low-level laser therapy in patients with chronic colonic motility dysfunction","volume":"16","author":"Ali","year":"2022","journal-title":"Front. Neurosci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.3389\/fnins.2019.01447","article-title":"Associations Between Colonic Motor Patterns and Autonomic Nervous System Activity Assessed by High-Resolution Manometry and Concurrent Heart Rate Variability","volume":"13","author":"Yuan","year":"2020","journal-title":"Front. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"619722","DOI":"10.3389\/fphys.2021.619722","article-title":"Optimizing Autonomic Function Analysis via Heart Rate Variability Associated With Motor Activity of the Human Colon","volume":"12","author":"Ali","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_27","unstructured":"Ali, M.K. (2022, October 13). Development of Methodologies to Assess Autonomic Nervous System Functioning and Neuromodulation for the Diagnosis and Treatment of Colonic Motility Disorders. Available online: https:\/\/macsphere.mcmaster.ca\/handle\/11375\/27757."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1542-474X.2008.00219.x","article-title":"Baroreflex Sensitivity: Measurement and Clinical Implications","volume":"13","author":"Pinna","year":"2008","journal-title":"Ann. Noninv. Electrocard."},{"key":"ref_29","first-page":"243","article-title":"The sympathetic nervous system and catecholamines metabolism in obstructive sleep apnoea","volume":"8","author":"Bisogni","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s10286-018-0547-6","article-title":"Roles of cardiac sympathetic neuroimaging in autonomic medicine","volume":"28","author":"Goldstein","year":"2018","journal-title":"Clin. Auton. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5406","DOI":"10.1038\/s41598-020-62225-2","article-title":"Assessing Autonomic Function from Electrodermal Activity and Heart Rate Variability During Cold-Pressor Test and Emotional Challenge","volume":"10","author":"Ghiasi","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1515\/folmed-2015-0036","article-title":"Heart Rate Variability as a Method for Assessment of the Autonomic Nervous System and the Adaptations to Different Physiological and Pathological Conditions","volume":"57","author":"Taralov","year":"2016","journal-title":"Folia Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1002\/dmrr.1224","article-title":"Methods of investigation for cardiac autonomic dysfunction in human research studies: Investigation Methods for Cardiac Autonomic Function","volume":"27","author":"Bernardi","year":"2011","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.3389\/fpsyg.2014.01040","article-title":"A healthy heart is not a metronome: An integrative review of the heart\u2019s anatomy and heart rate variability","volume":"5","author":"Shaffer","year":"2014","journal-title":"Front. Psychol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","article-title":"An Overview of Heart Rate Variability Metrics and Norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15761\/JIC.1000258","article-title":"Heart rate variability: Highlights from hidden signals","volume":"4","author":"Yilmaz","year":"2018","journal-title":"J. Integr. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"66","DOI":"10.12710\/cardiometry.2017.10.6676","article-title":"Heart rate variability analysis: Physiological foundations and main methods","volume":"10","author":"Baevsky","year":"2017","journal-title":"Cardiometry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"12051","DOI":"10.1038\/s41598-022-15945-6","article-title":"Diagnosis of colonic dysmotility associated with autonomic dysfunction in patients with chronic refractory constipation","volume":"12","author":"Liu","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Colombo, J., Arora, R., DePace, N.L., and Vinik, A.I. (2015). Clinical Autonomic Dysfunction, Springer International Publishing.","DOI":"10.1007\/978-3-319-07371-2"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"286","DOI":"10.5056\/jnm18094","article-title":"Ameliorating Effects of Electroacupuncture on Dysmotility, Inflammation, and Pain Mediated via the Autonomic Mechanism in a Rat Model of Postoperative Ileus","volume":"25","author":"Murakami","year":"2019","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s12012-007-0004-6","article-title":"Heart rate variability in rodents: Uses and caveats in toxicological studies","volume":"7","author":"Rowan","year":"2007","journal-title":"Cardiovasc. Toxicol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/1751143719853744","article-title":"Heart rate variability: Measurement and emerging use in critical care medicine","volume":"21","author":"Johnston","year":"2020","journal-title":"J. Intensive Care Soc."