Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin

Chander Shekhar, Phillip J. Monaghan, Julie Morris, Basma Issa, Peter J. Whorwell, Brian Keevil, Lesley A. Houghton

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background & Aims Patients with irritable bowel syndrome with constipation (IBS-C) and patients with functional constipation (FC) have similar symptoms, and these disorders overlap in their diagnostic features. Little is known about their overlap in physiology or the involvement of serotonin signaling. We investigated relationships between platelet-depleted plasma concentrations of serotonin, gastrointestinal symptoms, and motor-sensory function in patients with FC or IBS-C compared with healthy volunteers (controls). Methods We measured platelet-depleted plasma concentrations of serotonin in fasting and fed individuals with IBS-C (n = 23; 19-50 years old), FC (n = 11; 25-46 years old), and controls (n = 23; 20-49 years old) recruited in Manchester, UK. We also quantified abdominal and bowel-related symptoms, rectal sensitivity, oro-cecal transit, and colonic (whole intestine) transit. Results Patients with IBS-C or FC had similar baseline symptoms, bowel habits, oro-cecal and colonic transit, and fasting concentrations of serotonin and response to meal ingestion. Only patients with IBS-C had increased symptoms after ingestion of a meal (P <.001) - these patients tended to have lower sensory thresholds than patients with FC. Defecation frequency in the combined group of patients with IBS-C or FC correlated inversely with serotonin concentration (r = -0.4; P =.03). Serotonin concentration also correlated with pain threshold (r = 0.4; P =.02) and stool threshold (r = 0.5; P =.06), which correlated inversely with defecation frequency (r = -0.3; P =.10). Conclusions FC and IBS-C, based on Rome III criteria, are not distinct disorders, symptomatically or physiologically. Instead, they appear to lie in a spectrum of visceral sensitivity modulated by serotonin signaling. Symptom response to meal ingestion should be considered in patient classification.

Original languageEnglish (US)
Pages (from-to)749-757
Number of pages9
JournalGastroenterology
Volume145
Issue number4
DOIs
StatePublished - Oct 2013

Fingerprint

Irritable Bowel Syndrome
Constipation
Serotonin
Meals
Defecation
Eating
Fasting
Blood Platelets
Sensory Thresholds
Pain Threshold
Habits
Intestines
Healthy Volunteers

Keywords

  • Visceral Sensitivity 5-Hydroxytryptamine 5-HT Neurotransmitter

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin. / Shekhar, Chander; Monaghan, Phillip J.; Morris, Julie; Issa, Basma; Whorwell, Peter J.; Keevil, Brian; Houghton, Lesley A.

In: Gastroenterology, Vol. 145, No. 4, 10.2013, p. 749-757.

Research output: Contribution to journalArticle

Shekhar, Chander ; Monaghan, Phillip J. ; Morris, Julie ; Issa, Basma ; Whorwell, Peter J. ; Keevil, Brian ; Houghton, Lesley A. / Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin. In: Gastroenterology. 2013 ; Vol. 145, No. 4. pp. 749-757.
@article{79256c98546f4e6fb9abc30e16b413e8,
title = "Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin",
abstract = "Background & Aims Patients with irritable bowel syndrome with constipation (IBS-C) and patients with functional constipation (FC) have similar symptoms, and these disorders overlap in their diagnostic features. Little is known about their overlap in physiology or the involvement of serotonin signaling. We investigated relationships between platelet-depleted plasma concentrations of serotonin, gastrointestinal symptoms, and motor-sensory function in patients with FC or IBS-C compared with healthy volunteers (controls). Methods We measured platelet-depleted plasma concentrations of serotonin in fasting and fed individuals with IBS-C (n = 23; 19-50 years old), FC (n = 11; 25-46 years old), and controls (n = 23; 20-49 years old) recruited in Manchester, UK. We also quantified abdominal and bowel-related symptoms, rectal sensitivity, oro-cecal transit, and colonic (whole intestine) transit. Results Patients with IBS-C or FC had similar baseline symptoms, bowel habits, oro-cecal and colonic transit, and fasting concentrations of serotonin and response to meal ingestion. Only patients with IBS-C had increased symptoms after ingestion of a meal (P <.001) - these patients tended to have lower sensory thresholds than patients with FC. Defecation frequency in the combined group of patients with IBS-C or FC correlated inversely with serotonin concentration (r = -0.4; P =.03). Serotonin concentration also correlated with pain threshold (r = 0.4; P =.02) and stool threshold (r = 0.5; P =.06), which correlated inversely with defecation frequency (r = -0.3; P =.10). Conclusions FC and IBS-C, based on Rome III criteria, are not distinct disorders, symptomatically or physiologically. Instead, they appear to lie in a spectrum of visceral sensitivity modulated by serotonin signaling. Symptom response to meal ingestion should be considered in patient classification.",
keywords = "Visceral Sensitivity 5-Hydroxytryptamine 5-HT Neurotransmitter",
author = "Chander Shekhar and Monaghan, {Phillip J.} and Julie Morris and Basma Issa and Whorwell, {Peter J.} and Brian Keevil and Houghton, {Lesley A.}",
year = "2013",
month = "10",
doi = "10.1053/j.gastro.2013.07.014",
language = "English (US)",
volume = "145",
pages = "749--757",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin

AU - Shekhar, Chander

AU - Monaghan, Phillip J.

