BACKGROUND/AIMS: The pathways underlying rectal hypersensitivity to balloon distention in patients with irritable bowel syndrome (IBS) are not known. The aim of this study was to characterize the involvement of sacral and thoracolumbar afferents in the perception of rectal distention. METHODS: Rectal balloon distention was performed in 15 normal control subjects, 6 patients with spinal cord injury, and 50 patients with IBS using a slow-volume ramp (40 mL/min) or rapid phasic step distension. Additional studies were performed in the presence of 2% intrarectal lidocaine. RESULTS: Patients with spinal cord injury with lesions below T7 reported sensations only during phasic distention. Sixty percent of patients with IBS (n = 50) were hypersensitive for discomfort during phasic distention, whereas only 4% were hypersensitive during ramp distention. Less than 15% of patients were hypersensitive for the sensation of stool. In normal patients, lidocaine increased thresholds in response to slow ramp distention by 40%-70% but had no effect on perception in response to other types of distention. Lidocaine had no effect on (1) thresholds in response to either ramp or phasic distention in normosensitive or hypersensitive patients with IBS or (2) the rate of receptive relaxation or rectal compliance in any group. CONCLUSIONS: Rapid phasic distention preferentially stimulates splanchnic afferents. Hypersensitivity of these afferents in patients with IBS is unaffected by mucosally applied lidocaine.
BACKGROUND/AIMS: The pathways underlying rectal hypersensitivity to balloon distention in patients with irritable bowel syndrome (IBS) are not known. The aim of this study was to characterize the involvement of sacral and thoracolumbar afferents in the perception of rectal distention. METHODS: Rectal balloon distention was performed in 15 normal control subjects, 6 patients with spinal cord injury, and 50 patients with IBS using a slow-volume ramp (40 mL/min) or rapid phasic step distension. Additional studies were performed in the presence of 2% intrarectal lidocaine. RESULTS:Patients with spinal cord injury with lesions below T7 reported sensations only during phasic distention. Sixty percent of patients with IBS (n = 50) were hypersensitive for discomfort during phasic distention, whereas only 4% were hypersensitive during ramp distention. Less than 15% of patients were hypersensitive for the sensation of stool. In normal patients, lidocaine increased thresholds in response to slow ramp distention by 40%-70% but had no effect on perception in response to other types of distention. Lidocaine had no effect on (1) thresholds in response to either ramp or phasic distention in normosensitive or hypersensitivepatients with IBS or (2) the rate of receptive relaxation or rectal compliance in any group. CONCLUSIONS: Rapid phasic distention preferentially stimulates splanchnic afferents. Hypersensitivity of these afferents in patients with IBS is unaffected by mucosally applied lidocaine.
Authors: Suwebatu T Odunsi; Michael Camilleri; Adil E Bharucha; Athanasios Papathanasopoulos; Irene Busciglio; Duane Burton; Alan R Zinsmeister Journal: Dig Dis Sci Date: 2009-03-17 Impact factor: 3.199
Authors: Michael Camilleri; Sanna McKinzie; Irene Busciglio; Phillip A Low; Seth Sweetser; Duane Burton; Kari Baxter; Michael Ryks; Alan R Zinsmeister Journal: Clin Gastroenterol Hepatol Date: 2008-05-05 Impact factor: 11.382
Authors: Olafur S Palsson; Olivier Morteau; Eugene M Bozymski; John T Woosley; R Balfour Sartor; Michael J Davies; David A Johnson; Marsha J Turner; William E Whitehead Journal: Dig Dis Sci Date: 2004-08 Impact factor: 3.199