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Finsterer, J., Scorza, F.A., Scorza, C.A., and Fiorini, A.C. (2022). Consider differentials before diagnosing COVID-19 associated polyradiculitis. Eur. J. Transl. Myol., 32.","DOI":"10.4081\/ejtm.2022.10111"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.autneu.2004.08.007","article-title":"Heart rate variability in patients with different manifestations of gastroesophageal reflux disease","volume":"116","author":"Lee","year":"2004","journal-title":"Auton. Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1177\/0194599813482103","article-title":"Evaluating the Autonomic Nervous System in Patients with Laryngopharyngeal Reflux","volume":"148","author":"Huang","year":"2013","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/j.1440-1746.2004.03397.x","article-title":"Autonomic responses to heartburn induced by esophageal acid infusion","volume":"19","author":"Chen","year":"2004","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1111\/j.1440-1746.2006.04147.x","article-title":"Circadian change of cardiac autonomic function in correlation with intra-esophageal pH","volume":"21","author":"Lee","year":"2006","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1046\/j.1365-2982.2000.00230.x","article-title":"Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP)","volume":"12","author":"Hollerbach","year":"2000","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/nmo.12761","article-title":"The effects of proton pump inhibitors on autonomic tone in patients with erosive and non-erosive esophagitis","volume":"28","author":"Jones","year":"2016","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s10286-010-0054-x","article-title":"Autonomic function, gastroesophageal reflux in apparent life threatening event","volume":"20","author":"Tirosh","year":"2010","journal-title":"Clin. Auton. Res."},{"key":"ref_51","first-page":"CR68","article-title":"Parameters of the functional and morphological status of the upper digestive tract in alcohol-dependent male patients with depression and alexithymia in the context of autonomic nervous system activity and nitric oxide plasma level","volume":"10","author":"Swiatkowski","year":"2004","journal-title":"Med. Sci. Monit."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1111\/ner.13082","article-title":"Ameliorating Effects and Autonomic Mechanisms of Transcutaneous Electrical Acustimulation in Patients With Gastroesophageal Reflux Disease","volume":"23","author":"Hu","year":"2020","journal-title":"Neuromodul. Technol. Neural Interface"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.advms.2016.11.012","article-title":"Gastroesophageal reflux is not associated with short-term variability of parasympathetic activity in children","volume":"62","author":"Nowak","year":"2017","journal-title":"Adv. Med. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"88","DOI":"10.5152\/tjg.2017.16540","article-title":"Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease","volume":"28","author":"Floria","year":"2017","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/BF02317802","article-title":"Decreased sympathetic inhibition in gastroesophageal reflux disease","volume":"11","author":"Campo","year":"2001","journal-title":"Clin. Auton. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1177\/0300060517726442","article-title":"Impaired vagal activity to meal in patients with functional dyspepsia and delayed gastric emptying","volume":"46","author":"Guo","year":"2018","journal-title":"J. Int. Med. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1038\/s41598-017-19112-0","article-title":"Attentional and physiological processing of food images in functional dyspepsia patients: A pilot study","volume":"8","author":"Lee","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"G574","DOI":"10.1152\/ajpgi.00255.2019","article-title":"Sacral nerve stimulation increases gastric accommodation in rats: A spinal afferent and vagal efferent pathway","volume":"318","author":"Ye","year":"2020","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"G700","DOI":"10.1152\/ajpgi.00426.2020","article-title":"Transcutaneous auricular vagal nerve stimulation improves functional dyspepsia by enhancing vagal efferent activity","volume":"320","author":"Zhu","year":"2021","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"R106","DOI":"10.1152\/ajpregu.00256.2019","article-title":"Effects of electroacupuncture on stress-induced gastric dysrhythmia and mechanisms involving autonomic and central nervous systems in functional dyspepsia","volume":"319","author":"Zhang","year":"2020","journal-title":"Am. J. Physiol.