Lipid-induced intestinal gas retention in irritable bowel syndrome.
OBJECTIVE
We hypothesized that lipids, which induce various motor and sensory effects on the gut, modulate intestinal gas dynamics and that alteration of this regulatory mechanism may result in impaired gas transit in patients with irritable bowel syndrome (IBS).


METHODS
In 45 healthy subjects and 30 patients with IBS, evacuation of gas infused into the jejunum (at 12 mL/min) was measured for 2 hours. The effect of simultaneous duodenal perfusion of lipids at 0 kcal/min (saline), 0.5 kcal/min, and 1 kcal/min was tested in groups of 15 subjects each.


RESULTS
In healthy subjects, duodenal lipids at 1 kcal/min but not at 0 kcal/min or 0.5 kcal/min produced significant gas retention (281 +/- 53 mL vs. 22 +/- 64 mL at 0 kcal/min and -65 +/- 72 mL at 0.5 kcal/min; P < 0.05 for both). Patients with IBS exhibited gas retention during saline perfusion (259 +/- 85 mL at 0 kcal/min; P < 0.05 vs. healthy subjects) and were hypersensitive to duodenal lipids (505 +/- 61 mL retention at 0.5 kcal/min; P < 0.05 vs. saline and vs. healthy subjects). The "gas plus lipids" challenge test discriminated patients with 100% sensitivity and 93% specificity.


CONCLUSIONS
Physiologic concentrations of intestinal lipids exert an inhibitory control on intestinal gas transit, and this mechanism is up-regulated in patients with IBS. Hence, impaired gas propulsion, shown by the gas challenge test, may be useful as a diagnostic test if replicated in a larger series of patients.
Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Jordi
J
Serra
Beatrice
B
Salvioli
Fernando
F
Azpiroz
Juan-R
JR
Malagelada
D000328:Adult; D003109:Colonic Diseases, Functional / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004386:Duodenum; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D005740:Gases / Q000378:metabolism*; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D007583:Jejunum / Q000378:metabolism*; D008875:Middle Aged; D010477:Perfusion; D012016:Reference Values; D016037:Single-Blind Method
D005217:Fat Emulsions, Intravenous; D005740:Gases