Gastroenterology

Gastroenterology

Volume 131, Issue 4, October 2006, Pages 1003-1010
Gastroenterology

Clinical–alimentary tract
Relationship of Abdominal Bloating to Distention in Irritable Bowel Syndrome and Effect of Bowel Habit

https://doi.org/10.1053/j.gastro.2006.07.015Get rights and content

Background & Aims: The relationship between the sensation of bloating, often ranked as the most bothersome symptom by patients with irritable bowel syndrome (IBS), and actual distention manifest as an increase in abdominal girth is controversial. Investigation of this problem has been hampered by the lack of a reliable ambulatory technique to measure abdominal girth. The aim of this study was to use the technique of abdominal inductance plethysmography to compare diurnal variation in girth in IBS patients and healthy volunteers, relating these changes to the sensation of bloating. Methods: Abdominal girth was recorded for 24 hours in 20 IBS-constipation (age, 18–73 y), 20 IBS-diarrhea (age, 25–62 y) and 10 IBS-alternating (age, 21–59 y) female patients meeting Rome II criteria and 20 healthy female controls (age, 18–67 y). All subjects pursued normal daily activities, recording their symptoms of bloating and pain together with bowel habit. Results: All patients with IBS, irrespective of bowel habit, reported significantly greater bloating than controls (P < .0001). Forty-eight percent of patients also showed distention beyond the 90% control range, with this being most prominent in IBS-constipation. Bloating correlated strongly only with distention in IBS-constipation (r ≥ 0.48; P ≤ .02). Neither bloating nor distention in IBS was related to body mass index, age, parity, or psychologic status. Conclusions: Abdominal distention is a clearly definable phenomenon in IBS that can reach 12 cm. However, it only occurs in half of patients reporting bloating, and the 2 only correlate in IBS-constipation. Bloating and tentiodisn may differ pathophysiologically and this appears to be reflected in the bowel habit subtype.

Section snippets

Subjects

Fifty female patients who fulfilled Rome II criteria for IBS20 and specifically complained of bloating as part of their symptom complex were recruited from the outpatient department of the South Manchester University Hospital, of whom 20 had IBS-D (age, 25–62 y; mean, 38.1 y), 20 had IBS-C (age, 18–73 y; mean, 44.2 y), and 10 had an alternating bowel habit (IBS-alt) (age, 21–59 y; mean, 36.2 y). All patients underwent appropriate investigations to exclude organic disease21 and did not show any

Demographic Characteristics

The demographic and baseline characteristics of participants are summarized in Table 1. Analyses for homogeneity showed no relevant differences in these between-subject groups.

IBS patients vs healthy volunteers

IBS patients reported significantly more bloating both at the beginning and the end of day 1, and on waking on day 2 compared with healthy volunteers (P < .0001) (Figure 1). In addition, the IBS patients, but not the healthy volunteers, reported more severe bloating at the end of day 1 compared with both the beginning of

Discussion

This study objectively measured abdominal girth in IBS patients over a 24-hour period and assessed the relationship between bloating, distention, and bowel habit. It confirms that abdominal distention is a real phenomenon in IBS patients, with a proportion of patients showing a substantial increase in girth over the course of a day, which can reach up to 12 cm. Only in patients with IBS-C, however, was there a strong direct correlation between the symptom of bloating and distention.

The

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