Increased segmental activity and intraluminal pressures in the sigmoid colon of patients with the irritable bowel syndrome.

Abstract

SUMMARY Intraluminal pressure activity has been recorded in the unprepared true sigmoid colon of seven normal controls (mean age 37 years, range 22-55, three men) and seven patients with irritable bowel syndrome (IBS) (45 years, 24-75, four men) for 30 minutes before and 100 minutes after a standard 1000 kcal meal. Results differ from previously published data'3' by showing much higher indices of pressure activity with amplitudes up to 490 mmHg in IBS, and 450 mmHg in controls. Study segment activity index and mean pressure wave amplitudes were significantly (p<0O015 and p<O01) higher in IBS than controls, but per cent duration of activity was similar for the whole period of study. During the basal period in controls mean amplitudes recorded from the proximal sigmoid (40 cm from anus) were significantly (p<0O01) higher than those in the descending colon (50 cm), distal sigmoid (30 cm) and rectum (15 cm). This study shows that the increased colonic activity in IBS is characterised by increased amplitude, but not duration of pressure waves. In the basal state there is a high pressure zone in the proximal sigmoid colon of controls. Pressures in the unprepared colon of controls and IBS were higher than those measured under other experimental conditions.In most studies of colonic pressure activity'"' a rigid sigmoidoscope was used for insertion of the pressure sensors: this severely limited access to the colon.32 In the few studies"3 in which a colonoscope was used, the bowel was prepared and standard colonoscopy premedication was given. These measures were likely to affect subsequent recorded pressure activity.Studies of colonic pressure activity in patients with the irritable bowel syndrome have thus been largely limited to the rectosigmoid region, and many are probably confined to the rectum. Those studies of colonic pressure activity in which a colonoscope was used are probably not physiological, because the colon was devoid of faeces.The aim of this study was to measure the pressure response of the unprepared sigmoid colon to a standard meal in controls and patients with the irritable bowel syndrome (IBS).

Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome

“…It has been shown that IBS patients demonstrate a prolonged and exaggerated gastrocolonic response compared to control subjects [27]. The fat component of the food is the main stimulus for this response [28].…”

Reflections on the “type O” disorder

“…Richter & Bradley 109 Gastroesophageal reflux disease Sternberg et al 110 Chronic functional abdominal pain Rogers et al 111 Kellow & Phillips 112 Whitehead et al 113 Drossman et al 114 Crohn's disease Carney et al 115 Coronary artery disease Carney et al 116 It would appear that allopathic medicine is slowly adapting to the biopsychosocial model and that a whole new area of research referred to as neuropsychoimmunology has developed to investigate the model. 129 To illustrate this adaptation, Katon et al 130 found that patients with chest pain and normal coronary arteriograms had a higher level of anxiety, depression, and panic disorder than those with normal psychosocial characteristics and arteriographic studies that showed coronary stenosis.…”

“…In addition to the potential supraspinal influence on type M disorders, research has also shown that many type O disorders have a distinct supraspinal component (Table 6). [108][109][110][111][112][113][114][115][116][117][118][119][120][121] Furthermore, there is evidence that a reduction of this supraspinal effect may be beneficial to the patient outcome. 102,122,123 TREATMENT OF THE TYPE O CONDITION Despite anecdotal claims of success with type O conditions, success in management is not guaranteed nor is it predictable.…”

“…128 These include (1) a stressful event or challenge to the system, for example, an exposure to an infectious agent, loss of a family member, or problems Table 6. Some visceral conditions that medicine is recognizing to be strongly associated with supraspinal influences [108][109][110][111][112][113][114][115][116][117][118][119][120][121] Author(s) Condition…”

Augmented visceral perception

“…• As stress has clearly been defined as a factor in the exacerbations of IBS, introduction of stress-reduction techniques or enrollment in formal stress-management programs can be advocated. • Fats produce an exaggerated motor responses in the small intestine and colon of patients with IBS, which may underlie the prolonged gastrocolonic responses observed in some patients [62]. The avoidance of fat is commonly recommended to prevent this enhanced contractile responsiveness.…”