TY - JOUR
T1 - Bloating and Distention in Irritable Bowel Syndrome
T2 - The Role of Visceral Sensation
AU - Agrawal, Anurag
AU - Houghton, Lesley A.
AU - Lea, Richard
AU - Morris, Julie
AU - Reilly, Brian
AU - Whorwell, Peter J.
N1 - Funding Information:
Supported in part by an educational grant from Novartis Pharmaceuticals, Basal, Switzerland.
Funding Information:
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.
PY - 2008/6
Y1 - 2008/6
N2 - 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.
AB - 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.
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U2 - 10.1053/j.gastro.2008.02.096
DO - 10.1053/j.gastro.2008.02.096
M3 - Article
C2 - 18455167
AN - SCOPUS:44649097698
SN - 0016-5085
VL - 134
SP - 1882
EP - 1889
JO - Gastroenterology
JF - Gastroenterology
IS - 7
ER -