Motility Abnormalities in Irritable Bowel Syndrome

Abstract

Background/Aims: The intestinal pathophysiology in irritable bowel syndrome (IBS) is largely unknown. The lactulose breath test has been used to identify small bowel bacterial overgrowth in these patients. Methods: We studied intestinal transit in patients with IBS using of the SmartPill® (SP) wireless pH/pressure recording capsule and performed lactulose breath tests to look for physiologic abnormalities. Results: A total of 35/46 (76%) of the IBS patients had prolonged gastric emptying times. Constipation-predominant disease was associated with prolonged gut transit times. The mean hours ± SD for colonic transit time in the constipation group was 71.7 ± 61.1 (n = 13) compared with 22.5 ± 14.9 (n = 14) for diarrhea-predominant and 26.4 ± 21.5 (n = 20) for mixed clinical subtype (p = 0.0010). No correlation between small bowel transit time and abnormal breath hydrogen or methane excretion in the 46 combined patients with IBS was seen. Conclusions: Delayed gastric emptying was identified in IBS and in some patients may contribute to at least a component of their symptoms. Constipation-predominant IBS is associated with prolonged gut transit times. Otherwise, transit abnormalities do not appear to be important in IBS. Intestinal transit did not correlate with breath test results.

Is fecal microbiota transplantation (FMT) an effective treatment for patients with functional gastrointestinal disorders (FGID)?

“…Alterations of intestinal microbiota have been directly linked to immunity, motility, and neurologic changes that are characteristic of IBS. Compared with conventionally raised mice, germ‐free mice exhibit delayed gastric emptying, slower intestinal transit times and are significantly more susceptible to enteric infections, manifestations that are also seen in IBS . Moreover, introduction of a single, typically commensal, intestinal bacterial species, such as Lactobacillus or Bifidobacterium, into a germ‐free mouse, results in prolonged intestinal transit times .…”

Biomarkers of Irritable Bowel Syndrome

“…37 A more recent study revealed that IBS-C, which was associated with prolonged gut transit times, did not show an increase in positive testing for breath methane. 42 The authors explained the discrepancy with previous studies by variations in the definition of constipation, type of sugar, or proportion of patients with diarrhea. In contrast, measuring breath methane to determine therapeutic response to non-absorbable antibiotics such as neomycin and rifaximin has been well established.…”

“…30 However, other studies argue that methane production is not restricted to constipation-predominant diseases. 37,41,42 In a study of 1372 subjects with functional GI disorders, including 212 IBS patients, diarrhea was more common than constipation in patients with high methane levels on LBT/fructose breath tests. Furthermore, two-thirds of IBS-C patients did not have elevated methane levels after either lactose or fructose.…”

Chronic Kidney Disease Elicits an Intestinal Inflammation Resulting in Intestinal Dysmotility Associated with the Activation of Inducible Nitric Oxide Synthesis in Rat

“…The pathogenesis of intestinal dysmotility is complex [32,33]. Many factors, such as inflammation, inhibitory agents, and neurogenic reflexes, are involved in the development and progression of intestinal dysmotility in various diseases [8][9][10][11].…”