| 1. |
- Vanhoutvin, S. A. L. W., et al.
(författare)
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Alternative procedure to shorten rectal barostat procedure for the assessment of rectal compliance and visceral perception : a feasibility study
- 2012
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Ingår i: Journal of gastroenterology. - : Springer-Verlag Tokyo Inc.. - 0944-1174 .- 1435-5922. ; 47:8, s. 896-903
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Barostat methodology is widely used for assessing visceral perception. Different barostat protocols are described with respect to the measurement of rectal compliance and visceral perception. The choice of protocols affects the duration, which is normally 60-90 min, and accuracy of the procedure. This study aimed to shorten the procedure by using the semi-random distension protocol for both compliance and visceral perception measurement and a correction based on rectal capacity (RC) instead of minimal distension pressure (MDP).METHODS: Twelve irritable bowel syndrome (IBS) patients (7 females) and 11 healthy controls (8 females) underwent a barostat procedure. Compliance was determined during both a staircase distension and a semi-random protocol. Visceral perception data were compared as a function of pressure or relative volume, corrected for MDP or RC, respectively.RESULTS: Compliance measurement using the semi-random protocol instead of the staircase distension protocol resulted in an overestimation in healthy volunteers, but not in IBS patients. The overall conclusion that IBS patients had a lower compliance compared to controls was not different between protocols. Data presentation of the visceral perception scores as a function of corrected volume instead of pressures corrected for MDP did not alter the conclusion that sensation scores in IBS patients were higher as compared to healthy controls.CONCLUSIONS: This study showed that barostat procedures may be shortened by approximately 20 min, without losing the ability to discriminate between healthy controls and IBS patients. A correction for RC instead of MDP may improve the accuracy of the procedure.
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| 2. |
- Keszthelyi, D., et al.
(författare)
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Revisiting concepts of visceral nociception in irritable bowel syndrome
- 2012
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801. ; 16:10, s. 1444-1454
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Forskningsöversikt (refereegranskat)abstract
- Background and Objective Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal pain related to defecation with a change in bowel habit. Patients with IBS often exhibit increased visceral sensitivity, which can be tested clinically by rectal balloon distension procedures. This paper aims to give an overview of mechanisms involved in visceral hypersensitivity in IBS by reviewing recent literature. Databases and Data Treatment A literature search in the electronic databases Pubmed and MEDLINE was executed using the search terms visceral pain or visceral nociception or visceral hypersensitivity and irritable bowel syndrome. Both original articles and review articles were considered for data extraction. Results Recent advances in molecular neurophysiology provide knowledge to better understand the underlying mechanism in pain generation in the human gut, in particular, in IBS patients. Sensitization of peripheral nociceptive afferents, more specifically high-threshold afferents, has been proposed as one of the principle mechanism in the development of visceral hypersensitivity. On the other hand, central mechanisms also play an important role. In terms of clinical testing of visceral perception, considerable discrepancies remain, however, across different centres. Conclusion Alterations in the modulatory balance of pro- and antinociceptive central processing of noxious peripheral input may serve as in integrative hypothesis for explaining visceral hypersensitivity in IBS. Nevertheless, it remains troublesome to estimate the contribution of central and peripheral factors in visceral hypersensitivity, posing a challenge in determining effective therapeutic entities.
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