Advertisement

Digestive Diseases and Sciences

, Volume 38, Issue 2, pp 206–212 | Cite as

Altered esophageal pain threshold in irritable bowel syndrome

  • Mario Costantini
  • Giacomo Carlo Sturniolo
  • Giovanni Zaninotto
  • Renata D'Incà
  • Rita Polo
  • Remo Naccarato
  • Ermanno Ancona
Original Articles

Abstract

Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 μg/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control group. A pain threshold on esophageal distension significantly lower than in healthy subjects (11.5±1 ml vs 22.2±1.7 ml,P<0.01) was found in IBS patients. On the other hand, no differences between patients and controls were detected in lower esophageal sphincter pressure and length, esophageal body motility, or GER pattern; furthermore, bethanechol stimulation elicited similar esophageal body motility changes. Our study could confirm no detectable basal or bethanechol-induced esophageal motility disorders in IBS patients, nor enhanced GER. Esophageal involvement in IBS consists of a lower pain threshold on esophageal distension, possibly reflecting an altered visceral receptor sensitivity or modulation throughout the gut.

Key Words

irritable bowel syndrome esophageal motility gastroesophageal reflux esophageal provocative testing balloon distension test 24-hr pH monitoring 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Harvey RF, Salh SY, Read AE: Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1:632–634, 1983Google Scholar
  2. 2.
    Snape WJ Jr, Carlson GM, Cohen S: Colonic myoelectric activity in the irritable bowel syndrome. Gastroenterology 70:326–330, 1976Google Scholar
  3. 3.
    Snape WJ, Carlson GM, Matarazzo SA, Cohen S: Evidence that abnormal myoelectric activity produces colonic motor dysfunction in the irritable bowel syndrome. Gastroenterology 72:383–387, 1977Google Scholar
  4. 4.
    Latimer P, Sarna S, Campbell D, Latimer M, Waterfall W, Daniel EE: Colonic motor and myoelectrical activity: A comparative study of normal subjects, psychoneurotic patients and patients with the irritable bowel syndrome. Gastroenterology 80:893–901, 1981Google Scholar
  5. 5.
    Trotman IF, Misiewicz JJ: Sigmoid motility in diverticular disease and the irritable bowel syndrome. Gut 29:218–222, 1988Google Scholar
  6. 6.
    Narducci F, Bassotti G, Granata MT, Pelli MA, Gaburri M, Palumbo R, Morelli A: Colonic motility and gastric emptying in patients with irritable bowel syndrome. Effect of pretreatment with octylonium bromide. Dig Dis Sci 31:241–246, 1986Google Scholar
  7. 7.
    Thompson DG, Laidlaw JM, Wingate DL: Abnormal small bowel motility demonstrated by radio-telemetry in a patient with irritable colon. Lancet 2:321–323, 1979Google Scholar
  8. 8.
    Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987Google Scholar
  9. 9.
    Kellow JE, Phillips SF, Miller LJ, Zinsmeister AR: Dysmotility of the small intestine in irritable bowel syndrome. Gut 29:1236–1243, 1988Google Scholar
  10. 10.
    Van Wijk HJ, Akkermans LMA, Smout AJPM, ten Thije OJ: Gastric emptying and upper abdominal symptoms in the irritable bowel syndrome. Gastroenterology 94:A477, 1988Google Scholar
  11. 11.
    Whorwell PJ, Clouter C, Smith CL: Oesophageal motility in the irritable bowel syndrome. Br Med J 282:1101–1102, 1981Google Scholar
  12. 12.
    Smart HL, Nicholson DA, Atkinson M: Gastro-oesophageal reflux in the irritable bowel syndrome. Gut 27:1127–1131, 1986Google Scholar
  13. 13.
