Gastroenterology

Gastroenterology

Volume 123, Issue 3, September 2002, Pages 700-706
Gastroenterology

Clinical–Alimentary Tract
Lipid-induced intestinal gas retention in irritable bowel syndrome,☆☆

https://doi.org/10.1053/gast.2002.35394Get rights and content

Abstract

Background & Aims: We hypothesized that lipids, which induce various motor and sensory effects on the gut, modulate intestinal gas dynamics and that alteration of this regulatory mechanism may result in impaired gas transit in patients with irritable bowel syndrome (IBS). Methods: In 45 healthy subjects and 30 patients with IBS, evacuation of gas infused into the jejunum (at 12 mL/min) was measured for 2 hours. The effect of simultaneous duodenal perfusion of lipids at 0 kcal/min (saline), 0.5 kcal/min, and 1 kcal/min was tested in groups of 15 subjects each. Results: In healthy subjects, duodenal lipids at 1 kcal/min but not at 0 kcal/min or 0.5 kcal/min produced significant gas retention (281 ± 53 mL vs. 22 ± 64 mL at 0 kcal/min and −65 ± 72 mL at 0.5 kcal/min; P < 0.05 for both). Patients with IBS exhibited gas retention during saline perfusion (259 ± 85 mL at 0 kcal/min; P < 0.05 vs. healthy subjects) and were hypersensitive to duodenal lipids (505 ± 61 mL retention at 0.5 kcal/min; P < 0.05 vs. saline and vs. healthy subjects). The “gas plus lipids” challenge test discriminated patients with 100% sensitivity and 93% specificity. Conclusions: Physiologic concentrations of intestinal lipids exert an inhibitory control on intestinal gas transit, and this mechanism is up-regulated in patients with IBS. Hence, impaired gas propulsion, shown by the gas challenge test, may be useful as a diagnostic test if replicated in a larger series of patients.

GASTROENTEROLOGY 2002;123:700-706

Section snippets

Participants

Thirty patients with IBS (26 women and 4 men; age range, 24–63 years) and 45 healthy individuals (26 women and 19 men; age range, 18–33 years) participated in the study after giving written informed consent. Healthy subjects were recruited by public advertising and completed a pre-entry questionnaire to establish the absence of gastrointestinal symptoms. Patients with abdominal bloating were selected on the basis of Rome II IBS diagnostic criteria; they had no detectable abnormalities on

Effect of duodenal lipids on gas dynamics in healthy subjects

During duodenal perfusion of saline alone (control), healthy subjects tolerated the jejunal gas infusion without gas retention, abdominal symptoms, or distention (Figures 1–3).

. Effect of duodenal lipids on intestinal gas transit. Data are mean values ± SE of gas retained after 2-hour infusion. Duodenal lipids delayed gas transit, and this effect was significantly more pronounced in patients with IBS. *P < 0.05 vs. 0 Kcal in health; #P < 0.05 vs. 0 Kcal in IBS and 0.5 Kcal in health.

. Effect of

Discussion

We have shown both that intestinal gas transport is delayed by intraluminal lipids and that lipid-induced inhibition of gut propulsive motility is up-regulated in a subgroup of patients with IBS who report abdominal bloating. Furthermore, the differences in gas handling between patients and healthy controls seem so clear-cut that the gas challenge test may be used as a marker of disease in this type of patients.

The gut in healthy subjects is able to transport and evacuate large gas loads,

Acknowledgements

The authors thank Nuria Ferrer and Isidre Casals, Serveis Cientifico-Tecnics of the Central University of Barcelona, for help with gas infrared absorbance analysis; Maite Casaus and Anna Aparici for technical support; Gloria Santaliestra for secretarial assistance; and Cristine O'Hara for English-language editing of the manuscript.

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    Address requests for reprints to: Fernando Azpiroz, M.D., Digestive System Research Unit, Hospital General Vall d'Hebron, 08035 Barcelona, Spain. e-mail: [email protected]; fax: (34) 93 489 44 56.

    ☆☆

    Supported in part by the Spanish Ministry of Science and Technology (grant BSA 2001-2584), by the Catalonian Government (Generalitat de Catalunya, Department d'Universitats, Recerca i Societat de la Informació, RE: 2000SGR 00123), by the U.S. National Institutes of Health (DK 57064), by a scholarship from the Spanish Ministry of Education (CICYT) (to J.S.), and by a scholarship from the University of Bologna (to B.S.).

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