Sensibility of the rectum to distension and the anorectal distension reflex in ulcerative colitis.

Farthing, M J G; Lennard-Jones, J E

doi:10.1136/gut.19.1.64

Cited by 236 publications

(113 citation statements)

References 6 publications

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“…Rectal sensation was tested by inflating a latex balloon with air at 1 ml/s and determining the threshold volumes for first constant sensation, defecatory desire volume (DDV), and maximum tolerable volume (MTV). 46 Patients were considered to have RH if MTV was ,100 ml in females or ,80 ml in males (determined in 56 healthy control subjects). Pudendal nerve terminal motor latencies (PNTML) were recorded with the St Mark's pudendal stimulating electrode (Dantec Electronics Ltd, Bristol, UK).…”

Section: Standard Techniquesmentioning

confidence: 99%

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

Chan

2005

Gut

100

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Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n = 27) and those with normal rectal sensation (n = 25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence-namely, those with rectal hypersensitivity-who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.

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Section: Standard Techniquesmentioning

confidence: 99%

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

Chan

2005

Gut

100

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“…Several disturbances of gut function have been demonstrated in IBD, such as changes in sensory perception (Farthing & Lennard-Jones, 1978;Rao et al, 1987) and changes in gut motility (Snape et al, 1980;Loening-Baucke et al, 1989;Koch et al, 1990;Annese et al, 1997;Chrysos et al, 2001). These ®ndings re¯ect both in¯ammation-induced changes in the responsiveness of the smooth muscle and nerves.…”

Section: Introductionmentioning

confidence: 99%

Generalized loss of inhibitory innervation reverses serotonergic inhibition into excitation in a rabbit model of TNBS‐colitis

Depoortere¹,

Thijs²,

Peeters³

2002

British J Pharmacology

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1 In¯ammation may a ect subpopulations of neurons of the myenteric plexus. 2 In the present study the e ect of trinitrobenzene sulphonic acid (TNBS) induced colitis on nitrergic, purinergic and adrenergic inhibitory neurotransmission was studied as well as the consequences of the related changes on the response of 5-HT agonists using these neurotransmitters to mediate their e ect. 3 Strips from normal and colitis rabbits (135 mg kg 71 TNBS) were subjected to electrical ®eld stimulation (EFS, 0.3 ms, 6V, 0.5 ± 32 Hz, 10 s train). The response was measured isometrically in the absence or presence of L-NAME, suramin, guanethidine, the 5-HT agonists (5-HT 1/5A/7 : 5-carboxamidotryptamine (5-CT), 5-HT 2 : a-methyl-5-HT, 5-HT 3 : 2-methyl-5-HT, 5-HT 4 : 5-methoxytryptamine (5-MeOT)) or a combination. 4 In normal strips L-NAME (1 ± 32 Hz), suramin (0.5 ± 2, 8 Hz) and guanethidine (4, 16, 32 Hz) increased the response to EFS. This e ect was abolished in in¯amed strips and was accompanied by a decrease in nNOS expression. 5 In normal strips all 5-HT agonists induced pronounced (5-CT, a-methyl-5-HT) or small (2-methyl-5-HT, 5-MeOT) inhibitory neural responses. In in¯amed strips this was reversed to cholinergic excitatory responses.6 The e ect of in¯ammation on the 5-HT 4 response was mimicked by preincubation of normal strips with L-NAME or suramin. Accordingly, in in¯amed strips L-NAME or suramin did not a ect the excitatory e ects of 5-MeOT. 7 TNBS-colitis abolishes nitrergic, purinergic and adrenergic neurotransmission. This reverses serotonergic inhibition into excitation.

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“…In a number of patient groups, diarrhea is associated with increased rectal tone, [18][19][20][21] and we hypothesized that the same was true for patients with the carcinoid syndrome. The effect of 5-HT on rectal compliance remains obscure and needs further study.…”

Section: Discussionmentioning

confidence: 99%

“…Our hypotheses were based on the clinical presentation of patients with carcinoid diarrhea and on previous data from patients with diarrhea caused by ulcerative colitis, irritable bowel syndrome, or sequelae of radiation therapy. [18][19][20]31 Excessive production of 5-HT escaping hepatic first-pass metabolism is considered the main reason for the carcinoid syndrome. 5 As seen in most patients included in the present study, very high levels of 5-HT can be reached in the systemic circulation of patients with NET.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] However, it is well known from other patient groups that frequent bowel movements may be associated with rectal hypersensitivity and increased rectal tone. [18][19][20][21] The effects of excessive amounts of 5-HT on rectal mechano-sensory function are incompletely understood and unpredictable. Rectal stimulation with heat and mechanical distension is a novel method which allows detailed examination of rectal mechano-sensory function.…”

Section: Introductionmentioning

confidence: 99%

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Rectal Mechano-sensory Function in Patients with Carcinoid Diarrhea

Gregersen

Brock

Haase

et al. 2016

J Neurogastroenterol Motil

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Background/AimsIn patients with neuroendocrine tumors, excessive production of serotonin and other amines may cause the carcinoid syndrome, which is mainly characterized by diarrhea and flushing. Little is known about the pathophysiology of carcinoid diarrhea. In several other groups of patients, diarrhea may be associated with rectal hypersensitivity and increased rectal tone. Therefore, the aim of the present study was to compare rectal sensitivity and compliance in patients with carcinoid diarrhea and in healthy subjects. MethodsTwelve patients (6 males, aged 54-78 years, median 65 years), with carcinoid diarrhea and 19 healthy subjects (7 males, aged 50-78 years, median 61 years) were included. Rectal mechanical and heat stimulation was used for assessment of rectal mechano-sensory properties. ResultsOverall, 5.3% higher temperatures were needed to elicit sensory responses in patients with carcinoid diarrhea than in healthy subjects (P = 0.015). Posthoc analyses revealed that the sensory threshold to heat was 48.1 ± 3.1 o C in patients vs 44.7 ± 4.7 o C in healthy subjects (P = 0.041). In contrast, patients and healthy subjects showed no overall differences in rectal sensory response to mechanical distension (P = 0.731) or rectal compliance (P = 0.990). ConclusionsPatients with carcinoid diarrhea have higher sensory thresholds to heat stimulation in comparison to healthy subjects, but normal rectal sensation to mechanical distension and normal compliance. Therefore, treatment of carcinoid diarrhea should aim at prolonging gastrointestinal transit and decreasing secretion, rather than modifying rectal mechano-sensory function.

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Sensibility of the rectum to distension and the anorectal distension reflex in ulcerative colitis.

Cited by 236 publications

References 6 publications

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

Generalized loss of inhibitory innervation reverses serotonergic inhibition into excitation in a rabbit model of TNBS‐colitis

Rectal Mechano-sensory Function in Patients with Carcinoid Diarrhea

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