Meal-induced recto-sigmoid tone modification: a low-caloric meal accurately separates functional and organic gastrointestinal disease patients

Michele Di Stefano ^1*, Emanuela Miceli ¹, Antonio Missanelli ¹, Samanta Mazzocchi ¹ and GinoRoberto Corazza ¹

¹ I Department of Medicine, University of Pavia, IRCCS S.Matteo Hospital, Italy

^* To whom correspondence should be addressed. E-mail: m.distefano{at}smatteo.pv.it.

Accepted 14 January 2006

Abstract

Background and Aims: Diagnosis of irritable bowel syndrome is based on arbitrary criteria due to the lack of an accurate diagnostic test. The aim of this study was to evaluate whether recto-sigmoid tone modification after a meal represents an accurate diagnostic approach.

Methods: In a secondary care setting, 32 constipation-predominant and 24 diarrhoea-predominant IBS patients, 10 functional diarrhoea and 10 functional constipation patients, 29 organic gastrointestinal disease patients and 10 healthy volunteers underwent a rectal barostat test in order to measure fasting and post- prandial recto-sigmoid tone. Recto-sigmoid response was assessed following three meals containing different amounts of calories, 200 Kcal, 400 Kcal and 1000 Kcal.

Results: After 200 Kcal, healthy volunteers and patients with organic diseases showed a reduction of recto-sigmoid volume of at least 28% of fasting volume, indicating a meal-induced increase of muscle tone. On the contrary, patients with diarrhoea-predominant IBS showed a dilation of the recto-sigmoid colon, indicative of reduced tone and patients with constipation-predominant IBS showed a mild volume reduction or no modification. Functional diarrhoea and constipation patients showed recto-sigmoid tone modification resembling that of the corresponding IBS subtype. A 400 Kcal meal normalized recto-sigmoid tone in more than half the constipation- predominant IBS patients but none of the diarrhoea- predominant IBS patients. On the contrary, a 1000 Kcal meal normalized tone response in all IBS patients. Sensitivity of the test was 100%, specificity 93%, positive predictive value 96% and negative predictive value 100%.

Conclusion: A post-prandial reduction of recto- sigmoid tone of at least 28% of fasting value after a low- caloric meal accurately separates organic and functional gastrointestinal disease patients. This parameter may, therefore, be used in the positive diagnosis of IBS.

Keywords: barostat, functional bowel disorders, irritable bowel syndrome, rectal tone, visceral sensitivity

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