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Irritable bowel syndrome

Physiological and psychological differences between diarrhea-predominant and constipation-predominant patients

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Abstract

Patients with different irritable bowel symptoms and normal subjects were compared to determine whether subtypes of irritable bowel syndrome (IBS) could be distinguished on the basis of colonic motility or psychological test scores. A provocative test involving stepwise distension of the rectosigmoid area revealed two types of colonic motility. Slow contractions having durations of at least 15 sec and occurring at irregular intervals were more frequent in IBS patients than in normals but did not differentiate constipation from diarrhea. Fast contractions having durations of less than 15 sec and occurring in runs at frequencies of 6–9 cpm were more frequent in patients with diarrhea than in normals or constipated IBS patients. Constipated patients showed no more fast contractions than normals. Severity of bowel symptoms was correlated with the overall amount of motility (motility index) in patients with diarrhea but not in patients with constipation. Patients with IBS showed significantly elevated levels on the following psychological traits: anxiety, interpersonal sensitivity, depression, hostility, and somatization of affect. However, there were no significant trait differences between patients with diarrhea and those with constipation. Also, there was no correlation between amount of psychopathology and either colonic motility or severity of symptoms in the whole group of IBS patients.

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References

  1. Drossman DA, Powell DW, Sessions JT, Jr: The irritable bowel syndrome. Gastroenterology 73:811–822, 1977

    PubMed  Google Scholar 

  2. Wangel AG, Deller DJ: Intestinal motility in man. III. Mechanisms of constipation and diarrhea with particular reference to the irritable colon syndrome. Gastroenterology 48:69–84, 1965

    PubMed  Google Scholar 

  3. Holdstock DJ, Misiewicz JJ, Waller SL: Observations on the mechanism of abdominal pain. Gut 10:19–31, 1969

    PubMed  Google Scholar 

  4. Champion P: Some cases of the irritable bowel syndrome studied by intraluminal pressure recordings. Digestion 9:21–29, 1973

    PubMed  Google Scholar 

  5. Horowitz L, Farrar JT: Intraluminal small intestinal pressures in normal patients and in patients with functional gastrointestinal disorders. Gastroenterology 42:455–464, 1962

    PubMed  Google Scholar 

  6. Sullivan MA, Cohen S, Snape WJ, Jr: Colonic myoelectrical activity in irritable-bowel syndrome: Effect of eating and anticholinergics. N Engl J Med 298:878–883, 1978

    PubMed  Google Scholar 

  7. Snape WJ, Jr, Carlson GM, Matarazzo SA, Cohen S: Evidence that abnormal myoelectrical activity produces colonic motor dysfunction in the irritable bowel syndrome. Gastroenterology 72:383–387, 1977

    PubMed  Google Scholar 

  8. Almy TP, Tulin M: Alterations in colonic function in man under stress: Experimental production of changes simulating the “irritable colon.” Gastroenterology 8:616–626, 1947

    Google Scholar 

  9. Deller DJ, Wangel AG: Intestinal motility in man: I. A study combining the use of intraluminal pressure recording and cineradiography. Gastroenterology 48:45–57, 1965

    PubMed  Google Scholar 

  10. Connel AM, Jones FA, Rowlands EN: Motility of the pelviccolon: Part IV. Abdominal pain associated with colonic hypermotility after meals. Gut 6:105–112, 1965

    Google Scholar 

  11. Dinoso VP, Meshkinpour H, Lorber SH, Gutierrez JG, Chey WY: Motor responses of the sigmoid colon and rectum to exogenous cholecystokinin and secretin. Gastroenterology 65:438–444, 1973

    PubMed  Google Scholar 

  12. Gutierrez JG, Chey WY, Dinoso VP: Actions of cholecystokinin and secretin on the motor activity of the small intestine in man. Gastroenterology 67:35–41, 1974

    PubMed  Google Scholar 

  13. Snape WJ Jr, Carlson GM, Cohen S: Colonic myoelectric activity in the irritable bowel syndrome. Gastroenterology 70:326–330, 1976

