Colonic responses to gas loads in subgroups of patients with abdominal bloating.
OBJECTIVE
We sought to evaluate colonic gas accommodation, ileocecal competence, and colonic clearance in subgroups patients with abdominal bloating.


METHODS
Thirty-six patients complaining of abdominal bloating (12 constipation-predominant irritable bowel syndrome (IBS-C), 12 diarrhea-predominant irritable bowel syndrome (IBS-D), and 12 functional bloating) and 18 healthy controls were studied. Abdominal perception and girth were measured during: (i) 1 h continuous infusion of gas at 24 ml/min into the rectum (accommodation period) and (ii) 30 min free rectal gas evacuation (clearance period). In eight patients and eight healthy subjects, the gas infused was labeled with radioactive xenon (74 MBq (133)Xe), and gas distribution was determined by scintigraphy.


RESULTS
Colonic gas accommodation produced significantly more abdominal symptoms and distension in patients than in healthy subjects (3.8+/-0.2 vs. 2.4+/-0.3 perception score; P<0.001; 10.9+/-0.6 vs. 8.3+/-0.5 mm girth increment; P=0.009). Scintigraphy showed no differences in colonic gas distribution and no ileal gas reflux, but patients exhibited impaired gas clearance from the proximal colon (63%+/-10% clearance in 30 min vs. 80%+/-2% in health; P=0.042), resulting in more residual gas (506+/-46 vs. 174+/-47 ml; P<0.001), perception (1.9+/-0.2 vs. 1.0+/-0.2 score; P=0.015), and girth increment (4.2+/-0.7 vs. 2.2+/-0.5 mm; P=0.024); IBS-C patients exhibited increased sensation and objective distension, as opposed to sensation only in IBS-D and distension only in functional bloating.


CONCLUSIONS
Patients with abdominal bloating have normal colonic accommodation and ileocecal competence but impaired gas clearance from the proximal colon after retrograde infusion, and the consequences of this dysfunction are related to bowel habit.
Hernando-Harder
Ana C
AC
Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
Serra
Jordi
J
Azpiroz
Fernando
F
Milà
Marta
M
Aguadé
Santiago
S
Malagelada
Carolina
C
Tremolaterra
Fabrizio
F
Villoria
Albert
A
Malagelada
Juan-R
JR
D000005:Abdomen / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003106:Colon / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005414:Flatulence / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005772:Gastrointestinal Transit; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010465:Perception; D011877:Radionuclide Imaging; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014980:Xenon Radioisotopes
D014980:Xenon Radioisotopes