Kazci Omer, Ege Fahrettin, Aydemir Huseyin, Kazci Saliha, Aydin Sonay
Department of Radiology, Ankara Training and Research Hospital, Ankara 06600, Turkey.
Department of Neurology, VM Medicalpark Hospital, Ankara 06600, Turkey.
World J Radiol. 2023 Jul 28;15(7):226-233. doi: 10.4329/wjr.v15.i7.226.
Irritable bowel syndrome (IBS) is one of the most frequently referred conditions to the gastrointestinal outpatient clinic. The pathophysiology of IBS has not been determined with certainty. Visceral hypersensitivity is indicated as one of the pathophysiologies. The sympathetic nervous system is primarily in charge of controlling the arteries, and its effect is vasospasm in the medium and large arteries, resulting in decreased blood flow.
To demonstrate, using Doppler evaluation of the brachial artery, that sympathetic activity impairs vasomotor performance due to autonomic neuropathy, which we believe is associated with IBS.
There were 58 participants in the study. The control group consisted of 29 healthy patients, while the remaining 29 patients had been diagnosed with IBS. Patients who met the Rome IV criteria and had IBS were included in the study. People with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial, as were those with essential hypertension, diabetes mellitus, cardiovascular disease, or peripheral arterial disease, and patients diagnosed with anxiety or depression. Those with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial. A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa. The Doppler probe remained stationary throughout the experiment, allowing for continuous measurements. Then, to activate the sympathetic fibers, an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level the bipolar stimulus electrode. The artery diameter and flow rates were measured again immediately following the fifth stimulus.
In healthy persons with no history of chronic illness, there was a statistically significant decrease in flow rate after stimulation ( < 0.001). In addition, stimulation resulted in a statistically significant reduction in the diameter of the brachial artery ( < 0.001). Patients diagnosed with IBS had statistically significant vasodilation and an increase in flow rate.
Sympathetic stimulation causes a reduction in vascular diameter and blood flow, whereas it has the reverse effect on IBS patients. In investigating the involvement of autonomic neuropathy in the development of IBS, significant changes in brachial artery Doppler parameters were observed before and after stimulation of the median nerve with low-current sensory stimulation. This method is thought to be more user-friendly and comfortable than other methods described in the literature.
肠易激综合征（IBS）是胃肠门诊最常被转诊的病症之一。IBS的病理生理学尚未完全确定。内脏高敏感性被认为是其病理生理学之一。交感神经系统主要负责控制动脉，其作用是使中、大动脉发生血管痉挛，导致血流减少。
通过对肱动脉进行多普勒评估，证明交感神经活动因自主神经病变而损害血管运动功能，我们认为这与IBS有关。
本研究共有58名参与者。对照组由29名健康患者组成，其余29名患者被诊断为IBS。符合罗马IV标准且患有IBS的患者被纳入研究。已知患有可进展性多发性神经病或非IBS慢性病的患者，以及患有原发性高血压、糖尿病、心血管疾病或外周动脉疾病的患者，还有被诊断为焦虑或抑郁的患者均被排除在试验之外。中度至重度腕管综合征患者或因创伤导致正中神经损伤的患者也被排除在试验之外。使用多普勒探头从前臂肘窝上方2 cm处测量肱动脉的基线直径和血流速度。在整个实验过程中，多普勒探头保持静止，以便进行连续测量。然后，为了激活交感神经纤维，在手腕水平使用强度为10 mA、频率为1 Hz的电刺激5 s施加于正中神经 双极刺激电极。在第五次刺激后立即再次测量动脉直径和血流速度。
在无慢性病史的健康人中，刺激后血流速度有统计学意义的下降（<0.001）。此外，刺激导致肱动脉直径有统计学意义的减小（<0.001）。被诊断为IBS的患者有统计学意义的血管舒张和血流速度增加。
交感神经刺激会导致血管直径和血流减少，而对IBS患者则有相反的作用。在研究自主神经病变在IBS发病中的作用时，在用低电流感觉刺激正中神经前后，观察到肱动脉多普勒参数有显著变化。这种方法被认为比文献中描述的其他方法更方便用户且更舒适。
