Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome.
BACKGROUND
Visceral hypersensitivity is considered an important pathophysiological mechanism in irritable bowel syndrome, yet its relationship to symptoms is unclear.


OBJECTIVE
To detect possible associations between symptoms and the presence of hypersensitivity to rectal distension in patients with irritable bowel syndrome.


METHODS
Ninety-two irritable bowel syndrome patients and 17 healthy volunteers underwent a rectal barostat study. The association between specific irritable bowel syndrome symptoms and the presence of hypersensitivity was examined using Area under the Receiver Operating Characteristic curves.


RESULTS
Irritable bowel syndrome patients had significantly lower thresholds for discomfort/pain than healthy volunteers: 24 (18-30) and 30 (27-45) mmHg above minimal distending pressure, respectively. Forty-one patients (45%) showed hypersensitivity to rectal distension. Proportions of patients with different predominant bowel habits were similar in hypersensitive and normosensitive subgroups (diarrhoea predominant: 39 and 41%, respectively; alternating type: 27 and 28%, respectively; constipation predominant: 34 and 31%, respectively). Severe abdominal pain was more frequent in hypersensitive, compared with normosensitive patients (88% vs. 67%, P = 0.02), but none of the individual irritable bowel syndrome symptoms could accurately predict the presence of hypersensitivity, as assessed by Area under the Receiver Operating Characteristic curve analysis.


CONCLUSIONS
Hypersensitive and normosensitive irritable bowel syndrome patients present with comparable, heterogeneous symptomatology. Therefore, selection based on clinical parameters is unlikely to discriminate individual irritable bowel syndrome patients with visceral hypersensitivity from those with normal visceral sensitivity.
Kuiken
S D
SD
Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
Lindeboom
R
R
Tytgat
G N
GN
Boeckxstaens
G E
GE
D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D003106:Colon / Q000503:physiopathology*; D004106:Dilatation; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology*; D011312:Pressure; D012372:ROC Curve