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Comparative Study
. 2008 Oct;103(10):2550-61.
doi: 10.1111/j.1572-0241.2008.02066.x. Epub 2008 Aug 5.

Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits

Motoyori Kanazawa  1 , Olafur S Palsson, Syed I M Thiwan, Marsha J Turner, Miranda A L van Tilburg, Lisa M Gangarosa, Denesh K Chitkara, Shin Fukudo, Douglas A Drossman, William E Whitehead
Affiliations
Comparative Study

Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits

Motoyori Kanazawa et al. Am J Gastroenterol. 2008 Oct.

Abstract

Objectives: Irritable bowel syndrome (IBS) patients show pain hypersensitivity and hypercontractility in response to colonic or rectal distention. Aims were to determine whether predominant bowel habits and IBS symptom severity are related to pain sensitivity, colon motility, or smooth muscle tone.

Methods: One hundred twenty-nine patients classified as IBS with diarrhea (IBS-D, N = 44), IBS with constipation (IBS-C, N = 29), mixed IBS (IBS-M, N = 45), and unspecified IBS (IBS-U, N = 11) based on stool consistency, and 30 healthy controls (HC) were studied. A manometric catheter containing a 600-mL capacity plastic bag was positioned in the descending colon. Pain threshold was assessed using a barostat. Motility was assessed for 10 min with the bag minimally inflated (individual operating pressure [IOP]), 10 min at 20 mmHg above the IOP, and for 15-min recovery following bag inflation. Motility was also recorded for 30 min following an 810-kcal meal.

Results: Compared with HC, IBS patients had lower pain thresholds (medians 30 vs 40 mmHg, P < 0.01), but IBS subtypes were not different. IBS symptom severity was correlated with pain thresholds (rho =-0.36, P < 0.001). During distention, the motility index (MI) was significantly higher in IBS compared with HC (909 +/- 73 vs 563 +/- 78, P < 0.01). Average barostat bag volume at baseline was higher (muscle tone lower) in HC compared with IBS-D and IBS-M but not compared with IBS-C. The baseline MI and bag volume differed between IBS-D and IBS-C and correlated with symptoms of abdominal distention and dissatisfaction with bowel movements. Pain thresholds and MI during distention were uncorrelated.

Conclusions: Pain sensitivity and colon motility are independent factors contributing to IBS symptoms. Treatment may need to address both, and to be specific to predominant bowel habit.

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Conflict of interest statement

Conflicts of Interest and Author Roles: William E. Whitehead, Ph.D., is the guarantor of this paper, and he participated in study design, data collection, data analysis, and manuscript preparation. Motoyori Kanazawa, M.D., Ph.D., participated in study design, data analysis, and preparation of the manuscript. Olafur S. Palsson, Psy.D., participated in study design and data analysis. Syed IM Thiwan, M.D., participated in data collection. Marsha J. Turner, M.A., participated in data collection. Miranda AL van Tilburg, Ph.D., participated in data collection and data analysis. Lisa M. Gangarosa, M.D., participated in data collection. Denesh K. Chitkara, M.D., participated in data collection. Shin Fukudo, M.D., Ph.D., participated in data analysis and manuscript preparation. Douglas A. Drossman, M.D., participated in data collection. All financial support is declared in the acknowledgment, and none of the authors have competing interests.

Figures

Fig.1
Fig.1. Study protocol
Graphs on right show sequence of pressure changes during each phase of testing. IOP (individual operating pressure) is the pressure required to overcome the weight of overlying tissue and minimally inflate the barostat bag.
Fig.2
Fig.2. Pain threshold to intraluminal distention in the descending colon
Pain threshold in the descending colon was assessed using an electronic barostat by the ascending method of limit (AML). Each horizontal bar indicates the median value. The pain threshold was defined as the amount of pressure above IOP at which the subject first reported moderate pain (absolute distending pressure minus the IOP). If the subject reached 48 mmHg without reporting moderate pain, then the pain threshold was defined as 50 mmHg minus the IOP. HC, healthy controls (n=30); IBS-D, IBS with diarrhea (n=44); IBS-C, IBS with constipation (n=29); IBS-M, mixed IBS (n=45). *p<0.05, **p<0.01, vs. controls.
Fig.3
Fig.3. Relationship between colonic motility during distention period and pain threshold
No significant relationship was observed between colonic motility during distention period and visceral sensitivity in IBS patients (n=129; closed circles) or healthy subjects (n=30; open circles). Dashed lines show the 95% confidence intervals (CI): 49% of IBS patients showed contractile activity above the CI for controls in response to intraluminal distention, and 57% of patients had pain thresholds below the CI for controls. Of these patients, 31% showed both visceral hyper-contractivity and pain hypersensitivity.
See this image and copyright information in PMC

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