Brock C, Nissen T D, Gravesen F H, Frøkjaer J B, Omar H, Gale J, Gregersen H, Svendsen O, Drewes A M
Center for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Aalborg, Denmark.
Neurogastroenterol Motil. 2008 Aug;20(8):908-18. doi: 10.1111/j.1365-2982.2008.01126.x. Epub 2008 May 9.
Evaluation of rectal and rectosigmoid sensation is important in basic, clinical and pharmacological studies. New methods to evoke and assess multimodal (electrical, thermal and mechanical) experimental pain of the upper gut activate distinct pathways and mimics clinical pain. The aims of the current study were to characterize the sensory response and reproducibility to multimodal stimulation of rectum and the rectosigmoid. A multimodal rectal probe was developed. Mucosal electrostimulation was delivered at the recto-sigmoid junction. In Rectum, impedance planimetry was used for measurement of cross-sectional area (CSA) during distension. Circulation of water within the bag at either 4 or 60 degrees C was applied for thermal stimulation. The method was tested in 12 healthy volunteers (six men mean age 32 years) on two subsequent days. Mechanical and sensory responses and referred pain areas were assessed. Stimulation with electrical, thermal and mechanical modalities resulted in different sensory perceptions. The relationship between stimulus intensity and sensory response was linear for all modalities. Sensory response to different modalities did not differ between investigation days (all P-values > 0.1). Approximately 75% of subjects felt referred pain in distinct skin locations. Between-days reproducibility was good for all modalities [intra-class correlation (ICC) > or = 0.6]. At sensory threshold, CSA showed best reproducibility (ICC > or = 0.9). At pain detection threshold stretch ratio, CSA and electrostimulation showed best reproducibility (ICC = 1.0; 0.9; 0.9). The present model was easily implemented, robust and showed good reproducibility. It can be used to study pathophysiology or pharmacological interventions in healthy controls and in patients with diseases involving the distal hindgut.
在基础、临床和药理学研究中，评估直肠和直肠乙状结肠的感觉非常重要。诱发和评估上消化道多模式（电、热和机械）实验性疼痛的新方法可激活不同的通路并模拟临床疼痛。本研究的目的是描述直肠和直肠乙状结肠多模式刺激的感觉反应和可重复性。开发了一种多模式直肠探头。在直肠乙状结肠交界处进行黏膜电刺激。在直肠中，使用阻抗平面测量法在扩张过程中测量横截面积（CSA）。通过在4℃或60℃的袋内循环水进行热刺激。该方法在12名健康志愿者（6名男性，平均年龄32岁）身上进行了连续两天的测试。评估了机械和感觉反应以及牵涉痛区域。电、热和机械模式的刺激导致了不同的感觉。所有模式下刺激强度与感觉反应之间的关系均为线性。不同模式下的感觉反应在不同研究日之间没有差异（所有P值>0.1）。约75%的受试者在不同的皮肤部位感到牵涉痛。所有模式的日间可重复性良好[组内相关系数（ICC）≥0.6]。在感觉阈值时，CSA显示出最佳的可重复性（ICC≥0.9）。在疼痛检测阈值拉伸率时，CSA和电刺激显示出最佳的可重复性（ICC = 1.0；0.9；0.9）。本模型易于实施、稳健且显示出良好的可重复性。它可用于研究健康对照者以及涉及后肠远端疾病患者的病理生理学或药理学干预。
