Original article—alimentary tract
Prospective Study of Motor, Sensory, Psychologic, and Autonomic Functions in Patients With Irritable Bowel Syndrome

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Background & Aims: The aim of this study was to assess pathophysiology in irritable bowel syndrome (IBS). Methods: A total of 122 IBS patients (3 male) and 41 healthy females underwent the following: questionnaires (symptoms, psychology), autonomic function, gut transit, gastric volumes, satiation, rectal compliance, and sensation (thresholds and pain ratings) testing. Proportions of patients with abnormal (<10th and >90th percentiles) motor or sensory functions according to bowel symptoms (constipation [C], diarrhea [D], mixed [M),) pain/bloat, and number of primary symptoms were estimated. Results: IBS subgroups (C, D, M) were similar in age, gastric and small-bowel transit, satiation, gastric volumes, rectal compliance, sensory thresholds, and pain ratings. IBS was associated with body mass index, somatic symptoms, and anxiety and depression scores. Significant associations were observed with colonic transit (IBS-C [P = .078] and IBS-D [P < .05] at 24 h; IBS-D [P < .01] and IBS-M [P = .056] at 48 h): 32% of IBS patients had abnormal colonic transit: 20.5% at 24 hours and 11.5% at 48 hours. Overall, 20.5% of IBS patients had increased sensation to distensions: hypersensitivity (<10th percentile thresholds) in 7.6%, and hyperalgesia (pain sensation ratings to distension >90th percentile for ratings in health) in 13%. Conversely, 16.5% of IBS patients had reduced rectal sensation. Pain greater than 6 times per year and bloating were not associated significantly with motor, satiation, or sensory functions. Endorsing 1 to 2 or 3 to 4 primary IBS symptoms were associated with abnormal transit and sensation in IBS. Conclusions: In tertiary referral (predominantly female) patients with IBS, colonic transit (32%) is the most prevalent physiologic abnormality; 21% had increased and 17% had decreased rectal pain sensations. Comprehensive physiologic assessment may help optimize management in IBS.

Section snippets

Study Design and Participants

In a single-center, prospective study, 122 IBS patients (by Rome II criteria28) were recruited over a 4-year period; 119 were female and 3 (all in the IBS-D group) were male. Patients were recruited from an administrative database of 850 patients residing within 200 miles of the Mayo Clinic based on their primary presentation with IBS. Questionnaire responses assessed the coexistence of other gastrointestinal symptoms, psychologic disturbances, and the relationship of upper-abdominal symptoms

Participants

Participants' demographics and key psychologic data are shown in Table 1. IBS subgroups were similar in age. IBS-D and IBS-M patients had higher body mass index (BMI) values than healthy volunteers and IBS-C subjects. Physical examination (all performed by one experienced gastroenterologist [M.C.]) identified features suggestive of pelvic floor dysfunction in 12 patients: 5 with IBS-C, 2 with IBS-D, and 5 with IBS-M. All patients were referred to an evacuations disorder clinic and in 6 of 6 who

Discussion

In a group of predominantly female patients with IBS evaluated at a tertiary care center, abnormal colonic transit (32%) and rectal hyperalgesia (20.5%, increased sensory ratings) were the predominant disturbances of physiology, whereas the proportion with rectal hyposensitivity was 16.5%. These observations were based on patients characterized by bowel dysfunction and, particularly, abnormal functions were associated with endorsement of 1 to 4 primary IBS symptoms. In contrast, motor and

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    Supported in part by grants RO1-DK54681 and K24-DK02638 to Dr. Camilleri from the National Institutes of Health. Dr. Low is supported in part by National Institutes of Health grants NS32352, NS44233, NS22352, and NS43364, and by Mayo funds. The studies were conducted in the Mayo Clinical Research Unit, which is supported by National Institutes of Health CTSA grant RR024150.

    The excellent secretarial support of Mrs. Cindy Stanislav is gratefully acknowledged.

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