Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors.
OBJECTIVE
Duodenal lipid infusion increases colonic hypersensitivity in irritable bowel syndrome (IBS). Whether this is affected by bowel habit, psychologic factors, or sex is unknown.


METHODS
We included 61 patients with IBS (50 women, 11 men), 25 with diarrhea-predominant IBS, 17 with constipation-predominant IBS, 19 with alternating-type IBS, and 20 healthy controls (15 women, 5 men). A colonic distension trial was performed with a barostat before and after a 1-hour duodenal lipid infusion (3 kcal/min). Colonic thresholds, colonic tone, and the viscerosomatic referral pattern were assessed and compared between groups. Patients also completed the Hospital Anxiety and Depression scale.


RESULTS
The reduction in colonic pressure thresholds after vs before duodenal lipids was greater in patients than in controls for discomfort (P = .006) and pain (P < .0001). An increased viscerosomatic referral area for pain and discomfort during colonic distensions after vs before duodenal lipids was observed in patients but not in controls. The response was similar in IBS subgroups based on the predominant bowel habit, in patients with vs without anxiety and/or depression, and in women and men with IBS. The colonic tone response during lipid infusion was similar in IBS patients and controls, and in the different IBS subgroups.


CONCLUSIONS
IBS patients show increased colonic sensitivity and altered viscerosomatic referral pattern after duodenal lipids. This response is largely unaffected by the predominant bowel habit, psychologic factors, or sex, but seems to be related to IBS per se.
Simrén
Magnus
M
Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. magnus.simren@medicine.gu.se
Abrahamsson
Hasse
H
Björnsson
Einar S
ES
D000328:Adult; D000368:Aged; D003672:Defecation; D004041:Dietary Fats / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D043183:Irritable Bowel Syndrome / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D008055:Lipids / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors
D004041:Dietary Fats; D008055:Lipids