Digestive Diseases and Sciences

, Volume 39, Issue 3, pp 449–457 | Cite as

Evaluation of colonic sensory thresholds in IBS patients using a barostat

Definition of optimal conditions and comparison with healthy subjects
  • M. Bradette
  • M. Delvaux
  • G. Staumont
  • J. Fioramonti
  • L. Bueno
  • J. Frexinos
Original Articles


To study the role of abnormal visceral perception in the pathophysiology of the irritable bowel syndrome (IBS), we evaluated colonic tone and visceral perception during intracolonic distension using a flaccid balloon connected to a computerized barostat and placed in the descending colon of IBS patients and healthy controls. In the first part of the study, basal colonic tone and response to pharmacological (neostigmine and glucagon) and physiological (1000-kcal meal) stimuli were recorded in nine IBS patients. Colonic tone increased by 72±27% after injection of neostigmine and decreased by 88±62% after glucagon. After the meal, the maximal increase in colonic tone was 76±31% with the total response to the meal lasting 109.7±32.0 min. In the second part of the study, symptomatic responses (discomfort and pain thresholds) and pressure variations were evaluated during two different methods of distension (stepwise and intermittent) in a randomized order in the nine IBS patients and six healthy controls. Each distension method was repeated twice in IBS patients to study reproducibility. In IBS patients, the mean discomfort threshold volume was 172±76 ml when using stepwise and 167±43 ml when using intermittent distension. The mean pain threshold volume was 250±25 ml when using stepwise and 211±22 ml when using intermittent distension, this difference being statistically significant (P<0.02). Discomfort and pain threshold volumes recorded during the first session of the same distension method were not different from those recorded during the second one. When comparing IBS patients to controls, the pain threshold was reached at a volume ≤300 ml in all IBS patients versus only one control when using stepwise distensions (P<0.001) and in all IBS patients versus no control when using intermittent distensions (P<0.001). Intracolonic pressure-volume curves were similar in patients and controls. In conclusion, isovolumic distension of the colon is a reproducible method of evaluating viscerosensitivity, which is significantly increased in IBS patients. This increased viscerosensitivity is not related to abnormal colonic compliance and may, alone or in combination with other colonic abnormalities, explain the symptoms of irritable bowel syndrome.

