Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome
Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome
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DOI：
10.1016/s0016-5085(97)70219-1
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发表时间：
1997-01-01
期刊：
影响因子：
29.4
通讯作者：
Mayer, EA
中科院分区：
文献类型：
--
作者：
Munakata, J;Naliboff, B;Mayer, EA
背景和目标：只有一部分肠易激综合征（IBS）患者表现出对直肠扩张的超敏反应，目前的研究试图确定乙状结肠机械感受器的重复高压刺激是否会调节直肠疼痛和不适的感知。研究方法：在14名IBS患者和11名健康对照者中，在重复高压机械乙状结肠刺激之前和之后获得直肠感觉跟踪期间的不适和疼痛的感知阈值和直肠强直刺激感知强度的口头描述符评级，通过问卷调查评估胃肠道和心理症状。尽管IBS患者的基线直肠敏感性存在异质性，但在乙状结肠刺激后，100%的患者（无论基线敏感性如何）发生直肠痛觉过敏，表现为以下三个标准中的至少两个：降低了疼痛和不适的阈值，增加了内脏躯体介导和下腹部不适，持续时间超过了实验刺激。结论：在IBS患者中，重复刺激乙状结肠内脏传入导致中枢敏感化的发展，表现为痛觉过敏和直肠扩张期间内脏体介导的增加，以及在没有施加刺激的情况下自发性直肠乙状结肠痛觉过敏。重复乙状结肠收缩可诱导IBS患者的直肠乙状结肠痛觉过敏。
Background & Aims: Only a fraction of patients with irritable bowel syndrome (IBS) show hypersensitivity to rectal distention, The current study sought to determine if repetitive high-pressure stimulation of sigmoid mechanoreceptors modulates perception of rectal pain and discomfort. Methods: In 14 patients with IBS and 11 healthy controls, perception thresholds for discomfort and pain during rectal sensory tracking and verbal descriptor ratings of the perceived intensity of a rectal tonic stimulus were obtained before and after repetitive high-pressure mechanical sigmoid stimulation, Gastrointestinal and psychological symptoms were assessed by questionnaires, Results: Despite heterogeneity in baseline rectal sensitivity in patients with IBS, after sigmoid stimulation, 100% of patients, regardless of baseline sensitivity, developed rectal hyperalgesia manifested by at least two of the following three criteria: lowered thresholds for pain and discomfort and increased viscerosomatic referral and lower abdominal discomfort outlasting the experimental stimulation. This pattern of responses was not observed in any of the healthy controls, Conclusions: In patients with IBS, repetitive stimulation of sigmoid splanchnic afferents results in the development of central sensitization manifested as hyperalgesia and increased viscerosomatic referral during rectal distention and as spontaneous rectosigmoid hyperalgesia in the absence of applied stimuli, Repetitive sigmoid contractions may induce rectosigmoid hyperalgesia in patients with IBS.