-Regul. Integr. Comp. Physiol."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Zhou, J., Li, S., Wang, Y., Lei, Y., Foreman, R.D., Yin, J., and Chen, J.D.Z. (2017). Effects and mechanisms of auricular electroacupuncture on gastric hypersensitivity in a rodent model of functional dyspepsia. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174568"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"655","DOI":"10.2169\/internalmedicine.42.655","article-title":"Effects of epalrestat, an aldose reductase inhibitor, on diabetic neuropathy and gastroparesis","volume":"42","author":"Okamoto","year":"2003","journal-title":"Intern. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"G563","DOI":"10.1152\/ajpgi.00252.2009","article-title":"Ameliorating effects and mechanisms of electroacupuncture on gastric dysrhythmia, delayed emptying, and impaired accommodation in diabetic rats","volume":"298","author":"Yin","year":"2010","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"G390","DOI":"10.1152\/ajpgi.00272.2001","article-title":"Electroacupuncture accelerates gastric emptying in association with changes in vagal activity","volume":"282","author":"Ouyang","year":"2002","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"R31","DOI":"10.1186\/ar2385","article-title":"Mild autonomic dysfunction in primary Sj\u00f6gren\u2019s syndrome: A controlled study","volume":"10","author":"Cai","year":"2008","journal-title":"Arthritis Res. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e13810","DOI":"10.1111\/nmo.13810","article-title":"Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity","volume":"32","author":"Nguyen","year":"2020","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"10","DOI":"10.14740\/gr667w","article-title":"Autonomic Evaluation of Patients With Gastroparesis and Neurostimulation: Comparisons of Direct\/Systemic and Indirect\/Cardiac Measures","volume":"9","author":"Stocker","year":"2016","journal-title":"Gastroenterol. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4103\/ijn.IJN_331_19","article-title":"Delayed Gastric Emptying among Indian Patients with Non-Diabetic Chronic Kidney Disease","volume":"31","author":"Kumar","year":"2021","journal-title":"Indian J. Nephrol."},{"key":"ref_69","first-page":"784841","article-title":"Rectal Sensitivity in Diabetes Patients with Symptoms of Gastroparesis","volume":"2014","author":"Brock","year":"2014","journal-title":"J. Diabetes Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1007\/s10620-019-05848-4","article-title":"Heart Rate Variability and Gastric Electrical Response to a Cold Pressor Task in Youth with Functional Dyspepsia","volume":"65","author":"Schurman","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1007\/s10620-009-1027-6","article-title":"The Effect of a Meal and Water Loading on Heart Rate Variability in Children with Functional Dyspepsia","volume":"55","author":"Friesen","year":"2010","journal-title":"Dig. Dis. Sci."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1023\/A:1013246900041","article-title":"Autonomic Function in Patients with Functional Dyspepsia Assessed by 24-Hour Heart Rate Variability","volume":"47","author":"Mesquita","year":"2002","journal-title":"Dig. Dis. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.psyneuen.2009.10.004","article-title":"Psychological adjustment and autonomic disturbances in inflammatory bowel diseases and irritable bowel syndrome","volume":"35","author":"Pellissier","year":"2010","journal-title":"Psychoneuroendocrinology"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1136\/gut.2004.058685","article-title":"Sex specific alterations in autonomic function among patients with irritable bowel syndrome","volume":"54","author":"Tillisch","year":"2005","journal-title":"Gut"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1023\/B:DDAS.0000037820.54069.6c","article-title":"Modulation of Sleep Quality and Autonomic Functioning by Symptoms of Depression in Women with Irritable Bowel Syndrome","volume":"49","author":"Robert","year":"2004","journal-title":"Dig. Dis. Sci."