An exaggerated sensory component of the gastrocolonic response in patients with irritable bowel syndrome

BACKGROUND/AIMS Visceral hypersensitivity is a feature of the irritable bowel syndrome (IBS). Postprandial symptoms are common in these patients. The effects of nutrients on colonic perception in IBS are incompletely understood. SUBJECTS We studied 13 healthy subjects and 16 patients with IBS—eight had diarrhoea predominant (IBS-D) and eight constipation predominant (IBS-C) IBS. METHODS Colonic perception thresholds to balloon distension and viscerosomatic referral pattern were assessed before and after duodenal infusion of lipid or saline, respectively. At the end of the infusions, plasma levels of gastrointestinal peptides were determined. RESULTS Lipids lowered the thresholds for first sensation, gas, discomfort, and pain in the IBS group but only for gas in the control group. The percent reduction in thresholds for gas and pain after lipids was greater in the IBS and IBS-D groups but not in the IBS-C group compared with controls. IBS patients had an increased area of referred discomfort and pain after lipids compared with before infusion whereas the referral area remained unchanged in controls. No group differences in colonic tone or compliance were observed. In both groups higher levels of cholecystokinin, pancreatic polypeptide, peptide YY, vasoactive intestinal polypeptide, and neuropeptide Y were seen after lipids. Motilin levels were higher in patients and differences in the subgroups were observed. Levels of corticotrophin releasing factor were lower in the constipated group than in the diarrhoea group. CONCLUSIONS Postprandial symptoms in IBS patients may be explained in part by a nutrient dependent exaggerated sensory component of the gastrocolonic response.

[1]  A. Mangel,et al.  Review article: the safety and efficacy of alosetron, a 5‐HT3 receptor antagonist, in female irritable bowel syndrome patients , 1999, Alimentary pharmacology & therapeutics.

[2]  Lagier,et al.  Influence of age on rectal tone and sensitivity to distension in healthy subjects , 1999, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[3]  Y. Taché,et al.  Corticotropin-releasing factor and the brain-gut motor response to stress. , 1999, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[4]  J. Kellow,et al.  Physiological modulation of jejunal sensitivity in health and in irritable bowel syndrome , 1998, American Journal of Gastroenterology.

[5]  G. Bodemar,et al.  Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS). Patients' description of diarrhoea, constipation and symptom variation during a prospective 6‐week study , 1998, European journal of gastroenterology & hepatology.

[6]  W. Chey,et al.  Selectively enhanced phasic but not tonic gastrocolonic contractions in diarrhea-predominant irritable bowel syndrome: Role of serotonin 5-HT3 neural pathways , 1998 .

[7]  M. Camilleri,et al.  Rectal tone, distensibility, and perception: reproducibility and response to different distensions. , 1998, American journal of physiology. Gastrointestinal and liver physiology.

[8]  D. Perrett,et al.  Postprandial plasma 5-hydroxytryptamine in diarrhoea predominant irritable bowel syndrome: a pilot study , 1998, Gut.

[9]  E A Mayer,et al.  Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome. , 1997, Gastroenterology.

[10]  J. Rehfeld,et al.  Disturbed motilin and cholecystokinin release in the irritable bowel syndrome. , 1996, Scandinavian journal of gastroenterology.

[11]  A. Zinsmeister,et al.  Psychosensory modulation of colonic sensation in the human transverse and sigmoid colon. , 1995, Gastroenterology.

[12]  O. Nyrén,et al.  Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. , 1995, Gastroenterology.

[13]  M. Camilleri,et al.  Differences in colonic tone and phasic response to a meal in the transverse and sigmoid human colon. , 1995, Gut.

[14]  E A Mayer,et al.  Altered rectal perception is a biological marker of patients with irritable bowel syndrome. , 1995, Gastroenterology.

[15]  J. Malagelada,et al.  Selective dysfunction of mechanosensitive intestinal afferents in irritable bowel syndrome. , 1995, Gastroenterology.

[16]  J. Munakata,et al.  Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. , 1994, Gastroenterology.

[17]  E A Mayer,et al.  Basic and clinical aspects of visceral hyperalgesia. , 1994, Gastroenterology.

[18]  M. Crowell,et al.  Nutrient ingestion increases rectal sensitivity in humans , 1994, Physiology & Behavior.

[19]  M. Camilleri,et al.  Serotonergic mediation of postprandial colonic tonic and phasic responses in humans. , 1994, Gut.

[20]  M. Camilleri,et al.  Colonic tone and motility in patients with irritable bowel syndrome. , 1992, Mayo Clinic proceedings.

[21]  M. J. Fettman,et al.  Responses to cholecystokinin octapeptide in patients with functional abdominal pain syndromes , 1992, Journal of gastroenterology and hepatology.

[22]  J. Kellow,et al.  Enhanced perception of physiological intestinal motility in the irritable bowel syndrome. , 1991, Gastroenterology.

[23]  M. Camilleri,et al.  Variation of muscle tone in the human colon. , 1991, Gastroenterology.

[24]  T. Ness,et al.  A psychophysiological study in humans using phasic colonic distension as a noxious visceral stimulus , 1990, Pain.

[25]  P. Whorwell,et al.  Anorectal manometry in irritable bowel syndrome: differences between diarrhoea and constipation predominant subjects. , 1990, Gut.

[26]  J. Misiewicz,et al.  Increased segmental activity and intraluminal pressures in the sigmoid colon of patients with the irritable bowel syndrome. , 1989, Gut.

[27]  A. Zinsmeister,et al.  Dysmotility of the small intestine in irritable bowel syndrome. , 1988, Gut.

[28]  R. Spiller,et al.  Further characterisation of the 'ileal brake' reflex in man--effect of ileal infusion of partial digests of fat, protein, and starch on jejunal motility and release of neurotensin, enteroglucagon, and peptide YY. , 1988, Gut.

[29]  J. Wiley,et al.  Participation of gastric mechanoreceptors and intestinal chemoreceptors in the gastrocolonic response. , 1988, Gastroenterology.

[30]  A. Zinsmeister,et al.  Altered sensitivity of the gallbladder to cholecystokinin octapeptide in irritable bowel syndrome. , 1987, The American journal of physiology.

[31]  T. Adrian,et al.  Positive correlation between symptoms and circulating motilin, pancreatic polypeptide and gastrin concentrations in functional bowel disorders. , 1985, Gut.

[32]  I. Goldfine,et al.  Cholecystokinin bioactivity in human plasma. Molecular forms, responses to feeding, and relationship to gallbladder contraction. , 1985, The Journal of clinical investigation.

[33]  N. Read,et al.  Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns. , 1983, Gut.

[34]  S. Bloom,et al.  Motilin and human colonic activity , 1980, Regulatory Peptides.

[35]  E. Swarbrick,et al.  SITE OF PAIN FROM THE IRRITABLE BOWEL , 1980, The Lancet.

[36]  S. Cohen,et al.  Effect of dietary components on gastrocolonic response. , 1980, The American journal of physiology.

[37]  W. Snape,et al.  Effect of eating and gastrointestinal hormones on human colonic myoelectrical and motor activity , 1978 .

[38]  M. Sullivan,et al.  Colonic myoelectrical activity in irritable-bowel syndrome. Effect of eating and anticholinergics. , 1978, The New England journal of medicine.

[39]  J. Ritchie.  Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome 1 , 1973, Gut.