Camilleri Michael, McKinzie Sanna, Busciglio Irene, Low Phillip A, Sweetser Seth, Burton Duane, Baxter Kari, Ryks Michael, Zinsmeister Alan R
Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Clin Gastroenterol Hepatol. 2008 Jul;6(7):772-81. doi: 10.1016/j.cgh.2008.02.060. Epub 2008 May 5.
BACKGROUND & AIMS: The aim of this study was to assess pathophysiology in irritable bowel syndrome (IBS).
A total of 122 IBS patients (3 male) and 41 healthy females underwent the following: questionnaires (symptoms, psychology), autonomic function, gut transit, gastric volumes, satiation, rectal compliance, and sensation (thresholds and pain ratings) testing. Proportions of patients with abnormal (<10th and >90th percentiles) motor or sensory functions according to bowel symptoms (constipation [C], diarrhea [D], mixed [M),) pain/bloat, and number of primary symptoms were estimated.
IBS subgroups (C, D, M) were similar in age, gastric and small-bowel transit, satiation, gastric volumes, rectal compliance, sensory thresholds, and pain ratings. IBS was associated with body mass index, somatic symptoms, and anxiety and depression scores. Significant associations were observed with colonic transit (IBS-C [P = .078] and IBS-D [P < .05] at 24 h; IBS-D [P < .01] and IBS-M [P = .056] at 48 h): 32% of IBS patients had abnormal colonic transit: 20.5% at 24 hours and 11.5% at 48 hours. Overall, 20.5% of IBS patients had increased sensation to distensions: hypersensitivity (<10th percentile thresholds) in 7.6%, and hyperalgesia (pain sensation ratings to distension >90th percentile for ratings in health) in 13%. Conversely, 16.5% of IBS patients had reduced rectal sensation. Pain greater than 6 times per year and bloating were not associated significantly with motor, satiation, or sensory functions. Endorsing 1 to 2 or 3 to 4 primary IBS symptoms were associated with abnormal transit and sensation in IBS.
In tertiary referral (predominantly female) patients with IBS, colonic transit (32%) is the most prevalent physiologic abnormality; 21% had increased and 17% had decreased rectal pain sensations. Comprehensive physiologic assessment may help optimize management in IBS.
本研究旨在评估肠易激综合征（IBS）的病理生理学。
共计122例IBS患者（3例男性）和41例健康女性接受了以下检查：问卷调查（症状、心理状况）、自主神经功能、肠道转运、胃容量、饱腹感、直肠顺应性以及感觉（阈值和疼痛评分）测试。根据肠道症状（便秘[C]、腹泻[D]、混合型[M]）、疼痛/腹胀以及主要症状数量，估算运动或感觉功能异常（<第10百分位数和>第90百分位数）的患者比例。
IBS亚组（C、D、M）在年龄、胃和小肠转运、饱腹感、胃容量、直肠顺应性、感觉阈值以及疼痛评分方面相似。IBS与体重指数、躯体症状以及焦虑和抑郁评分相关。观察到与结肠转运存在显著关联（24小时时IBS-C[P = 0.078]和IBS-D[P < 0.05]；48小时时IBS-D[P < 0.01]和IBS-M[P = 0.056]）：32%的IBS患者存在结肠转运异常，24小时时为20.5%，48小时时为11.5%。总体而言，20.5%的IBS患者对扩张的感觉增强：7.6%为感觉过敏（阈值<第10百分位数），13%为痛觉过敏（对扩张的疼痛感觉评分>健康人群评分的第90百分位数）。相反，16.5%的IBS患者直肠感觉减退。每年疼痛超过6次以及腹胀与运动、饱腹感或感觉功能无显著关联。认可1至2种或3至4种主要IBS症状与IBS患者的转运和感觉异常相关。
在三级转诊（主要为女性）的IBS患者中，结肠转运异常（32%）是最常见的生理异常；21%的患者直肠疼痛感觉增强，17%的患者直肠疼痛感觉减退。全面的生理评估可能有助于优化IBS的管理。
