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. 2018 Feb;67(2):255-262.
doi: 10.1136/gutjnl-2016-312361. Epub 2017 Jan 19.

Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts

Magnus Simrén  1   2 , Hans Törnblom  1 , Olafur S Palsson  2 , Miranda A L van Tilburg  2 , Lukas Van Oudenhove  3 , Jan Tack  3 , William E Whitehead  2
Affiliations

Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts

Magnus Simrén et al. Gut. 2018 Feb.

Abstract

Objective: Our aim was to evaluate the association between visceral hypersensitivity and GI symptom severity in large cohorts of patients with functional GI disorder (FGID) and to adjust for psychological factors and general tendency to report symptoms.

Design: We included five cohorts of patients with FGIDs (IBS or functional dyspepsia; n=1144), who had undergone visceral sensitivity testing using balloon distensions (gastric fundus, descending colon or rectum) and completed questionnaires to assess GI symptom severity, non-GI somatic symptoms, anxiety and depression. Subjects were divided into sensitivity tertiles based on pain/discomfort thresholds. GI symptom severity was compared between sensitivity tertiles in each cohort and corrected for somatisation, and anxiety and depression.

Results: In all five cohorts, GI symptom severity increased gradually with increasing visceral sensitivity, with significant differences in GI symptom severity between the sensitivity tertiles (p<0.0001), with small to medium effect sizes (partial η2: 0.047-0.11). The differences between sensitivity tertiles remained significant in all cohorts after correction for anxiety and depression, and also after correction for non-GI somatic symptom reporting in all of the cohorts (p<0.05).

Conclusions: A gradual increase in GI symptom severity with increasing GI sensitivity was demonstrated in IBS and functional dyspepsia, which was consistent across several large patient groups from different countries, different methods to assess sensitivity and assessments in different parts of the GI tract. This association was independent of tendency to report symptoms or anxiety/depression comorbidity. These findings confirm that visceral hypersensitivity is a contributor to GI symptom generation in FGIDs.

Keywords: FUNCTIONAL DYSPEPSIA; IRRITABLE BOWEL SYNDROME; VISCERAL HYPERSENSITIVITY.

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Conflict of interest statement

Competing interests: MS has received unrestricted research grants from Danone, and Ferring Pharmaceuticals, and served as a Consultant/Advisory Board member for AstraZeneca, Danone, Nestlé, Chr Hansen, Almirall, Allergan, Albireo, Glycom and Shire, and as a speaker for Tillotts, Takeda, Shire and Almirall. HT has served as Consultant/Advisory Board member for Almirall, Danone and Shire. MALvT has obtained research support from Takeda for investigator initiated study. OSP has received salary support from a research grants from Takeda Pharmaceuticals and Salix Pharmaceuticals and from a consulting agreement with Ironwood Pharmaceuticals and an educational grant provided by Takeda Pharmaceuticals, and received a speaker honorarium in an educational programme supported by Ironwood Pharmaceuticals and Takeda Pharmaceuticals. JT has given scientific advice to Almirall, AstraZeneca, Danone, Menarini, Novartis, Nycomed, Ocera, Ono pharma, Shire, SK Life Sciences, Theravance, Tranzyme, Xenoport, and Zeria Pharmaceuticals, and has been member of the Speaker bureau for: Abbott, Almirall, AlfaWasserman, AstraZeneca, Janssen, Menarini, Novartis, Nycomed, Shire, Zeria. WEW received research grants from Takeda, Ironwood, Salix, and the Rome Foundation; served as a consultant to Biomerica USA, Ono Pharmaceuticals and Ferring; and received unrestricted educational grants from Takeda and Ferring.

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