Disturbances of Motility and Visceral Hypersensitivity in Irritable Bowel Syndrome: Biological Markers or Epiphenomenon

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Gastrointestinal Motor Dysfunction in Irritable Bowel Syndrome; is Irritable Bowel Syndrome a Motility Disorder?

Dysmotility long has been considered a major factor in the pathophysiology of IBS, as indicated by the use of such terms as the spastic colon to describe what now is referred to as IBS. Accordingly, it was suggested that gut spasm or other abnormal contractile activities led to the development of symptoms in IBS. There are, indeed, several reports of abnormal motor patterns in many parts of the gastrointestinal (GI) tract in IBS [9], [10].

Initially, the focus was on the colon, and several

Visceral hypersensitivity and hyperalgesia; the ubiquitous phenomena in functional gastrointestinal disorders, including irritable bowel syndrome?

There has been recent interest in these phenomena, not only in IBS, but also in functional disorders in general [42]. The phenomenon of visceral hypersensitivity to distention and other intraluminal stimuli, common to patients with noncardiac pain, functional dyspepsia, and the irritable bowel, appears to demonstrate organ specificity in these various disorders [43]. It was suggested recently that both visceral hypersensitivity [44] and visceral hyperalgesia [45], the phenomenon whereby stimuli

If dysmotility and visceral hypersensitivity are not biological markers, can another unifying hypothesis explain their occurrence and association with symptoms in irritable bowel syndrome?

An extensive literature documents the potential for stress and psychopathology to influence GI motor, sensory, and secretory function, both in the short- and in the long-term. As reviewed in an article by Palsson and Drossman elsewhere in this issue, patients with IBS traditionally have been assumed, on the basis of scanty evidence, to suffer from a variety of psychological disturbances. More recent evidence suggests, on the contrary, that most patients with IBS are indistinguishable from the

Pathophysiological hypotheses are not mutually exclusive

In attempting to make sense of current theories of pathophysiology in IBS, it is important to maintain an open mind and to accept the distinct possibility that more than one of these factors may interact in a given patient. The role of psycho–social factors in the predilection to postinfective-IBS is a nice illustration of such an interaction. Insights are being gained into how stress and psychopathology might modulate the inflammatory response [95], [96]. Thus, the neurotransmitters, substance

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