Exaggerated motility of the descending colon with repetitive distention of the sigmoid colon in patients with irritable bowel syndrome
Exaggerated motility of the descending colon with repetitive distention of the sigmoid colon in patients with irritable bowel syndrome
复制标题
DOI：
10.1007/bf03326434
复制
发表时间：
2002-01-01
影响因子：
6.3
通讯作者：
Hongo, M
中科院分区：
文献类型：
--
作者：
Fukudo, S;Kanazawa, M;Hongo, M
背景内脏高敏感性是肠易激综合征(IBS)的发病机制之一，但它不能解释肠易激综合征(IBS)的全部症状，即排便后腹痛缓解的排便习惯改变。我们验证了我们的假设，即管腔刺激和壁面反应之间的异常联系可能在IBS的病理生理学中起一定作用。方法：研究方法。IBS患者10例，中位年龄21岁，男5例，女5例；健康对照组10例，中位年龄21岁，男5例，女5例。将带有三个换能器的测压导管插入降结肠，并在乙状结肠远端放置气囊。另一根有三个换能器的导管插入十二指肠。基础状态30min后，用球囊扩张刺激乙状结肠30min，然后恢复30min。球囊扩张100次，每次刺激由5-S充气和10-S放气组成，最大充气量为50ml。用放射免疫法测定血浆促肾上腺皮质激素(ACTH)水平。结果。反复性结肠扩张使IBS患者降结肠运动指数(S/S%)显著升高(P<0.05)，而对照组则无明显变化(P>0.05)。组间差异显著(P<；0.05)，周期效应(P<；0.02)和X组周期交互作用(P<；0.01)。对照组的十二指肠运动指数在结肠扩张后显著降低(从169+/-25降至104+/-14，P<；0.01)，而IBS患者的十二指肠运动指数无明显变化(从156+/-17降至124+/-20)。肠易激综合征患者的球囊扩张感觉阈值(74±10ml)显著低于对照组(125.00±6ml，P<；0.001)。IBS患者与对照组血浆ACTH水平差异无统计学意义。结论。在IBS患者中，乙状结肠远端低于感觉阈值的重复扩张导致结肠运动过度。扩张抑制了健康受试者的小肠运动，但这种抑制在IBS患者中被钝化。这些结果提示，IBS患者不仅可能存在内脏高敏感性，还可能存在肠道反射异常。
Background Visceral hypersensitivity is one of the mechanisms of irritable bowel syndrome (IBS), but it does not explain the entire symptomatology, i.e., altered bowel habit with abdominal pain relieved by defecation. We tested our hypothesis that an abnormal link between luminal stimulation and mural response may have some role in the pathophysiology of IBS. Methods. Patients with IBS (n = 10, median 21 years old, 5 male patients, 5 female patients) and healthy control subjects (n = 10, median 21 years old, 5 men, 5 women) were studied. A manometric catheter with three transducers was inserted to the descending colon and a balloon was placed in the distal sigmoid colon. Another catheter with three transducers was inserted to the duodenum. After baseline for 30min, the sigmoid colon was stimulated by balloon distention for 30min followed by recovery for 30 min. Balloon distention was repeated 100 times, and each stimulation consisted of a 5-s inflation and a 10-s deflation, with a volume of 50ml maximum. The sensory threshold of balloon inflation was then examined, and plasma adrenocorticotropic hormone (ACTH) was measured with radioimmunoassay. Results. Repetitive colonic distention induced a significant increase in motility indices (mmHg s/s%) of the descending colon in the IBS patients (from 118 +/- 25 to 333 +/- 108, P < 0.05) but not of those in controls (from 90 +/- 16 to 89 +/- 19). A significant group difference (P < 0.05), period effect (P < 0.02), and group X period interactions (P < 0.01) were detected with two-way ANOVA. Duodenal motility indices in controls were significantly reduced by colonic distention (from 169 +/- 25 to 104 +/- 14, P < 0.01), but those in the IBS patients were not (from 156 +/- 17 to 124 +/- 20). The sensory threshold of balloon inflation in the IBS patients (74 +/- 10ml) was significantly lower than that in controls (125 +/- 6ml, P < 0.001). There was no significant difference in plasma ACTH levels between the IBS patients and controls. Conclusions. Repetitive distention of the distal sigmoid colon below the sensory threshold induced orad exaggerated motility of the colon in IBS patients. The distention inhibited motility of the small intestine in healthy subjects, but this inhibition was blunted in IBS patients. These results suggest that IBS patients may have not only visceral hypersensitivity, but also an abnormal intestinal reflex.