Evidence for two distinct perceptual alterations in irritable bowel syndrome
Evidence for two distinct perceptual alterations in irritable bowel syndrome
复制标题
DOI：
10.1136/gut.41.4.505
复制
发表时间：
1997-10-01
期刊：
影响因子：
24.5
通讯作者：
Mayer, EA
中科院分区：
文献类型：
--
作者：
Naliboff, BD;Munakata, J;Mayer, EA
背景和目的：内脏痛觉过敏被认为是肠易激综合征（IBS）症状产生的一个因素。然而，先前使用肠球囊扩张的研究使用了心理物理程序，不能提供充分和公正的内脏敏感性测量。方法：对45例IBS患者（罗马标准阳性）和14例对照患者进行3项心理物理任务检查，采用直肠球囊扩张和计算机化扩张装置。不适阈值和耐受性在相压力刺激的上升序列和交互阈值跟踪过程中进行评估。此外，刺激反应函数由直肠膨胀的强度和不愉快等级产生。结果：与对照组相比，IBS患者的不适阈值和对上升刺激的耐受性显著降低。相比之下，追踪过程中的不适阈值和上升序列的刺激反应曲线在两组之间没有差异。心理物理数据的因子分析与直肠膨胀相关的两种截然不同且不相关的感知改变的存在是一致的：对内脏刺激的高度警惕，表现为使用描述“不适”的反应标准降低；直肠超敏，表现为不适感阈值降低，刺激反应曲线左移。结论：肠易激综合征患者作为一个群体更倾向于对内脏感觉进行负面标记，对直肠球囊膨胀的耐受性较低。一个亚组患者也有基线直肠超敏反应，通过不适感阈值和刺激强度判断的无偏测量来评估。
Background and aims-Visceral hyperalgesia has been implicated as a factor contributing to symptom generation in irritable bowel syndrome (IBS). However, previous studies using intestinal balloon distension have used psychophysical procedures which do not provide adequate and unbiased measures of visceral sensitivity.Methods-Three psychophysical tasks were examined in 45 patients with IBS (positive Rome criteria) and 14 controls using rectal balloon distension with a computerised distension device. Discomfort threshold and tolerance were assessed during an ascending series of phasic pressure stimuli and during an interactive threshold tracking procedure. In addition, stimulus response functions were generated from intensity and unpleasantness ratings of the rectal distensions.Results-Discomfort threshold and tolerance for the ascending stimuli were significantly lower for the patients with IBS compared with the controls. In contrast, discomfort thresholds during the tracking procedure and stimulus response curves for the ascending series were not different between the groups. A factor analysis of the psychophysical data was consistent with the presence of two distinct and unrelated perceptual alterations related to rectal distension: hypervigilance for visceral stimuli, manifested as lowered response criteria for using the descriptor ''discomfort''; and rectal hypersensitivity, manifested as a lower discomfort threshold and left shift of the stimulus response curves.Conclusions-Patients with IBS as a group have a greater propensity to label visceral sensations negatively and show a lower tolerance for rectal balloon distension. A subgroup of patients also have baseline rectal hypersensitivity, assessed by unbiased measures of discomfort threshold and stimulus intensity judgements.