Impaired intestinal gas propulsion in manometrically proven dysmotility and in irritable bowel syndrome.
BACKGROUND
Intestinal manometry is the current gold standard for diagnosing small bowel dysmotility; however, the functional significance of abnormal manometry is unknown. Our aim was to determine whether, and to what extent, intestinal gas propulsion is impaired in patients with manometrically proven dysmotility compared with healthy controls and patients with IBS.


METHODS
Clearance and tolerance of a jejunal gas load (12 mL min(-1) for 2 h) were measured in 15 patients with severe abdominal symptoms and intestinal dysmotility evidenced by manometry, 15 patients with IBS and 15 healthy subjects. Thereafter, the effect of neostigmine (0.5 mg i.v. bolus) vs placebo (i.v. saline) was tested in six dysmotility patients.


RESULTS
After 2-h gas infusion, patients with dysmotility developed significantly more gas retention (717 +/- 91 mL) than IBS patients (372 +/- 82 mL; P = 0.0037) and healthy subjects (17 +/- 67 mL; P < 0.0001 vs dysmotility; P = 0.0060 vs IBS). Despite the greater retention in dysmotility patients, abdominal perception (2.5 +/- 0.6 score) and distension (7 +/- 2 mm girth increment) were similar to IBS (3.9 +/- 0.6 score and 7 +/- 2 mm, respectively). In dysmotility patients, neostigmine produced immediate clearance of gas, and by 30 min had reduced gas retention (by -552 +/- 182 vs 72 +/- 58 mL after saline; P = 0.008), abdominal symptoms (by -0.8 +/- 0.3 score vs 0.3 +/- 0.2 after saline; P = 0.019) and distension (girth change -5 +/- 1 mm; P = 0.003 vs-2 +/- 2 mm after saline).


CONCLUSIONS
Patients with manometric dysmotility have markedly impaired intestinal gas propulsion. In IBS patients, impaired gas propulsion is less pronounced but associated with concomitant sensory dysfunction and poor tolerance of gas retention.
Serra
J
J
University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Villoria
A
A
Azpiroz
F
F
Lobo
B
B
Santos
J
J
Accarino
A
A
Malagelada
J-R
JR
D000328:Adult; D000368:Aged; D005260:Female; D005414:Flatulence / Q000188:drug therapy / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology*; D007583:Jejunum / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage; D012372:ROC Curve; D011795:Surveys and Questionnaires
D009388:Neostigmine