Accarino A M, Azpiroz F, Malagelada J R
Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain.
Gastroenterology. 1995 Mar;108(3):636-43. doi: 10.1016/0016-5085(95)90434-4.
BACKGROUND/AIMS: Experimental studies have shown gut hypersensitivity in irritable bowel syndrome. The aim of this study was to determine whether heightened perception of gut distention in irritable bowel syndrome is related to either decreased gut compliance, altered mechanosensitive afferents, or nonspecific sensory dysfunction.
In 17 patients with irritable bowel syndrome and 15 healthy controls, stimulus-related perception of (1) intestinal balloon distentions, (2) transmucosal electrical nerve stimulation (15 Hz, 100 microseconds), and (3) somatic transcutaneous electrical nerve stimulation (100 Hz, 100 microseconds) was measured. Individual stimuli of 1-minute duration were randomly applied at 5-minute intervals.
Patients tolerated smaller intestinal volumes than controls (33 +/- 3 mL vs. 43 +/- 4 mL, respectively; mean +/- SE; P < 0.05), whereas both intestinal compliance and perception of transmucosal electrical nerve stimulation were normal (patients tolerated 58 +/- 5 mA and healthy subjects tolerated 69 +/- 5 mA). Interestingly, patients perceived both stimuli more diffusely than controls; 48% +/- 9% distentions and 52% +/- 9% electrical stimuli were perceived over more than one abdominal region vs. 21% +/- 9% and 18% +/- 6%, respectively, in controls (P < 0.05 for both). In contrast to gut distentions, patients showed higher tolerance of somatic stimuli than controls (68 +/- 7 mA vs. 42 +/- 6 mA, respectively; P < 0.05).
Patients with irritable bowel syndrome show selective hypersensitivity of intestinal mechanosensitive pathways associated with a nonspecific, probably central dysfunction of viscerosomatic referral.
背景/目的：实验研究表明肠易激综合征患者存在肠道超敏反应。本研究旨在确定肠易激综合征患者肠道扩张感知增强是否与肠道顺应性降低、机械敏感传入神经改变或非特异性感觉功能障碍有关。
对17例肠易激综合征患者和15名健康对照者进行如下测量：（1）肠气囊扩张、（2）经黏膜电神经刺激（15Hz，100微秒）和（3）躯体经皮电神经刺激（100Hz，100微秒）的刺激相关感知。持续1分钟的单个刺激以5分钟的间隔随机施加。
患者耐受的肠容量小于对照者（分别为33±3mL和43±4mL；平均值±标准误；P<0.05），而肠道顺应性和经黏膜电神经刺激的感知均正常（患者耐受58±5mA，健康受试者耐受69±5mA）。有趣的是，患者对两种刺激的感知均比对照者更弥散；分别有48%±9%的扩张和52%±9%的电刺激在一个以上腹部区域被感知，而对照者分别为21%±9%和18%±6%（两者P均<0.05）。与肠道扩张相反，患者对躯体刺激的耐受性高于对照者（分别为68±7mA和42±6mA；P<0.05）。
肠易激综合征患者表现出肠道机械敏感通路的选择性超敏反应，伴有内脏-躯体牵涉的非特异性、可能为中枢性的功能障碍。