AU - Morris, Julie

AU - Issa, Basma

AU - Whorwell, Peter J.

AU - Keevil, Brian

AU - Houghton, Lesley A.

PY - 2013/10

Y1 - 2013/10

N2 - Background & Aims Patients with irritable bowel syndrome with constipation (IBS-C) and patients with functional constipation (FC) have similar symptoms, and these disorders overlap in their diagnostic features. Little is known about their overlap in physiology or the involvement of serotonin signaling. We investigated relationships between platelet-depleted plasma concentrations of serotonin, gastrointestinal symptoms, and motor-sensory function in patients with FC or IBS-C compared with healthy volunteers (controls). Methods We measured platelet-depleted plasma concentrations of serotonin in fasting and fed individuals with IBS-C (n = 23; 19-50 years old), FC (n = 11; 25-46 years old), and controls (n = 23; 20-49 years old) recruited in Manchester, UK. We also quantified abdominal and bowel-related symptoms, rectal sensitivity, oro-cecal transit, and colonic (whole intestine) transit. Results Patients with IBS-C or FC had similar baseline symptoms, bowel habits, oro-cecal and colonic transit, and fasting concentrations of serotonin and response to meal ingestion. Only patients with IBS-C had increased symptoms after ingestion of a meal (P <.001) - these patients tended to have lower sensory thresholds than patients with FC. Defecation frequency in the combined group of patients with IBS-C or FC correlated inversely with serotonin concentration (r = -0.4; P =.03). Serotonin concentration also correlated with pain threshold (r = 0.4; P =.02) and stool threshold (r = 0.5; P =.06), which correlated inversely with defecation frequency (r = -0.3; P =.10). Conclusions FC and IBS-C, based on Rome III criteria, are not distinct disorders, symptomatically or physiologically. Instead, they appear to lie in a spectrum of visceral sensitivity modulated by serotonin signaling. Symptom response to meal ingestion should be considered in patient classification.

AB - Background & Aims Patients with irritable bowel syndrome with constipation (IBS-C) and patients with functional constipation (FC) have similar symptoms, and these disorders overlap in their diagnostic features. Little is known about their overlap in physiology or the involvement of serotonin signaling. We investigated relationships between platelet-depleted plasma concentrations of serotonin, gastrointestinal symptoms, and motor-sensory function in patients with FC or IBS-C compared with healthy volunteers (controls). Methods We measured platelet-depleted plasma concentrations of serotonin in fasting and fed individuals with IBS-C (n = 23; 19-50 years old), FC (n = 11; 25-46 years old), and controls (n = 23; 20-49 years old) recruited in Manchester, UK. We also quantified abdominal and bowel-related symptoms, rectal sensitivity, oro-cecal transit, and colonic (whole intestine) transit. Results Patients with IBS-C or FC had similar baseline symptoms, bowel habits, oro-cecal and colonic transit, and fasting concentrations of serotonin and response to meal ingestion. Only patients with IBS-C had increased symptoms after ingestion of a meal (P <.001) - these patients tended to have lower sensory thresholds than patients with FC. Defecation frequency in the combined group of patients with IBS-C or FC correlated inversely with serotonin concentration (r = -0.4; P =.03). Serotonin concentration also correlated with pain threshold (r = 0.4; P =.02) and stool threshold (r = 0.5; P =.06), which correlated inversely with defecation frequency (r = -0.3; P =.10). Conclusions FC and IBS-C, based on Rome III criteria, are not distinct disorders, symptomatically or physiologically. Instead, they appear to lie in a spectrum of visceral sensitivity modulated by serotonin signaling. Symptom response to meal ingestion should be considered in patient classification.

KW - Visceral Sensitivity 5-Hydroxytryptamine 5-HT Neurotransmitter

UR - http://www.scopus.com/inward/record.url?scp=84884418594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884418594&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2013.07.014

DO - 10.1053/j.gastro.2013.07.014

M3 - Article

C2 - 23872499

AN - SCOPUS:84884418594

VL - 145

SP - 749

EP - 757

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 4

ER -