Clinical–Alimentary TractBloating and Distention in Irritable Bowel Syndrome: The Role of Visceral Sensation
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
References (41)
- et al.
Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit
Gastroenterology
(2006) - et al.
Sensation of bloating and visible abdominal distention in patients with irritable bowel syndrome
Am J Gastroenterol
(2001) - et al.
Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome
Am J Gastroenterol
(1999) - et al.
Abdominal bloating
Gastroenterology
(2005) - et al.
Altered rectal perception is a biological marker of patients with irritable bowel syndrome
Gastroenterology
(1995) - et al.
Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds
Gastroenterology
(2002) - et al.
Modulation of gastric sensory and motor functions by nitrergic and α-2 adrenergic agents in humans
Gastroenterology
(1999) - et al.
Evidence for hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome
Gastroenterology
(1994) - et al.
Origin of gas retention and symptoms in patients with bloating
Gastroenterology
(2005) - et al.
Abdominal wall muscle activity in irritable bowel syndrome with bloating
Am J Gastroenterol
(2001)
Impaired viscerosomatic reflexes and abdominal-wall dystony associated with bloating
Gastroenterology
Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome
Lancet
Hypnotherapy in irritable bowel syndrome: a large scale audit of a clinical service with an examination of factors influencing responsiveness
Am J Gastroenterol
Ambulatory abdominal inductance plethysmography: towards objective assessment of abdominal distension in irritable bowel syndrome
Gut
A device for 24-hour ambulatory monitoring of abdominal girth using inductive plethysmography
Physiol Meas
Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders
Neurogastroenterol Motil
Urge and no-urge constipation predominant irritable bowel syndrome (IBS): sensory dysfunction of the whole gut
Gastroenterology
Sub-types of constipation predominant irritable bowel syndrome based on rectal perception
Gut
Functional bowel disorders and functional abdominal pain
Gut
Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract
Dig Dis Sci
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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.