Article
An exaggerated sensory component of the gastrocolonic response in
patients with irritable bowel syndrome
M Simrén, H Abrahamsson, E S Björnsson
Department of
Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
Correspondence to: M Simrén, Section of Gastroenterology, Department of Internal Medicine, Sahlgrenska University Hospital, S-41345 Göteborg, Sweden. magnus.simren{at}medicine.gu.se
Accepted for publication 18 July 2000
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.
SUBJECTSWe studied 13 healthy subjects and 16 patients with IBSeight had diarrhoea
predominant (IBS-D) and eight constipation predominant (IBS-C) IBS.
METHODSColonic
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.
RESULTSLipids 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.
CONCLUSIONSPostprandial
symptoms in IBS patients may be explained in part by a nutrient
dependent exaggerated sensory component of the gastrocolonic response.
Keywords: irritable bowel syndrome; lipids; colonic perception; visceral hypersensitivity; gastrointestinal peptides
© 2001 by Gut
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