Azpiroz F
Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Can J Gastroenterol. 1999 Mar;13 Suppl A:12A-14A. doi: 10.1155/1999/963469.
Growing evidence suggests that symptoms in patients with irritable bowel syndrome (IBS) may be due to a visceral sensory dysfunction. Specifically, it has been shown that patients with IBS have hypersensitive responses to distension of the rectum, whereas their tolerance to somatic stimuli is normal or even increased. Furthermore, patients with IBS have hypersensitivity of the small bowel, which selectively affects mechanosensitive afferents, with normal perception of electrical stimulation of the gut. Sensory dysfunctions may also be associated with altered reflex activity, which may contribute to the clinical symptoms. Normally, a series of mechanisms at different strata of the nervous system modulate visceral afferent input and determine conscious perception. Conceivably, a dysfunction of these regulatory mechanisms may alter sensitivity in clinical conditions. To date, neither the origin nor the clinical significance of visceral hyperalgesia has been elucidated. However, it seems likely that the sensory and reflex dysfunctions of the gut in IBS may combine to different degrees, and their interaction may explain the clinical pleomorphism of the syndrome.
越来越多的证据表明，肠易激综合征（IBS）患者的症状可能归因于内脏感觉功能障碍。具体而言，已有研究表明，IBS患者对直肠扩张有超敏反应，而他们对躯体刺激的耐受性正常甚至增强。此外，IBS患者存在小肠超敏反应，这选择性地影响机械敏感传入神经，对肠道电刺激的感知正常。感觉功能障碍也可能与反射活动改变有关，这可能导致临床症状。正常情况下，神经系统不同层次的一系列机制调节内脏传入输入并决定意识感知。可以想象，这些调节机制的功能障碍可能会在临床情况下改变敏感性。迄今为止，内脏痛觉过敏的起源和临床意义均未阐明。然而，IBS患者肠道的感觉和反射功能障碍似乎可能在不同程度上相互结合，它们之间的相互作用可能解释了该综合征的临床多形性。