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"102","DOI":"10.5056\/jnm15067","article-title":"Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome","volume":"22","author":"Jarrett","year":"2015","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e650","DOI":"10.1111\/nmo.12177","article-title":"Autonomic response to a visceral stressor is dysregulated in irritable bowel syndrome and correlates with duration of disease","volume":"25","author":"Cheng","year":"2013","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.jpain.2012.02.007","article-title":"Autonomic Nervous System Function in Young Children With Functional Abdominal Pain or Irritable Bowel Syndrome","volume":"13","author":"Jarrett","year":"2012","journal-title":"J. Pain"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.physbeh.2016.01.042","article-title":"Baroreflex mechanisms in Irritable Bowel Syndrome: Part I. Traditional indices","volume":"157","author":"Davydov","year":"2016","journal-title":"Physiol. Behav."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1111\/nmo.12812","article-title":"Relationships of abdominal pain, reports to visceral and temperature pain sensitivity, conditioned pain modulation, and heart rate variability in irritable bowel syndrome","volume":"28","author":"Jarrett","year":"2016","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1097\/j.pain.0000000000000942","article-title":"Interacting influences of gender and chronic pain status on parasympathetically mediated heart rate variability in adolescents and young adults","volume":"158","author":"Walker","year":"2017","journal-title":"Pain"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Pellissier, S., Dantzer, C., Mondillon, L., Trocme, C., Gauchez, A.-S., Ducros, V., Mathieu, N., Toussaint, B., Fournier, A., and Canini, F. (2014). Relationship between Vagal Tone, Cortisol, TNF-Alpha, Epinephrine and Negative Affects in Crohn\u2019s Disease and Irritable Bowel Syndrome. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0105328"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Tanaka, Y., Kanazawa, M., Kano, M., Tashiro, M., and Fukudo, S. (2018). Relationship between sympathoadrenal and pituitary-adrenal response during colorectal distention in the presence of corticotropin-releasing hormone in patients with irritable bowel syndrome and healthy controls. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0199698"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1080\/00365529850171800","article-title":"Nyhlin, U. Wiklund, Spectral Analysis of Heart Rate Variability in Patients with Irritable Bowel Syndrome","volume":"33","author":"Karling","year":"1998","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/j.1365-2982.2006.00877.x","article-title":"Heart rate variability is related to pain severity and predominant bowel pattern in women with irritable bowel syndrome","volume":"19","author":"Cain","year":"2007","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e13320","DOI":"10.1111\/nmo.13320","article-title":"Heart rate variability characteristics of patients with irritable bowel syndrome and associations with symptoms","volume":"30","author":"Polster","year":"2018","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1111\/j.1572-0241.2000.02318.x","article-title":"Autonomic Regulation of Cardiac Function During Sleep in Patients With Irritable Bowel Syndrome","volume":"95","author":"Orr","year":"2000","journal-title":"Am. J. Gastroenterol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1111\/j.1572-0241.1999.00861.x","article-title":"Characterization of autonomic dysfunction in patients with irritable bowel syndrome by means of heart rate variability studies","volume":"94","author":"Adeyemi","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"G797","DOI":"10.1152\/ajpgi.00018.2018","article-title":"Electroacupuncture via chronically implanted electrodes improves gastrointestinal motility by balancing sympathovagal activities in a rat model of constipation","volume":"316","author":"Wang","year":"2019","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Miyagi, T., Yamazato, M., Nakamura, T., Tokashiki, T., Namihira, Y., Kokuba, K., Ishihara, S., Sakima, H., and Ohya, Y. (2022). Power spectral analysis of heart rate variability is useful as a screening tool for detecting sympathetic and parasympathetic nervous dysfunctions in Parkinson\u2019s disease. BMC Neurol., 22.","DOI":"10.1186\/s12883-022-02872-2"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"G609","DOI":"10.1152\/ajpgi.00150.2018","article-title":"Sacral nerve stimulation with appropriate parameters improves constipation in rats by enhancing colon motility mediated via the autonomic-cholinergic mechanisms","volume":"317","author":"Huang","year":"2019","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"G293","DOI":"10.1152\/ajpgi.00049.2018","article-title":"Preventive