Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Str, 31-121, Kraków, Poland.
Department of Gastroenterology and Hepatology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Sci Rep. 2023 Jun 9;13(1):9420. doi: 10.1038/s41598-023-36445-1.
Altered gut regulation, including motor and secretory mechanisms, is characteristic of irritable bowel syndrome (IBS). The severity of postprandial symptoms in IBS patients is associated with discomfort and pain; gas-related symptoms such as bloating and abdominal distension; and abnormal colonic motility. The aim of this study was to assess the postprandial response, i.e., gut peptide secretion and gastric myoelectric activity, in patients with constipation-predominant IBS. The study was conducted on 42 IBS patients (14 males, 28 females, mean age 45.1 ± 15.3 years) and 42 healthy participants (16 males, 26 females, mean age 41.1 ± 8.7 years). The study assessed plasma gut peptide levels (gastrin, CCK-Cholecystokinin, VIP-Vasoactive Intestinal Peptide, ghrelin, insulin) and gastric myoelectric activity obtained from electrogastrography (EGG) in the preprandial and postprandial period (meal-oral nutritional supplement 300 kcal/300 ml). Mean preprandial gastrin and insulin levels were significantly elevated in IBS patients compared to the control group (gastrin: 72.27 ± 26.89 vs. 12.27 ± 4.91 pg/ml; p < 0.00001 and insulin: 15.31 ± 12.92 vs. 8.04 ± 3.21 IU/ml; p = 0.0001), while VIP and ghrelin levels were decreased in IBS patients (VIP: 6.69 ± 4.68 vs. 27.26 ± 21.51 ng/ml; p = 0.0001 and ghrelin: 176.01 ± 88.47 vs. 250.24 ± 84.55 pg/ml; p < 0.0001). A nonsignificant change in the CCK level was observed. IBS patients showed significant changes in postprandial hormone levels compared to the preprandial state-specifically, there were increases in gastrin (p = 0.000), CCK (p < 0.0001), VIP (p < 0.0001), ghrelin (p = 0.000) and insulin (p < 0.0001). Patients with IBS showed reduced preprandial and postprandial normogastria (59.8 ± 22.0 vs. 66.3 ± 20.2%) compared to control values (83.19 ± 16.7%; p < 0.0001 vs. 86.1 ± 9.4%; p < 0.0001). In response to the meal, we did not observe an increase in the percentage of normogastria or the average percentage slow-wave coupling (APSWC) in IBS patients. The postprandial to preprandial power ratio (PR) indicates alterations in gastric contractions; in controls, PR = 2.7, whereas in IBS patients, PR = 1.7, which was significantly lower (p = 0.00009). This ratio reflects a decrease in gastric contractility. Disturbances in the postprandial concentration of gut peptides (gastrin, insulin and ghrelin) in plasma may contribute to abnormal gastric function and consequently intestinal motility, which are manifested in the intensification of clinical symptoms, such as visceral hypersensitivity or irregular bowel movements in IBS patients.
肠调节改变，包括运动和分泌机制，是肠易激综合征（IBS）的特征。IBS 患者餐后症状的严重程度与不适和疼痛有关；与气体相关的症状，如腹胀和腹部膨胀；以及异常的结肠蠕动。本研究旨在评估便秘型 IBS 患者的餐后反应，即肠道肽分泌和胃肌电活动。研究对象为 42 名 IBS 患者（男性 14 名，女性 28 名，平均年龄 45.1±15.3 岁）和 42 名健康参与者（男性 16 名，女性 26 名，平均年龄 41.1±8.7 岁）。研究评估了血浆胃肠肽水平（胃泌素、CCK-胆囊收缩素、VIP-血管活性肠肽、ghrelin、胰岛素）和胃电活动（EGG）在餐前和餐后（口服营养补充 300 卡路里/300 毫升）期间的变化。与对照组相比，IBS 患者的平均餐前胃泌素和胰岛素水平显著升高（胃泌素：72.27±26.89 与 12.27±4.91 pg/ml；p<0.00001 和胰岛素：15.31±12.92 与 8.04±3.21 IU/ml；p=0.0001），而 VIP 和 ghrelin 水平在 IBS 患者中降低（VIP：6.69±4.68 与 27.26±21.51 ng/ml；p=0.0001 和 ghrelin：176.01±88.47 与 250.24±84.55 pg/ml；p<0.0001）。CCK 水平无显著变化。与餐前状态相比，IBS 患者餐后激素水平发生显著变化——胃泌素（p=0.000）、CCK（p<0.0001）、VIP（p<0.0001）、ghrelin（p=0.000）和胰岛素（p<0.0001）增加。与对照组相比，IBS 患者餐前和餐后正常胃电活动（59.8±22.0 与 66.3±20.2%）减少（p<0.0001 与 83.19±16.7%；p<0.0001 与 86.1±9.4%）。对餐后反应，我们没有观察到 IBS 患者正常胃电活动的百分比或平均慢波耦合百分比（APSWC）增加。餐后与餐前功率比（PR）反映了胃收缩的变化；在对照组中，PR=2.7，而在 IBS 患者中，PR=1.7，显著降低（p=0.00009）。这一比值反映了胃收缩性的降低。血浆中肠肽（胃泌素、胰岛素和 ghrelin）餐后浓度的改变可能导致异常的胃功能，进而导致肠道蠕动，表现为临床症状的加剧，如内脏高敏感性或 IBS 患者的不规则肠蠕动。
