Recto‐colonic reflex is impaired in patients with irritable bowel syndrome

Veek, Patrick P. J. van der; Steenvoorden, M.M.C.; Steens, Jeroen; Schaar, Peter; Brussee, Jessica; Masclee, Ad

doi:10.1111/j.1365-2982.2007.00921.x

Cited by 25 publications

(16 citation statements)

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“…This was consistent with early studies of the rectosigmoid reflex by Connell et al (6), which showed an increase in motor activity in some SCI patients and healthy subjects. Using a variety of different protocols and techniques, others have shown a more definite reflex (14,28). The origin of this variability remains unclear, and the ideal distension-and-recording protocol for this reflex is yet to be established.…”

Section: Discussionmentioning

confidence: 99%

Colorectal responses to distension and feeding in patients with spinal cord injury

Suttor

Ng²,

Rutkowski³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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Suttor VP, Ng C, Rutkowski S, Hansen RD, Kellow JE, Malcolm A. Colorectal responses to distension and feeding in patients with spinal cord injury. Am J Physiol Gastrointest Liver Physiol 296: G1344 -G1349, 2009. First published April 9, 2009 doi:10.1152/ajpgi.90408.2008.-The role of the central nervous system in enteroenteric motor reflexes remains controversial. Our aims were as follows: 1) to evaluate colorectal, rectocolic, gastrocolonic, and gastrorectal reflex responses in patients with cervical spinal cord injury (SCI) and 2) to compare these responses with those in healthy subjects. In six patients with SCI (5 male, 42 Ϯ 4 yr) and six healthy control subjects (5 male, 36 Ϯ 5 yr), 2-min phasic distensions were performed randomly via dual-barostat balloons in the colon and rectum. Continuous colonic and rectal balloon volumes were recorded during distensions and after a 1,000-kcal liquid meal. Mean balloon volumes were recorded before, during, and after phasic distensions and over 60 min postprandially. The colorectal response was similar in control subjects and SCI patients (rectal volume reduction ϭ 28 Ϯ 11% and 15 Ϯ 5% in SCI patients and healthy subjects, respectively); the rectocolic response was variable. The gastrocolonic response was present in all subjects (colonic volume reduction ϭ 49 Ϯ 4% and 44 Ϯ 3% in SCI patients and healthy subjects, respectively), with a time effect in the first 30 min (P Ͻ 0.0001) and a group effect in the second 30 min (P Ͻ 0.004). The gastrorectal response was present in four SCI patients and five healthy subjects (rectal volume reduction ϭ 38 Ϯ 4% and 41 Ϯ 3% in SCI patients and healthy subjects, respectively), with a time effect in the first 30 min (P Ͻ 0.0001) but no group effect in the second 30 min. Intact neural transmission between the spinal cord and higher centers is not essential for normal colorectal motor responses to feeding and distension; however, a degree of central nervous system and neurohormonal modulation of these responses is likely. gastrocolonic; gastrorectal; rectocolic; colon; spinal injury THE STUDY OF REFLEX MOTOR activity within the gut has received increasing attention in recent years. In reference to the colorectum, previous studies demonstrated that distension of the descending colon can be associated with an increase in rectal tone, a phenomenon termed the "colorectal" reflex (14,20). In addition, rectal distension provokes an opposite effect, with a reduction in colonic tone and phasic motor activity, a phenomenon termed the "rectocolic" reflex. In healthy subjects, Law et al. (14) found that the rectocolic response was clear and reproducible but the colorectal response was more subtle; conversely, studies from our unit demonstrated a clear and definitive colorectal response and a more variable rectocolic response (20).The neural pathways involved in these reflexes in humans, particularly the roles of intrinsic vs. extrinsic pathways and the role of the spinal cord, remain unclear. Patients with complete spinal cord injury (SCI) provid...

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Section: Discussionmentioning

confidence: 99%

Colorectal responses to distension and feeding in patients with spinal cord injury

Suttor

Ng²,

Rutkowski³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…MDP has been used in a large number of studies to correct for differences in intra-abdominal pressure between subjects [4, 5, 10, 13, 14, 19, 20]. The variation that exists between the methods to determine MDP hampers the comparison between various studies.…”

Section: Discussionmentioning

confidence: 99%

Alternative procedure to shorten rectal barostat procedure for the assessment of rectal compliance and visceral perception: a feasibility study

et al. 2012

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BackgroundBarostat methodology is widely used for assessing visceral perception. Different barostat protocols are described with respect to the measurement of rectal compliance and visceral perception. The choice of protocols affects the duration, which is normally 60–90 min, and accuracy of the procedure. This study aimed to shorten the procedure by using the semi-random distension protocol for both compliance and visceral perception measurement and a correction based on rectal capacity (RC) instead of minimal distension pressure (MDP).MethodsTwelve irritable bowel syndrome (IBS) patients (7 females) and 11 healthy controls (8 females) underwent a barostat procedure. Compliance was determined during both a staircase distension and a semi-random protocol. Visceral perception data were compared as a function of pressure or relative volume, corrected for MDP or RC, respectively.ResultsCompliance measurement using the semi-random protocol instead of the staircase distension protocol resulted in an overestimation in healthy volunteers, but not in IBS patients. The overall conclusion that IBS patients had a lower compliance compared to controls was not different between protocols. Data presentation of the visceral perception scores as a function of corrected volume instead of pressures corrected for MDP did not alter the conclusion that sensation scores in IBS patients were higher as compared to healthy controls.ConclusionsThis study showed that barostat procedures may be shortened by approximately 20 min, without losing the ability to discriminate between healthy controls and IBS patients. A correction for RC instead of MDP may improve the accuracy of the procedure.Electronic supplementary materialThe online version of this article (doi:10.1007/s00535-012-0543-x) contains supplementary material, which is available to authorized users.

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“…Since this response is preserved even after a gastrectomy, the term "colonic motor response to eating" is preferable to "gastrocolonic reflex." 458 This reflex may contribute to the postprandial urge to defecate and to postprandial abdominal discomfort in IBS. A biphasic response with early (first 60 minutes) and late (120 and 150 minutes) components have also been described.…”

Section: Colonic Contractile Response To a Mealmentioning

confidence: 99%