    PubMed  Google Scholar 

  14. Chowdhury AB, Dinoso VP, Lorber SH: Characterization of a hyperactive segment at the rectosigmoid junction. Gastroenterology 71:584–588, 1976

    PubMed  Google Scholar 

  15. Chaudhary NA, Truelove SC: The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 31:307–322, 1962

    PubMed  Google Scholar 

  16. Waller SL, Misiewicz JJ: Prognosis in the irritable bowel syndrome, Lancet 2:753–756, 1969

    Google Scholar 

  17. Liss JL, Alpers D, Woodruff RA: The irritable colon syndrome and psychiatric illness. Dis Nerv System 34:151–157, 1973

    Google Scholar 

  18. Young SJ, Alpers DH, Norland CC, Woodruff RA: Psychiatric illness and the irritable bowel syndrome: Practical implications for the primary physician. Gastroenterology 70:162–166, 1976

    PubMed  Google Scholar 

  19. Hislop IG: Psychological significance of the irritable colon syndrome. Gut 12:452–457, 1971

    PubMed  Google Scholar 

  20. Derogatis LR, Rickels K, Rock AF: The SCL-90 and the MMPI: A step in the validation of a new self-report scale. Br J Psychiatry 128:280–289, 1976

    PubMed  Google Scholar 

  21. Bruning JL, Kintz BL: Computational Handbook of Statistics. Atlanta, Georgia, Scott, Foresman, 1968

    Google Scholar 

  22. Taylor I, Duthie HL, Smallwood R, Linkens D: The effect of stimulation on the myoelectrical activity of the rectosigmoid in man. Gut 15:599–607, 1974

    PubMed  Google Scholar 

  23. Mitra R, Chura CM, Rajendra GR, Schuster MM: Abnormal responses to rectal distension in irritable bowel syndrome. Gastroenterology 66:770, 1974

    Google Scholar 

  24. Connell AM: The motility of the pelvic colon. Part II. Paradoxical motility in diarrhea and constipation. Gut 7:342–348, 1962

    Google Scholar 

  25. Misiewicz JJ, Connell AM, Pontes FA: Comparison of the effects of meals and prostigmine on the proximal and distal colon in patients with and without diarrhea. Gut 7:468–473, 1966

    PubMed  Google Scholar 

  26. Waller SL, Misiewicz JJ, Kiley N: Effect of eating on motility of the pelvic colon in constipation and diarrhea. Gut 13:805–811, 1972

    PubMed  Google Scholar 

  27. Ritchie J: Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973

    PubMed  Google Scholar 

  28. Winer BJ: Statistical Principles in Experimental Design. New York, McGraw-Hill, 1962

    Google Scholar 

  29. Latimer PR, Capbell D, Latimer MR, Sarna SK, Daniel EE, Waterfall WE: Colonic motility in irritable bowel syndrome (IBS). Gastroenterology 76:1181, 1979

    Google Scholar 

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Authors and Affiliations

  1. Hohns Hopkins University School of Medicine, National Institute on Aging, National Institutes of Health, PHS, U.S. Department of Health, Education and Welfare, Bethesda

    William E. Whitehead PhD, Bernard T. Engel PhD & Marvin M. Schuster MD

  2. Laboratory of Behavioral Sciences, Gerontology Research Center, (Baltimore)

    William E. Whitehead PhD, Bernard T. Engel PhD & Marvin M. Schuster MD

  3. Division of Digestive Diseases, Baltimore City Hospital, 21224, Baltimore, Maryland

    William E. Whitehead PhD, Bernard T. Engel PhD & Marvin M. Schuster MD

Authors
  1. William E. Whitehead PhD
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  2. Bernard T. Engel PhD
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  3. Marvin M. Schuster MD
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Additional information

Supported by Research Scientist Development Award 1 K01 MH00133 to William E. Whitehead and by the Intramural Research Program of the National Institute on Aging.

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Whitehead, W.E., Engel, B.T. & Schuster, M.M. Irritable bowel syndrome. Digest Dis Sci 25, 404–413 (1980). https://doi.org/10.1007/BF01395503

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  • DOI: https://doi.org/10.1007/BF01395503

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