effects of transcutaneous electrical acustimulation on ischemic stroke-induced constipation mediated via the autonomic pathway","volume":"315","author":"Liu","year":"2018","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"G368","DOI":"10.1152\/ajpgi.00467.2014","article-title":"Electrical neuromodulation at acupoint ST36 normalizes impaired colonic motility induced by rectal distension in dogs","volume":"309","author":"Jin","year":"2015","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1590\/s1677-5538.ibju.2021.0177","article-title":"Evaluation of autonomic function in children and adolescents with overactive bladder","volume":"47","author":"Gondim","year":"2021","journal-title":"Int. Braz. J. Urol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"8798974","DOI":"10.1155\/2020\/8798974","article-title":"Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation","volume":"2020","author":"Liu","year":"2020","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e4912","DOI":"10.7717\/peerj.4912","article-title":"Gastrointestinal transit time and heart rate variability in patients with mild acquired brain injury","volume":"6","author":"Enevoldsen","year":"2018","journal-title":"PeerJ"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"912442","DOI":"10.3389\/fnins.2022.912442","article-title":"Sleep Deficiency Is Associated With Exacerbation of Symptoms and Impairment of Anorectal and Autonomic Functions in Patients With Functional Constipation","volume":"16","author":"Liu","year":"2022","journal-title":"Front. Neurosci."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"560802","DOI":"10.1155\/2014\/560802","article-title":"Transcutaneous Neuromodulation at Posterior Tibial Nerve and ST36 for Chronic Constipation","volume":"2014","author":"Zhang","year":"2014","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/SGA.0b013e31824e2d63","article-title":"The Effect of Biofeedback Training on Patients With Functional Constipation","volume":"35","author":"Ding","year":"2012","journal-title":"Gastroenterol. Nurs."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/MCG.0000000000001184","article-title":"Transcutaneous Neuromodulation at ST36 (Zusanli) is More Effective than Transcutaneous Tibial Nerve Stimulation in Treating Constipation","volume":"54","author":"Wu","year":"2020","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Chen, C.-Y., Chen, J.-R., Ke, M.-D., Huang, C.-H., Hsueh, Y.-H., and Kuo, C.-D. (2010, January 6\u20139). Treatment effect of acupuncture and electric stimulation on chronic constipation patients. Proceedings of the 2010 IEEE Asia Pacific Conference on Circuits and Systems, Kuala Lumpur, Malaysia.","DOI":"10.1109\/APCCAS.2010.5775056"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"419","DOI":"10.4161\/gmic.29417","article-title":"The microbiota-gut-brain axis in functional gastrointestinal disorders","volume":"5","author":"Collins","year":"2014","journal-title":"Gut Microbes"},{"key":"ref_103","first-page":"47","article-title":"Neuromodulation and Neurostimulation for the Treatment of Functional Gastrointestinal Disorders","volume":"18","author":"Chen","year":"2022","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40101-019-0193-2","article-title":"Pitfalls of assessment of autonomic function by heart rate variability","volume":"38","author":"Hayano","year":"2019","journal-title":"J. Physiol. Anthropol."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Colombo, J., Arora, R., DePace, N.L., and Vinik, A.I. (2015). Drawbacks of Heart Rate Variability Analysis and Application of Parasympathetic and Sympathetic Monitoring. Clinical Autonomic Dysfunction: Measurement, Indications, Therapies, and Outcomes, Springer International Publishing.","DOI":"10.1007\/978-3-319-07371-2_3"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1023\/A:1026698800742","article-title":"Postprandial Changes of Sympathovagal Balance Measured by Heart Rate Variability","volume":"44","author":"Lu","year":"1999","journal-title":"Dig. Dis. Sci."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/2\/293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:04:28Z","timestamp":1760119468000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/2\/293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":106,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["diagnostics13020293"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13020293","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,12]]}}}