    Whorwell PJ, McCallum M, Creed FH, Roberts CT: Noncolonic features of irritable bowel syndrome. Gut 27:37–40, 1986Google Scholar
  14. 14.
    Prior A, Whorwell PJ: Gynaecological consultation in patients with the irritable bowel syndrome. Gut 30:996–998, 1989Google Scholar
  15. 15.
    Whorwhell PJ, Lupton EW, Erduran D, Wilson K: Bladder smooth muscle dysfunction in patients with irritable bowel syndrome. Gut 27:1014–1017, 1986Google Scholar
  16. 16.
    Prior A, Wilson K, Whorwell PJ, Faragher EB: Irritable bowel clinic in the gynecological clinic. Survey of 798 referrals. Dig Dis Sci 34:1820–1824, 1989Google Scholar
  17. 17.
    White AM, Stevens WH, Upton AR, O'Byrne PM, Collins SM: Airway responsiveness to inhaled methacholine in patients with irritable bowel syndrome. Gastroenterology 100:68–74, 1991Google Scholar
  18. 18.
    Ritchie J: Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973Google Scholar
  19. 19.
    Whitehead WE, Engel BT, Schuster MM: Patients with irritable bowel syndrome: Physiological and psychological differences between diarrhea-predominant and constipation-predominant patients. Dig Dis Sci 25:404–413, 1980Google Scholar
  20. 20.
    Kullman G, Fielding JF: Rectal distensibility in the irritable bowel syndrome. Ir Med J 74:140–142, 1981Google Scholar
  21. 21.
    Whitehead WE, Holtkotter B, Enck P, Hoelzl R, Holmes KD, Anthony J, Shabsin HS, Schuster MM: Tolerance for rectosigmoid distension in irritable bowel syndrome. Gastroenterology 98:1187–1192, 1990Google Scholar
  22. 22.
    Manning AP, Thompson WG, Heaton KW, Morris AF: Towards positive diagnosis of the irritable bowel. Br Med J 2:653–654, 1978Google Scholar
  23. 23.
    Svedlund J, Sjin I, Dotewall G: GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 33:129–134, 1988Google Scholar
  24. 24.
    Zaninotto G, DiMario F, Costantini M, Baffa R, Germanà B, Dal Santo PL, Rugge M, Bolzan M, Naccarato R, Ancona E: Oesophagitis and pH of refluxate: An experimental and clinical study. Br J Surg 79:161–164, 1992Google Scholar
  25. 25.
    Zaninotto G, Ancona E, Costantini M, Polo R, Rossi M, Finco C, Cecolin G, Sebartoli G: Limiti dell'esame manometrico tradizionale e vantaggi della manometria computerizzata nello studio della motilità esofagea. Min Gastroenterol Dietol 37:11–19, 1991Google Scholar
  26. 26.
    Zaninotto G, DeMeester TR, Schwizer W, Johansson K-E, Cheng S-C: The lower esophageal sphincter in health and disease. Am J Surg 155:104–111, 1988Google Scholar
  27. 27.
    Bombeck CT, Vas O, DeSalvo J, Donahue PE, Nyhus LM: Computerized axial manometry of the esophagus: A new method for the assessment of antireflux operation. Ann Surg 206:465–472, 1987Google Scholar
  28. 28.
    Johnson LF, DeMeester TR: Twenty-four hour pH monitoring of distal esophagus: A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332, 1974Google Scholar
  29. 29.
    Richter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986Google Scholar
  30. 30.
    Barish CF, Castell DO, Richter JE: Graded esophageal balloon distension. A new provocative test for noncardiac chest pain. Dig Dis Sci 31:1292–1298, 1986Google Scholar
  31. 31.
    Benjamin SB, Richter JE, Cordova CM, Knuff TE, Castell DO: Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction. Gastroenterology 84:893–901, 1983Google Scholar
  32. 32.
    Rosner B: Fundamentals of Biostatistics. Boston, PWS-Kent Publishing, 1990Google Scholar
  33. 33.
    Cook IJ, Van Eeden A, Collins SM: Patients with irritable bowel syndrome have greater pain tolerance than normal subjects. Gastroenterology 93:727–733, 1987Google Scholar
