Patterns of colonic dismotility and visceral hypersensitivity at various clinical variants of irritable bowel syndrome

Aim of investigation. To evaluate motor function disorders of the large intestine and visceral hypersensitivity (VHS) role at various clinical variants of irritable bowel syndrome (IBS). Material and methods. Overall 120 IBS patients were studied. The age of patients varied from 18 to 52 years (mean 34±11,4 years). The diagnosis is verified by modern instrumental and laboratory diagnostic methods (colonoscopy with biopsy, abdominal ultrasonography etc.), and complied to Rome-III criteria. According to specified criteria, all patients were divided into groups according to prevailing symptoms. Twenty-four patients had constipation predominant IBS, 68 had diarrhea predominant variant of IBS, 28 had unclassified IBS variant. All patients underwent investigation of the background and stimulated colonic motility. The motor function of the colon was studied by solid-state catheter manometry method. The balloon-dilatation test was applied to studying of VHS. Results. Investigation of the large intestinal contractility has revealed that 118 of 120 patients had various disorders of colonic motor function. Several patterns of motor activity were determined according to the frequency of contractions: hypokinetic, hypokinetic with segmental contractions, proximal to distal regions contraction discoordination, normokinetic and hyperkinetic. Comparative analysis has revealed that in all patient groups hypokinetic type of motor activity prevails (57%) that indicates decrease of background motility of sigmoid, colon and rectum at IBS. Stimulated motility examination revealed also electric activity disorders of the colon as well. Sixty-five patients underwent balloon and dilatation test: in 40 of them (62%) signs of VHS of were found. Conclusions. Basal electrophysiologic signs of motor and evacuatory function disorders at different IBS variants were not revealed. Nevertheless causative relationship between large intestinal motility changes and disease symptoms is possible. Signs of VHS are found in the most of patients that proves an important role of this factor in the origin of IBS symptoms, especially - in constipation predominant variant.

синдром раздраженного кишеч-ника, моторика толстой кишки, висцеральная гиперчувствительность

1. Ардатская М.Д. Синдром раздраженного кишечника. Consilium medicum, 2010:60-5.

2. Баринов Э.Ф., Сулаева О.Н. Роль серотонина в физиологии и патологии желудочно-кишечного тракта. Рос журн гастроэнтерол гепатол колопроктол 2012; 21(2):4-13.

3. Ивашкин В.Т., Полуэктова Е.А. Синдром раздраженного кишечника: патофизиологические и клинические аспекты проблемы. Рос журн гастроэнтерол гепатол колопроктол 2015; 25(1):4-16.

4. Караулько И.В. Синдром раздраженного кишечника. Журн Гродненского гос мед ун-та 2011; 4(36).

5. Маев И.В., Черемушкин С.В. Синдром раздраженного кишечника: Пособие для врачей. М., 2012. 52 с.

6. Полуэктова Е.А., Кучумова С.Ю., Шептулин А.А., Ивашкин В.Т. Лечение синдрома раздраженного кишечника с позиций современных представлений о патогенезе заболевания. Рос журн гастроэнтерол гепатол колопроктол 2013; 23(1):57-65.

7. Трухманов А.С., Сторонова О.А., Ивашкин В.Т. Клиническое значение исследования двигательной функции пищеварительной системы: прошлое, настоящее, будущее. Рос журн гастроэнтерол гепатол колопроктол 2013; 23(5):4-14.

8. Шульпекова Ю.О. Патогенетическое значение ацетилхолина и возможности применения холинолитиков при синдроме раздраженного кишечника. Рос журн гастроэнтерол гепатол колопроктол 2011; 21(1):26-31.

9. Aziz Q., Thompson D.G. Brain-gut axis in health and disease. Gastroenterology 1998; 114:559-78.

10. Azpiroz F., Bouin M., Camilleri M., et al. Mechanisms of hypersensitivityin IBS and functional disorders. Neurogastroenterol Motil 2007; 19 (Suppl. 1):62-88.

11. Bueno L., Fioramonti J. Visceral perception: inflammatory and non-inflammatory mediators. Gut 2002; 51 (Suppl. 1):19-23.

