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. 2000 Oct;47(4):497–505. doi: 10.1136/gut.47.4.497

Perceptual responses in patients with inflammatory and functional bowel disease

L Chang 1, J Munakata 1, E Mayer 1, M Schmulson 1, T Johnson 1, C Bernstein 1, L Saba 1, B Naliboff 1, P Anton 1, K Matin 1
PMCID: PMC1728092  PMID: 10986209

Abstract

BACKGROUND AND AIMS—Enhanced visceral sensitivity following a transient inflammatory process in the gut has been postulated as an aetiological mechanism of irritable bowel syndrome (IBS). In this study we compared perceptual responses to rectosigmoid distension in patients with mild chronic inflammation of the rectum (ulcerative colitis (UC)) and patients without mucosal inflammation (IBS) to determine if chronic low grade mucosal inflammation may be a plausible explanation for rectosigmoid hypersensitivity reported in both IBS and UC patients.
METHODS—UC disease activity was quantified using activity index scores. Perception thresholds for discomfort during rectosigmoid distension were compared between 11 UC patients with quiescent or mild disease activity, 18 IBS patients, and 13 healthy controls.
RESULTS—Although UC activity index scores negatively correlated with perceptual thresholds for discomfort (r=−0.76, p=0.016), UC patients had higher discomfort thresholds compared with IBS patients and controls before (p=0.02) and after (p<0.001) a noxious sigmoid conditioning stimulus.
CONCLUSIONS—Rectal perception was attenuated in UC but enhanced in IBS. In chronic mild inflammation, activation of antinociceptive mechanisms may prevent the development of visceral hyperalgesia. Low grade mucosal inflammation alone is unlikely to be responsible for symptoms in functional gastrointestinal disorders.


Keywords: ulcerative colitis; irritable bowel syndrome; abdominal pain

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Figure 1  .

Figure 1  

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Sequence of rectal and sigmoid distension paradigms. Rectal threshold tracking and tonic distension paradigms were performed before and after the sigmoid conditioning stimulus. This illustration does not represent the actual number of distensions given.

Figure 2  .

Figure 2  

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Correlation of ulcerative colitis activity index and rectal discomfort thresholds. Broken line indicates mean rectal discomfort threshold in normal controls.

Figure 3  .

Figure 3  

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Rectal discomfort thresholds in normal controls, and in patients with ulcerative colitis (UC) and inflammatory bowel disease (IBS) before (open columns) and after (filled columns) noxious sigmoid stimulus. (Bottom) Mean rectal discomfort thresholds are shown; *significant differences compared with the two other groups (p<0.05); †significant difference compared with IBS group. (Top) Individual rectal discomfort thresholds. In this and subsequent figures, values are mean (SEM).

Figure 4  .

Figure 4  

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Mean peak sensory ratings for perception of pressure during the initial pressure pulse of the noxious sigmoid stimulus in normal subjects, and in patients with ulcerative colitis (UC) and inflammatory bowel disease (IBS). *Significant difference compared with the two other groups (p<0.05).

Figure 5  .

Figure 5  

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Viscerosomatic referral areas to which healthy subjects and patients with ulcerative colitis (UC) and inflammatory bowel disease (IBS) referred their sensations in response to the tonic rectal stimulus before (left) and after (right) noxious sigmoid stimulus. *Significant difference compared with patients with IBS (p<0.05).

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