Abstract
Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We measured the sensory thresholds for initial perception (IP), desire to defecate (DD), and urgency (U) in response to rectal balloon distension, and the thresholds for initial perception and for discomfort in response to esophageal balloon distension in 12 patients with irritable bowel syndrome (IBS) and 10 patients with functional dyspepsia (FD), in comparison with healthy controls. As expected, IBS patients exhibited lower rectal sensory thresholds than controls (P<0.0001), but in addition had significantly lower sensory thresholds for both perception and discomfort evoked by balloon distension of the esophagus (mean ±SEM: 8.8±1.3 ml vs 12.1±1.5 ml (P<0.05) and 12.2±1.4 ml vs 16.4±1.4 ml (P<0.02) respectively. Patients with FD showed similarily enhanced esophageal sensitivity, with thresholds for perception and discomfort of 8.1±0.9 ml (P<0.02), and 10.1±1.0 ml (P<0.001), respectively, but were also found to have sensory thresholds for rectal distension similar to those observed in the IBS group, significantly lower than in controls: IP 45.0±17.6 vs 59.3±1.5 ml (P<0.001), DD 98.0±17.9 vs 298.7±9.0 ml (P<0.0001), U 177.2±25.4 vs 415.1 ±12.6 ml (P<0.0001). Somatic nerve sensory thresholds showed no significant differences between the patient and control groups. Our findings indicate that alterations in visceral sensitivity in functional gastrointestinal disease affect sites in the gut other than the putative organ of symptom origin, supporting the concept of generally enhanced visceral awareness in patients with functional bowel disorders.
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Talley NJ, Zinsmeister AR, van Dyke C, Melton LJ: Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 101:927–932, 1991
Thompson WG: Non-ulcer dyspepsia. Can Med Assoc J 130:565–569, 1984
Latimer P, Sarna S, Campbell D, Latimer M, Waterfall W, Daniel EE: Colonic motor and myoelectrical activity: A comparative study of normal subjects psychoneurotic patients and patients with the irritable bowel syndrome. Gastroenterology 80:893–901, 1981
Trotman IF, Misiewicz JJ: Sigmoid motility in diverticular discase and the irritable bowel syndrome. Gut 29:218–222 1988
Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985
Waldron B, Cullen PT, Kumar R, Smith D, Jankowski J, Hopwood D, Sutton D, Kennedy N, Campbell FC: Evidence for hypomotility in non-ulcer dyspepsia: A prospective multifactorial study. Gut 32:246–251, 1991
Talley NJ, Piper DW: The association between non-ulcer dyspepsia and other gastrointestinal disorders. Scand J Gastroenterol 20:898–900, 1985
Thompson WG, Heaton KW: Functional bowel disorders in apparently healthy people. Gastroenterology 79:283–288, 1980
Whorwell PJ, Lupton PW, Erduran D, Wilson K: Bladder smooth muscle dysfunction in patients with irritable bowel syndrome. Gut 27:1014–1017, 1986
Whorwell PJ, Clouter C, Smith CL: Oesophageal motility in the irritable bowel syndrome. Br Med J 282:1101–1102, 1981
Kellow JE, Phillips SF, Miller LJ, Zinsmeister AR: Dysmotility of the small intestine in irritable bowel syndrome. Gut 29:1236–1243, 1988
Bassoti G, Pelli MA, Morelli A: Duodenojejunal motor activity in patients with chronic dyspeptic symptoms. J Clin Gastroenterol 12:17–21, 1990
McKee DP, Quigley EMM: Intestinal motility in irritable bowel syndrome: is IBS a motility disorder? Dig Dis Sci 38:1761–1772, 1993
Mearin F, Malagelada JR: Upper gut motility and perception in functional dyspepsia. Eur J Gastroenterol Hepatol 4:615–621, 1992
Whitehead WE, Holtcotter B, Enck P, Hoelzl R, Holmes KD, Anthony J, Shabsin HS, Schuster MM: Tolerance for rectosigmoid distention in irritable bowel syndrome. Gastroenterology 98:1187–1192, 1990
Ritchie J: Pain from distention of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973
Kellow JE, Eckersley GM, Jones MP: Enhanced perception of physiological intestinal motility in the irritable bowel syndroms. Gastroenterology 101:1621–1627, 1991
Mearin F, Cucala M, Azpiroz F, Malagelada J-R: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101:999–1006, 1991
Bradette M, Pare P, Douville P, Morin A: Visceral perception in health and functional dyspepsia. Dig Dis Sci 36:52–58, 1991
Richter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986
Cannon RO, Benjamin SB: Chest pain as a consequence of abnormal visceral nociception. Dig Dis Sci 38:193–196, 1993
Vantrappen G, Janssens J, Ghillebert G: The irritable oesophagus—a frequent cause of angina-like pain. Lancet 1:1232–1234, 1987
Trimble KC, Pryde A, Heading RC: Altered oesophageal sensory thresholds in patients with symptomatic but not excess gastresophageal reflux—a demonstration of the “irritable oesophagus”. Gut 34(4):S18, 1993, (abstract)
Thompson WG, Creed F, Drossman DA, Heaton KW, Mazzacca G: Functional bowel disease and functional abdominal pain. Gastroenterol Int 5:75–91, 1992
Heading RC: Definitions of dyspepsia. Scand J Gastroenterol 26(suppl. 182):1–6, 1991
Varma JS, Smith AN: Reproducibility of the proctometrogram. Gut 27:288–292, 1986
De Caestecker JS, Pryde A, Heading RC: Site and mechanism of pain perception with oesophageal balloon distention and intravenous edrophonium in patients with esophageal chest pain. Gut 33:580–586, 1992
Benjamin SR, Richter JE, Cordova CM, Knuff TE, Castell DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 84:893–901, 1983
Barlow JD, Thompson DG: Reproducibility of perception to oesophageal distention. Gut 35(suppl 2):S8, 1994
Costantini M, Sturniolo GC, Zaninotto G, D'Inca R, Polo R, Naccarato R, Ancona E: Altered esophageal pain threshold in irritable bowel syndrome. Dig Dis Sci 38:206–212, 1993
Greydanus MP, Vassallo M, Camillieri M, Nelson DK, Hanson RB, Thomforde GM: Neurohormonal factors in functional dyspepsia: Insights on pathophysiological mechanisms. Gastroenterology 100:1311–1318, 1991
Coffin B, Azpiroz F, Guarner F, Malagelada JR: Selective gastric hypersensitivity and reflex hyporeactivity in functional dyspepsia. Gastroenterology 107:1345–1351, 1994
Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE: Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int 3:159–172, 1990
Talley NJ: Symptom patterns in functional dyspepsia. Eur J Gastroenterol Hepatol 4:597–601, 1992
Watson WC, Sullivan SN, Corke M, Rush D: Incidence of oesophageal symptoms in patients with irritable bowel syndromes. Gut 17:827, 1976
Cook IJ, Van Eeden A, Collins SM: Patients with irritable bowel syndrome have greater pain tolerance than normal subjects. Gastroenterology 93:727–733, 1987
Mayer EA, Raybould HE: Role of visceral afferent mechanisms in functional bowel disorders. Gastroenterology 99:1688–1704, 1990
Smout AJPM, De Vore MS, Castell DO: Abnormalities of cerebral potentials evoked by esophageal distention in patients with non-cardiac chest pain. Gastroenterology 98:A393, 1990
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Trimble, K.C., Farouk, R., Pryde, A. et al. Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Digest Dis Sci 40, 1607–1613 (1995). https://doi.org/10.1007/BF02212678
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DOI: https://doi.org/10.1007/BF02212678