Steens J, Van Der Schaar P J, Penning C, Brussee J, Masclee A A M
Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Neurogastroenterol Motil. 2002 Jun;14(3):241-7. doi: 10.1046/j.1365-2982.2002.00332.x.
Irritable bowel syndrome (IBS) consists of various subtypes. It is not known whether these subtypes share a common pathophysiology. Evaluation of motor and sensory function of the rectum using a barostat may help to explore a common pathophysiological background or differences in pathophysiology in subtypes of IBS. We have evaluated compliance, tone and sensitivity of the rectum, in both fasting state and postprandially, using a computerized barostat in 15 patients with diarrhoea-predominant IBS (IBS-D), 14 patients with constipation-predominant IBS (IBS-C) and compared the results with those obtained in 12 healthy controls. Rectal compliance as calculated over the steep part of the pressure-volume curve (17-23 mmHg) was decreased in both IBS groups (IBS-D 8.0 +/- 1.4 mL mmHg-1; IBS-C 5.6 +/- 1.1 mL mmHg-1) compared with controls (24.7 +/- 3.5 mL mmHg-1). The perception of urge was increased only in IBS-D patients, whereas pain perception was significantly increased in both IBS groups. Spontaneous adaptive relaxation was decreased in IBS-D patients. Postprandially, rectal volume decreased significantly in the controls and in IBS-D patients, but not in IBS-C patients. In conclusion, both rectal motor and sensory characteristics are different between IBS-D and IBS-C patients. Therefore, testing of rectal visceroperception, adaptive relaxation and the rectal response to a meal may help distinguish groups of patients with different subtypes of irritable bowel syndrome.
肠易激综合征（IBS）由多种亚型组成。目前尚不清楚这些亚型是否具有共同的病理生理学机制。使用压力测定仪评估直肠的运动和感觉功能可能有助于探索IBS亚型的共同病理生理背景或病理生理学差异。我们使用计算机化压力测定仪，在空腹状态和餐后状态下，对15例腹泻型IBS（IBS-D）患者、14例便秘型IBS（IBS-C）患者的直肠顺应性、张力和敏感性进行了评估，并将结果与12名健康对照者的结果进行了比较。与对照组（24.7±3.5 mL mmHg-1）相比，两个IBS组（IBS-D 8.0±1.4 mL mmHg-1；IBS-C 5.6±1.1 mL mmHg-1）在压力-容积曲线陡峭部分（17-23 mmHg）计算出的直肠顺应性均降低。仅IBS-D患者的便意感知增加，而两个IBS组的疼痛感知均显著增加。IBS-D患者的自发适应性松弛降低。餐后，对照组和IBS-D患者的直肠容积显著减小，但IBS-C患者没有。总之，IBS-D和IBS-C患者的直肠运动和感觉特征均不同。因此，测试直肠内脏感觉、适应性松弛和直肠对进餐的反应可能有助于区分不同亚型肠易激综合征的患者群体。