Key words

colonic distension irritable bowel syndrome viscerosensitivity barostat colonic tone visceral thresholds 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Whitehead WE, Engle BJ, Schuster MM: Irritable bowel syndrome: physiological and psychological difference between diarrhea-predominant and constipation-predominant patients. Dig Dis Sci 35:404–413, 1980Google Scholar
  2. 2.
    Buéno L, Fioramonti J, Rukebusch Y, Frexinos J, Coulon P: Evaluation of colonic myoelectric activity in health and in functional disorders. Gut 21:480–485, 1985Google Scholar
  3. 3.
    Frexinos J, Fioramonti J, Buéno L: Colonic myoelectrical activity in IBS painless diarrhoea. Gut 28:1613–1618, 1987PubMedGoogle Scholar
  4. 4.
    Welgan P, Meshkinpour H, Beeler M: Effect of anger on colon motor and myoelectric activity in the irritable bowel syndrome. Gastroenterology 14:1150–1156, 1988Google Scholar
  5. 5.
    Camilleri M, Neri M: Motility disorders and stress. Dig Dis Sci 34:1777–1786, 1989PubMedGoogle Scholar
  6. 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, 1978PubMedGoogle Scholar
  7. 7.
    Bazzocchi G, Ellis J, Villanueva-Meyer J, Jing J, Reddy SN, Meno I, Snape WJ Jr: Postprandial colonic transit and motor activity in chronic constipation. Gastroenterology 98:686–693, 1990PubMedGoogle Scholar
  8. 8.
    Snape WJ Jr: Irritable bowel syndrome.In Functional Disorders of the Gastro-intestinal Tract. S Cohen, RD Soloway (eds). New York, Churchill Livingstone, 1987, pp 69–83Google Scholar
  9. 9.
    Bell AM, Pemberton JH, Hanson RB, Zinmeister AR: Variations in muscle tone of the human rectum: Recordings with an electromechanical barostat. Am J Physiol 260:G17-G25, 1991PubMedGoogle Scholar
  10. 10.
    Steadman CJ, Phillips SF, Camilleri M, Talley NJ, Haddad A, Hanson R: Control of muscle tone in the human colon. Gut 33:541–546, 1992PubMedGoogle Scholar
  11. 11.
    Aspiroz F, Malagelada JR: Physiological variations in canine gastric tone by an electronic barostat. Am J Physiol 248:G229-G237, 1985PubMedGoogle Scholar
  12. 12.
    Aspiroz F, Malagelada JR: Intestinal control of gastric tone. Am J Physiol 249:G501-G509, 1985PubMedGoogle Scholar
  13. 13.
    Aspiroz F, Malagelada JR: Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 92:934–943, 1987PubMedGoogle Scholar
  14. 14.
    Ritchie J: Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973PubMedGoogle Scholar
  15. 15.
    Swarbrich ET, Bat L, Hegorty JE, Williams CB: Site of pain from the irritable bowel. Lancet 0:443–446, 1980Google Scholar
  16. 16.
    Whitehead WE, Holtkotter B, Enck P, Hoelzi R, Homes KD, Anthony J, Shasbin HS, Schuster MM: Tolerance for rectosigmoid distension in irritable bowel syndrome. Gastroenterology 98:1187–1192, 1990PubMedGoogle Scholar
  17. 17.
    Ritchie J: Mechanisms of pain in irritable bowel syndrome.In Irritable Bowel Syndrome. NW Read (ed). Philadelphia, Grune and Stratton, 1985, pp 163–172Google Scholar
  18. 18.
    Dawson AM: Origin of pain in the irritable bowel syndrome.In Irritable Bowel Syndrome. NW Read (ed). Philadelphia, Grune and Stratton, 1985, pp 155–162Google Scholar
  19. 19.
    Bradette M, Paré P: Visceral perception in health and in functional dyspepsia. A cross-over study of gastric distension with placebo and domperidone. Dig Dis Sci 36:52–58, 1991PubMedGoogle Scholar
  20. 20.
    Lémann M, Dederding JP, Flourié B, Franchisseur C, Rambaud JC, Jian R: Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. Dig Dis Sci 36:1249–1254, 1991PubMedGoogle Scholar
  21. 21.
    Richter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986PubMedGoogle Scholar
  22. 22.
    De Caestecker JJ, Pryde A, Hedding RC: Site and mechanism of pain perception with oesophageal balloon distension and intravenous edrophonium in patients with oesophageal chest pain. Gut 33:580–586, 1992PubMedGoogle Scholar
  23. 23.
    Sun WM, Read NW, Prior A, Daly JA, Cheah SK, Grundy D: Sensory and motor responses to rectal distension vary according to rate and pattern of balloon inflation. Gastroenterology 99:1008–1015, 1990PubMedGoogle Scholar
  24. 24.
    Manning AP, Thompson WG, Heaton KW, Morris AF: Towards a positive diagnosis of the irritable bowel syndrome. Br Med J 2:653–654, 1978PubMedGoogle Scholar
  25. 25.
    Varma JS, Smith AN: Reproducibility of the proctometrogram. Gut 27:288–292, 1986PubMedGoogle Scholar
  26. 26.
    Kendall GPN, Thompson DG, Day SJ, Lennard-Jones JE: Inter-and intraindividual variation in pressure-volume relations of the rectum in normal subjects and patients with the irritable bowel syndrome. Gut 31:1062–1068, 1990PubMedGoogle Scholar
  27. 27.
    Blumberg H, Haupt P, Janig W, Kohler W: Encoding of visceral noxious stimuli in the discharge patterns of visceral afferent fibres from the colon. Pfluegers Arch 398:33–40, 1983Google Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • M. Bradette
    • 1
    • 2
  • M. Delvaux
    • 1
    • 2
  • G. Staumont
    • 1
    • 2
  • J. Fioramonti
    • 1
    • 2
  • L. Bueno
    • 1
    • 2
  • J. Frexinos
    • 1
    • 2
  1. 1.From the Laboratory of Digestive MotilityGastroenterology Unit, CHU RangueilToulouse
  2. 2.Department of PharmacologyINRAToulouseFrance

Personalised recommendations