Disturbances of Motility and Visceral Hypersensitivity in Irritable Bowel Syndrome: Biological Markers or Epiphenomenon
Section snippets
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
References (97)
- et al.
Irritable bowel syndrome: a technical review for practice guideline development
Gastroenterology
(1997) - et al.
A diagnostic score for the irritable bowel syndrome and its value in the exclusion of organic disease
Gastroenterology
(1984) Disturbances in small bowel motility
Baillieres Best Pract Res Clin Gastroenterol
(1999)- et al.
Altered small bowel motility in irritable bowel syndrome is correlated with symptoms
Gastroenterology
(1987) - et al.
Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome
Gastroenterology
(1990) - et al.
Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome
Gastroenterology
(2002) - et al.
Lipid-induced intestinal gas retention in irritable bowel syndrome
Gastroenterology
(2002) - et al.
Prokinetic effects in patients with intestinal gas retention
Gastroenterology
(2002) - et al.
Abnormal colonic fermentation in irritable bowel syndrome
Lancet
(1998) The problem of gas in the irritable bowel syndrome
Am J Gastroenterol
(2000)