12. Bueno L., Fioramonti J., Delvaux M. Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations. Gastroenterology 1997; 112:1714-43.

13. Camilleri M. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med 2012; 367:1626-35.

14. Chen A., Dworkin S., Haug J., Gehrig J. Human pain responsivity in a tonic pain model: phycological determinants. Pain 1989; 37:143-60.

15. Cooke H.J. Neurotransmitters in neuronal reflexes regulating intestinal secretion. Ann N Y Acad Sci 2000; 915:77-80.

16. Crowell M.D. Role of serotonin in the pathophysiology of the irritable bowel syndrome. Br J Pharmacol 2004; 141:1285-93.

17. Dean B.B., Aguilar D., Barghout V., Kahler K.H., Frech F., Groves D., Ofman J.J. Impairment in work productivity and health-related quality of life in patients with IBS. Am J Manag Care 2005; 11:17-26.

18. Drossman D.A., Corrazziari E., Delvaux M., Spiller R., Talley N.J., Thompson W.G. Rome III: The functional gastrointestinal disorders. McLean, VA: Degnon Associates; 2006.

19. Elenkov U., Wilder R.L., Chrousos G.P. The sympathetic nerve-an integrative interface between two supersystems: the brain and immune system. Pharmacol Rev 2000; 52:585-638.

20. Gershon M.D. The enteric nervous system: a second brain. Hosp Pract. 1996;34:31-42.

21. Hobson A.R., Aziz Q. Central nervous system processing of human visceral pain in health and disease. New Physiol Sci 2003; 18:109-14.

22. Karantanos T., Markoutsaki T., Gazouli M., Anagnou N.P, Karamanolis D.G. Current insights in to the pathophysiology of irritable bowel syndrome. Gut Pathog 2010; 2:3. Published online 2010 May 13.

23. Lee O.Y. Asian motility studies in irritable bowel syndrome. J Neurogastroenterol Motil 2010;16:120-30.

24. Levy R.L., Jones K.R., Whitehead W.E., et al. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology 2001:121:799-804.

25. Likun Zhong, Xiaohua Hou. Pathophysiologic findings of irritable bowel syndrome in China. J Neurogastroenterol Motil 2012; 18(1):19-33.

26. Magdy El-Salhy. Irritable bowel syndrome: Diagnosis and pathogenesis. World J Gastroenterol 2012; 18(37):5151-63.

27. Mayer E.A., Chang L., Lembo T. Brain-gut interactions: implications for newer therapy. Eur J Surg 1998; (Suppl.) 582:50-5.

28. Mayer E.A, Gebhart G.F. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994; 107:271-93.

29. Munakata J., Mayer E.A., Chang L., et al. Autonomic and neuroendocrine responses to recto-sigmoid stimulation. Gastroenterology 1998;114:808.

30. Posserud I., Ersryd A., Simrén M. Functional findings in irritable bowel syndrome. World J Gastroenterol 2006; 12(18):2830-8.

31. Sarna S.K. Physiology and pathophysiology of colonic motor activity. Dig Dis Sci 1991; 36:827-62.

32. Spiller R., Aziz Q., Creed F., Emmanuel A., Houghton L., Hungin P., Jones R., Kumar D., Rubin G., Trudgill N., Whorwell P. Guidelines on the irritable bowel syndrome: mechanisms and practical management. J List Gut 2007; 56(12):1770-98.

33. Tracey D.J., Walker J.S. Pain due to nerve damage: are inflammatory mediators involved? Inflamm Res 1995; 44:407-11.

34. Yan Chi, Xin-Guang Liu, Hua-Hong Wang, Jun-Xia Li, Yi-Xuan Li. Effect of the 5-HT4 receptor and serotonin transporter on visceral hypersensitivity in rats. Braz J Med Biol Res 2012; 45(10):948-54.

35. Yoo Jin Lee, Kyung Sik Park. Irritable bowel syndrome: Emerging paradigm in pathophysiology. World J Gastroenterol 2014; 20(10):2456-69.