Pain thresholds measured by the barrostat predict the severity of clinical pain in patients with irritable bowel syndrome

Whttehead, WE; Diamant, N.E.; Meyer, K A; Mikula, Kristi; Hu, JB; Jia, Hongyu; Bangdiwala, Shrikant I.; Toner, Brenda B.; Drossman, Doug

doi:10.1016/s0016-5085(98)83500-2

Cited by 10 publications

(11 citation statements)

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“…These findings are in line with observations by Whitehead et al (32) in patients with irritable bowel syndrome. They investigated the relation between pain reported by irritable bowel syndrome patients in the 2 weeks before the study and pain experienced during rectal distension and reported a correlation between the two that was comparable with the correlations observed in this study.…”

Section: Gastrointestinal Sensations In Patients With Diabetessupporting

confidence: 93%

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Vermeijden²,

et al. 2003

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OBJECTIVE -Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively.RESEARCH DESIGN AND METHODS -Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 Ϯ 11.3 years) using 100 mg 13 C-enriched octanoic acid added to a solid meal.RESULTS -Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T 50 : 99.5 Ϯ 35.4 vs. 76.8 Ϯ 21.4 min, P Ͻ 0.003; Ret 120 min : 30.6 Ϯ 17.2 vs. 20.4 Ϯ 9.7%, P Ͻ 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r ϭ 0.46, P Ͻ 0.0001), whereas sensations experienced in the previous 2 weeks did not.CONCLUSIONS -This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not. Diabetes Care 26:3116 -3122, 2003T he prevalence of delayed gastric emptying in patients with diabetes has been subject to debate for several decades. Cross-sectional studies using scintigraphic techniques to measure gastric emptying have shown delayed gastric emptying in patients with diabetes varying from 30 to 60% (1-11). However, there are several important limitations to these studies. First, the vast majority of these studies have been performed in small numbers of patients or in selected patients, which may account for the high percentage of patients showing delayed gastric emptying in some of these studies. Second, none of these studies has been performed during relative euglycemic conditions, whereas recent studies have provided evidence that hyperglycemia has a substantial effect on the rate of gastric emptying (12,13). After taking the aforementioned into account, the prevalence of delayed gastric emptying in diabetic patients who are not selected for gastrointestinal symptoms has yet to be determined.Previous studies have reported a weak association between gastric emptying and upper gastrointestinal symptoms experienced by patients in the period preceding the gastric emptying test, with the exception of the study performed by Jones et al. (10). They studied a large cohort of diabetic subjects over a period Ͼ10 years and reported that abdominal bloating and fullness were as...

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Section: Gastrointestinal Sensations In Patients With Diabetessupporting

confidence: 93%

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Vermeijden²,

et al. 2003

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“…Pain is often described in purely physiological terms reflecting the assumption that perceived intensity of stimulation correlates well with the level of noxious stimulation. However, the role of psychological factors in the modulation of pain processing has received much attention and the impact of factors such as stress, anxiety, mood and personality on an individual’s pain experience is well recognized 44–48 …”

Section: Brain Responses To Visceral Stimuli In Healthy Subjectsmentioning

confidence: 99%

Brain imaging approaches to the study of functional GI disorders: A Rome Working Team Report

Mayer

Aziz

Coen

et al. 2009

Neurogastroenterology Motil

189

156

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Progresses in the understanding of human brain‐gut interactions in health and disease have been limited by the lack of non‐invasive techniques to study brain activity. The advent of neuroimaging techniques has made it possible not only to study the structure and function of the brain, but also to characterize signaling system underlying brain function. This article gives a brief overview of relevant functional neuroanatomy, and of the most commonly used brain imaging techniques. It summarizes published functional brain imaging studies using acute visceral stimulation of the oesophagus, stomach and colon in healthy control subjects and patients with functional GI disorders, and briefly discusses pertinent findings from these studies. The article concludes with a critical assessment of published studies, and with recommendations for improved study paradigms and analysis strategies.

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“…Of the few studies that have reported these data, the relationships appear to be small or non-existent. Two studies, reported in abstract form, suggest that the correlation between pain symptoms and rectal and sigmoid sensitivity range between 0.3 and 0.4—that is, only between 9% and 16% of abdominal pain symptoms are explained by rectosigmoid sensitivity during experimental distension 42 43. Several more recent studies have also reported a significant positive relationship between a visceral sensitivity measure and abdominal pain symptoms 44 45.…”

Section: The Current Approach To Drug Developmentmentioning

confidence: 99%

Functional GI disorders: from animal models to drug development

Mayer¹,

Bradesi²,

Chang³

et al. 2008

Gut

146

136

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Despite considerable efforts by academic researchers and by the pharmaceutical industry, the development of novel pharmacological treatments for irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders has been slow and disappointing. The traditional approach to identifying and evaluating novel drugs for these symptom-based syndromes has relied on a fairly standard algorithm using animal models, experimental medicine models and clinical trials. In the current article, the empirical basis for this process is reviewed, focusing on the utility of the assessment of visceral hypersensitivity and GI transit, in both animals and humans, as well as the predictive validity of preclinical and clinical models of IBS for identifying successful treatments for IBS symptoms and IBS-related quality of life impairment. A review of published evidence suggests that abdominal pain, defecation-related symptoms (urgency, straining) and psychological factors all contribute to overall symptom severity and to health-related quality of life. Correlations between readouts obtained in preclinical and clinical models and respective symptoms are small, and the ability to predict drug effectiveness for specific as well as for global IBS symptoms is limited. One possible drug development algorithm is proposed which focuses on pharmacological imaging approaches in both preclinical and clinical models, with decreased emphasis on evaluating compounds in symptom-related animal models, and more rapid screening of promising candidate compounds in man.Despite the tremendous efforts by academia and industry alike during the past 15 years, the success rate for effective drug development for irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders (FGIDs) remains unimpressive. Only two new IBS treatments-that is, alosetron and tegaserod-have gained initial Food and Drug Administration (FDA) approval as a new IBS treatment so far. However, both of these medications are only available in the USA as part of a restricted access programme, due to side effects.1 Of the many failed compounds that never saw the light of the peer-reviewed literature, only a small number were officially announced as a failure, including the peripheral visceral k-opioid agonist fedotozine, the selective m 3 muscarinic receptor antagonist darifenacin and the selective NK 3 receptor antagonist talnetant. Despite this discouraging news, and despite the fact that several major companies have decided to leave the IBS field altogether, several new and promising compounds are in various stages of early clinical development. 3There have been advances in the field including development of agreed upon definitions of the major syndromes (as well as a myriad of other FGIDs), 4 animal models with some face and construct validity for the human syndrome 5 and identification of a continuously increasing number of molecular targets on epithelial and immune cells and visceral afferent neurons, 6 and in the central nervous system (CNS). ....

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Pain thresholds measured by the barrostat predict the severity of clinical pain in patients with irritable bowel syndrome

Cited by 10 publications

References 0 publications

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Brain imaging approaches to the study of functional GI disorders: A Rome Working Team Report

Functional GI disorders: from animal models to drug development

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