  34. 34.
    Prior A, Maxton DG, Whorwell PJ: Anorectal manometry in irritable bowel syndrome: Difference between diarrhea and constipation predominant subjects. Gut 31:458–462, 1990Google Scholar
  35. 35.
    Stark GA, McMahan TP, Richter JE: Increasing evidence for the irritable gut syndrome. Gastroenterology 92:A1652, 1987Google Scholar
  36. 36.
    Smout AJPM, DeVore MS, Castell DO: Abnormalities of cerebral potentials evoked by esophageal distension in patients with noncardiac chest pain. Gastroenterology 98:A393, 1990Google Scholar
  37. 37.
    Smart HL, Atkinson M: Abnormal vagal function in irritable bowel syndrome. Lancet 2:475–478, 1987Google Scholar
  38. 38.
    Palmer RL, Stonehill E, Crisp AH, Waller SL, Misiewicz JJ: Psychological characteristics of patients with irritable bowel syndrome. Postgrad Med J 50:416–419, 1974Google Scholar
  39. 39.
    Watson WC, Sullivan SN, Corke M, Rush D: Incidence of oesophageal symptoms in patients with irritable bowel syndromes. Gut 17:827, 1976Google Scholar
  40. 40.
    Fuchs KF, DeMeester TR, Albertucci M: Specificity and sensitivity of objective diagnosis of gastroesophageal reflux test. Surgery 102:575–580, 1987Google Scholar
  41. 41.
    Ayres RCS, Robertson DAF, Naylor K, Smith CL: Stress and oesophageal motility in normal subjects and patients with irritable bowel syndrome. Gut 30:1540–1543, 1989Google Scholar
  42. 42.
    Soffer EE, Scalabrini P, Pope CE II, Wingate DL: Effect of stress on oesophageal motor function in normal subjects and in patients with the irritable bowel syndrome. Gut 29:1591–1594, 1988Google Scholar
  43. 43.
    Zaninotto G, DeMeester TR, Bremner CG, Smyrk TC, Cheng S-C: Esophageal function in patients with reflux-induced strictures and its relevance to surgical treatment. Ann Thorac Surg 47:362–370, 1989Google Scholar
  44. 44.
    Barker JR, Alexander-Williams J: The effect of cholecystectomy on oesophageal symptoms. Br J Surg 61:346–348, 1974Google Scholar
  45. 45.
    Zaninotto G, Costantini M, Finco C, Buin F, Polo R, Boccù C, Ancona E: Gallstones and gastro-oesophageal reflux disease: are there any associations? Eur Surg Res 23(S1):18, 1991Google Scholar
  46. 46.
    Drossman DA, McKee DC, Sandler RS, Mitchell M, Cramer EM, Lowman BC, Burger AL: Psychosocial factors in the irritable bowel syndrome. Gastroenterology 95:701–708, 1988Google Scholar
  47. 47.
    Thompson WG, Heaton KW: Functional bowel disorders in apparently healthy people. Gastroenterology 79:283–288, 1980Google Scholar
  48. 48.
    Kellow JE, Eckersley GM, Jones MP: Enhanced perception of physiological intestinal motility in the irritable bowel syndrome. Gastroenterology 101:1621–1627, 1991Google Scholar
  49. 49.
    Nostrant TT, Sams J, Huber T: Bethanechol increases the diagnostic yield in patients with esophageal chest pain. Gastroenterology 91:1141–1146, 1986Google Scholar
  50. 50.
    Hollis JB, Castell DO: Effects of cholinergic stimulation on human esophageal peristalsis. J Appl Physiol 40:40–43, 1976Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Mario Costantini
    • 1
    • 2
  • Giacomo Carlo Sturniolo
    • 1
    • 2
  • Giovanni Zaninotto
    • 1
    • 2
  • Renata D'Incà
    • 1
    • 2
  • Rita Polo
    • 1
    • 2
  • Remo Naccarato
    • 1
    • 2
  • Ermanno Ancona
    • 1
    • 2
  1. 1.Department of Surgery (Chirurgia Generale 2)Università di PadovaPadovaItaly
  2. 2.Division of GastroenterologyUniversity of PaduaPaduaItaly

Personalised recommendations