Gastroenterology

Gastroenterology

Volume 134, Issue 7, June 2008, Pages 1882-1889
Gastroenterology

Clinical–Alimentary Tract
Bloating and Distention in Irritable Bowel Syndrome: The Role of Visceral Sensation

https://doi.org/10.1053/j.gastro.2008.02.096Get rights and content

Background & Aims: Abdominal bloating is an extremely intrusive symptom of irritable bowel syndrome (IBS) that is not always accompanied by an increase in abdominal girth (distention), raising the possibility that these 2 features of the condition may not share a common pathophysiology. A number of mechanisms have been postulated for bloating and distention, but the role of visceral sensation, which is often abnormal in IBS, has not been previously investigated, and this study aimed to address this question. Methods: Abdominal girth measured by ambulatory abdominal inductance plethysmography and bloating severity was recorded over 24 hours in 39 IBS-constipation (ages, 18–73 years) and 29 IBS-diarrhea patients (ages, 20–59 years) meeting Rome II criteria. Within 1 week, rectal sensory thresholds were assessed with a barostat using the ascending method of limits and tracking. Results: IBS patients who suffered with bloating alone had lower thresholds for pain (P = .005), desire to defecate (P = .044), and first sensation (P = .07) compared with those who had concomitant distention irrespective of bowel habit. When patients were grouped according to sensory threshold, hyposensitive individuals had distention significantly more than those with hypersensitivity (P = .001), and this was observed more in the constipation subgroup. Static and dynamic compliance did not differ among any of the groups. Conclusions: The symptom of bloating alone is associated with visceral hypersensitivity, suggesting that the pathogenesis of bloating and distention may not be the same. Consequently, treatment approaches may have to be different, and measuring visceral sensation could have utility in choosing the right therapeutic modality.

Section snippets

Patients

Sixty-eight patients with IBS, 39 with IBS-C, and 29 with IBS-D (age range, 18–73; mean, 37.4 years; 63 females) who satisfied the ROME II criteria12 and suffered from bloating as part of their symptom complex were recruited from the outpatient department of University Hospital of South Manchester NHS Foundation Trust. All but 6 patients (4 IBS-C and 2 IBS-D) in the study group were barostat naïve. Forty-five age- and sex-matched healthy volunteers (age range, 20–67; mean, 35.1 years; 42

Distending vs Nondistending Patients

Compared with the 97.5 percentile of the diurnal change in abdominal girth (ie, distention) seen in healthy volunteers (ie, 2.8 cm),1 41% of all IBS patients, 49% of IBS-C patients, and 31% of IBS-D patients exhibited abdominal distention (Table 1). All subgroups had similar baseline characteristics, although IBS-C patients with concomitant bloating and distention (B + D) tended to be slightly older (P = .07) than patients with bloating alone (B) (Table 1). Likewise, IBS patients overall with

Discussion

This study has clearly shown that there is a relationship between the symptom of bloating without distention and the presence of visceral hypersensitivity. In contrast, when an actual increase in girth is experienced during the course of the day, this is more likely to be associated with visceral hyposensitivity.

As already mentioned, there have been a number of postulated mechanisms for these phenomena, although some, such as deliberate protrusion of the abdomen or excessive gas, have been

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    Supported in part by an educational grant from Novartis Pharmaceuticals, Basal, Switzerland.

    Conflicts of interest and financial disclosure: Professor P. J. Whorwell and Dr L. A. Houghton have received remuneration for advice, and their department has also received financial support from Novartis Pharmaceuticals, GlaxoSmithKline, Pfizer, Solvay Pharmaceuticals, Rotta Research, Procter and Gamble, Danone Research, Astellas Pharma, and Tillots Pharma. Dr A. Agrawal, Dr R. Lea, J. Morris, and B. Reilly have no conflicts of interest to disclose.

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