Colonic Tone and Motility in Patients With Irritable Bowel Syndrome

Vassallo, Mario; Camilleri, Michael; Phillips, Sidney F.; Steadman, Charles; Talley, Nicholas J.; Hanson, Russell B.; Haddad, Anne C.

doi:10.1016/s0025-6196(12)60796-4

Cited by 80 publications

(49 citation statements)

References 19 publications

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“…Several studies have previously reported that IBS patients show various alterations in their autonomic, immunologic and visceral response to food intake. 11,[15][16][17][18][19][20][21][22]29,30 However, to the best of our knowledge this is one of the first studies to propose a meal as a way to induce GI symptoms in IBS patients and compare their symptom responses to healthy controls, with the intention to create a tool for disease evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Altered visceral sensitivity is associated with IBS symptoms 14 and increased visceral sensitivity has been demonstrated in IBS patients after duodenal lipid infusion as well as after a liquid meal. [15][16][17] The postprandial colonic motor response is altered in IBS patients [18][19][20][21] and small bowel motility abnormalities become more evident after food intake. 22 Other factors that could be involved include intolerance to specific foods, 23 carbohydrate malabsorption 24 and altered colonic fermentation, 25 together with ineffective gas handling, which is further impaired by lipids.…”

Section: Introductionmentioning

confidence: 99%

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Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

et al. 2013

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Background: Patients with irritable bowel syndrome (IBS) often complain of worsening of symptoms after meal intake. Meal challenge tests have previously been used to study symptoms and pathophysiology in functional dyspepsia. Objective: The objective of this article is to evaluate differences in gastrointestinal (GI) symptom response to a standardized meal test in IBS compared to healthy controls. Methods: We included 67 patients with IBS and 16 healthy controls. After an overnight fast the subjects were served breakfast (540 kcal; 36% fat, 15% proteins, 49% carbohydrates; 8.9 g fiber). They completed visual analog scales assessing severity of six GI symptoms (abdominal pain, bloating, discomfort, nausea, gas, fullness) before breakfast and every 30 minutes up to 240 minutes after breakfast. The patients also completed a questionnaire (IBS-SSS) to assess IBS symptom severity during the preceding week. The course of symptom scores over time was analyzed using mixed models. Results: The meal was well tolerated and all subjects completed the test period. In patients, significant effects of time (initial increase to a maximum, followed by a return to baseline) were found for fullness, bloating, nausea and discomfort (all p values < 0.01 for linear, quadratic and third-order effect of time). In IBS patients, an independent significant association between IBS-SSS scores and all postprandial symptoms, except for nausea, was found (all p < 0.01). In controls, a significant linear, quadratic and third-order effect of time (all p < 0.0001) was found for fullness only. The difference in time course for bloating and discomfort between IBS patients and controls was confirmed when comparing the groups directly (significant time-by-group interaction effects, all p < 0.05), but not for nausea. On average, IBS patients scored significantly higher than controls on all symptoms, except for nausea (significant main effects of group, all p < 0.05). Conclusions: A standardized meal test seems to be a promising tool to study the symptom pattern in IBS and potentially to follow the effect of interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

et al. 2013

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“…This inconsistency has been addressed by exploring whether the IBS dysfunction affects exclusively sensory pathways or whether reflex pathways involved in the regulation of motility are also affected. Despite that gross motor abnormalities cannot be detected by manometry in IBS (10), some clinical data, such as the characteristic alteration of bowel habit, suggest that motility regulation may also be distorted (16). Indeed, it has been shown that IBS patients display exaggerated reflex responses to gut stimuli (3).…”

Section: Clinical Relevancementioning

confidence: 99%

Dimensions of Gut Dysfunction in Irritable Bowel Syndrome: Altered Sensory Function

Azpiroz

1999

Canadian Journal of Gastroenterology and Hepatology

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Growing evidence suggests that symptoms in patients with irritable bowel syndrome (IBS) may be due to a visceral sensory dysfunction. Specifically, it has been shown that patients with IBS have hypersensitive responses to distension of the rectum, whereas their tolerance to somatic stimuli is normal or even increased. Furthermore, patients with IBS have hypersensitivity of the small bowel, which selectively affects mechanosensitive afferents, with normal perception of electrical stimulation of the gut. Sensory dysfunctions may also be associated with altered reflex activity, which may contribute to the clinical symptoms. Normally, a series of mechanisms at different strata of the nervous system modulate visceral afferent input and determine conscious perception. Conceivably, a dysfunction of these regulatory mechanisms may alter sensitivity in clinical conditions. To date, neither the origin nor the clinical significance of visceral hyperalgesia has been elucidated. However, it seems likely that the sensory and reflex dysfunctions of the gut in IBS may combine to different degrees, and their interaction may explain the clinical pleomorphism of the syndrome.

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“…The most widely used definition in epidemiological studies is given by the revised Roma criteria, where IBS is characterized by abdominal discomfort or pain that cannot be explained on the basis of structural or biochemical abnormalities and that has at least two of the following three features: (1) pain is relieved with defecation; (2) its onset is associated with a change in the frequency of bowel movements (diarrhea or constipation), and (3) its onset is associated with changes in the stool consistency (loose, watery, or pellet-like) [15]. Furthermore, altered bowel motility, visceral hypersensitivity, psychosocial factors, imbalance in neurotransmitters, and infections have all been proposed to play a role in the development of IBS [16, 17, 18, 19, 20, 21]. …”

Section: Introductionmentioning

confidence: 99%

Irritable Bowel Syndrome and Bronchial Hyperresponsiveness: Is There a Link?

Riccioni

Vecchia²,

Menna³

et al. 2004

Digestion

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Background/Aim: Many studies have demonstrated a high prevalence of bronchial hyperresponsiveness in patients with irritable bowel syndrome (IBS). The aim of this 24-month prospective study was to evaluate the prevalence of IBS in asthmatic patients. Methods: We analyzed 623 asthmatic patients that were evaluated for body mass index, sex, and age before undergoing both a methacholine challenge test (MCHt) and skin prick tests. Results: We found that 276 asthmatic patients (44.3%) were positive on the MCHt, while 347 (55.7%) were negative. We also found that 27 (9.7%) of the 276 patients with a positive MCHt and 44 (12.7%) of the 347 patients with a negative MCHt were affected by IBS. Therefore, there was no statistically significant difference between positive MCHt tests and IBS. The PC₂₀ (mean provocation concentration of methacholine producing a 20% reduction in forced expiratory volume in 1 s ≤16 mg/ml) in all patients tested was 8.64 ± 2.58 mg/ml, being 8.75 ± 2.52 and 8.55 ± 2.32 mg/ml for males and females, respectively. Conclusions: These results do not demonstrate a relationship between MCHt and IBS. However, a relationship might still exist in a subpopulation of patients whose symptoms worsen by stress.

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Colonic Tone and Motility in Patients With Irritable Bowel Syndrome

Cited by 80 publications

References 19 publications

Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls

Dimensions of Gut Dysfunction in Irritable Bowel Syndrome: Altered Sensory Function

Irritable Bowel Syndrome and Bronchial Hyperresponsiveness: Is There a Link?

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