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PubMed1998

Scope of the problem of functional digestive disorders.

Functional dyspepsia and the irritable bowel syndrome (IBS) are amongst the most widely recognised functional gastrointestinal disorders. Symptom based diagnostic criteria have been developed and refined for the syndromes (the Rome criteria) and these are now widely applied in clinical research. Both functional dyspepsia and IBS are remarkably prevalent in the general population, affecting approximately 20% and 10% of persons, respectively. The prevalence is stable from year to year because the onset of these disorders is balanced by their disappearance in the population. Clinically useful predictors of the course of these disorders have not been identified. Approximately one third of persons with functional dyspepsia concurrently have IBS. In most studies from Western countries, it has been shown that only a minority with functional dyspepsia and IBS present for medical care; the factors that explain consultation behaviour remain inadequately defined although fear of serious disease and psychological distress may be important. The majority of patients diagnosed as having functional dyspepsia or IBS continue to have symptoms long term with a significant impact on quality of life. The indirect costs of the functional gastrointestinal disorders greatly outweigh the direct costs but overall these conditions are responsible for a major proportion of health care consumption. Rational management of the functional gastrointestinal disorders will only follow a better understanding of the natural history of these conditions.

Colonic Diseases, Functional↗
PubMed1990

Role of visceral afferent mechanisms in functional bowel disorders.

This report analyzes the clinical and physiological evidence supporting a role for altered visceral afferent mechanisms in the pathogenesis of two functional bowel syndromes: noncardiac chest pain and the irritable bowel syndrome. Considerable recent evidence indicates that increased contractility is present only in a minority of patients and that hypercontractile episodes are not temporally related to abdominal pain. In contrast, altered sensation and motor reflexes in response to physiological stimuli, such as mechanical distention or acid, is common when appropriately investigated. The vagal and spinal afferent innervation mediates visceral sensation and is involved in multiple reflex loops regulating gastrointestinal effector function, such as motility and secretion. Sensory input can be modulated peripherally at the afferent nerve terminal, at the level of prevertebral ganglia, the spinal cord, and the brainstem. An up-regulation of afferent mechanisms would result both in altered conscious perception of physiological stimuli and in altered motor reflexes. Current evidence is consistent with an alteration in the peripheral functioning of visceral afferents and/or in the central processing of afferent information in the etiology of altered somatovisceral sensation and motor function observed in patients with functional bowel disease.

Afferent Pathways↗
PubMed2000

Gastrointestinal symptoms and subjects cluster into distinct upper and lower groupings in the community: a four nations study.

OBJECTIVE: It is unknown whether distinct functional GI (GI) symptom groupings occur in the general population and whether these are similar across different cultures. Although symptom-based diagnostic criteria have been developed for upper and lower GI syndromes (the Rome criteria), the classification is controversial. We aimed to identify whether independent symptom-based subgroups exist in four countries consistent with the Rome criteria. METHODS: Random samples of the community were mailed a validated questionnaire based on the Bowel Disease Questionnaire in Rochester, MN (n = 2,220), in Sydney, Australia (n = 1,135), and in Essen, Germany (n = 500). A different validated questionnaire was mailed to a random sample in Osthammar, Sweden (n = 1,517). Only the common questions (n = 22) were used in the current analysis, and these were essentially identical in wording. The underlying structure of the item responses was examined using factor analysis. Initial factors were extracted using principal components analysis and then rotated using Varimax. Clustering of symptoms among individuals was examined though cluster analysis, using the factors as the basis for clustering. RESULTS: Response rates varied from 64% to 80%; responders and nonresponders were similar sociodemographically. All four studies yielded similar factor structures. All countries reported symptom groupings consistent with the irritable bowel syndrome (IBS), dyspepsia and/or gastroesophageal reflux, and constipation; all except Sweden also had a diarrhea group. The cluster analysis yielded slightly more disparate results but a healthy group was present in all populations. All four populations had an IBS and/or bowel dysfunction cluster identified; a gastroesophageal reflux cluster was also present in all countries. CONCLUSIONS: The similarity of factor and cluster structures found in these four nations suggest that patterns of GI symptoms and groupings of individuals are similar across these Western cultures. These results are consistent with the current international Rome classification for separate upper and lower functional GI disorders.

Adult↗
PubMed1986

Circadian variation in the propagation velocity of the migrating motor complex.

Using twin intraluminal pressure-sensitive radiotelemetric capsules for prolonged monitoring of proximal small bowel motility in healthy volunteers, we observed a significant (p less than 0.001) variation between daytime (6.44 +/- 0.74 cm/min, mean +/- SD) and nocturnal (2.90 +/- 0.35 cm/min) propagation velocities of the migrating motor complex. An identical variation in propagation velocity was observed in patients suffering from the irritable bowel syndrome. These data suggested a circadian variation, but did not exclude alternative hypotheses. Data were therefore compiled from healthy sheep and pigs supplied with ad libitum rations each morning and adapted to a 12 h light, 12 h dark schedule. Recording from implanted electrodes showed a significant (p less than 0.01) reduction in migrating motor complex velocity from 27.8 +/- 5.1 cm/min by day to 16.7 +/- 3.1 cm/min at night in sheep, and from 20.6 +/- 2.4 to 13.4 +/- 1.9 cm/min in pigs. The nocturnal reduction remained when the animals were fed in the evening. These observations suggest a circadian variation in mammalian migrating motor complex propagation velocity that is not merely a function of variation in intraluminal content.

Animals↗
PubMed1998

A study of intestinal dysfunction induced by restraint stress in rats.

BACKGROUND: The pathogenesis of intestinal dysfunction induced by stress has not been established. We tried to clarify possible causal mechanisms of irritable bowel syndrome. METHODS: An experimental model of intestinal dysfunction was designed using loading restraint stress in rats. A cannula was inserted into the origin of the duodenum or colon, with the other end leading to the skin. To provide intestinal content, a semi-solid colored marker was used for monitoring intestinal transit. After 1 week the marker was injected into the intestine through the cannula under unanesthetized wakefulness. RESULTS: Under restraint stress, transit in the small intestine was suppressed, but actual suppression took place only in the upper half, where the contents normally moved fast. Transit time in the colon was reduced by restraint stress. This reduction was attributed to the disappearance of the stagnant region, which was present under normal conditions. CONCLUSIONS: These results suggested that restraint stress affects the function of the pacemaker site of the intestine.

Animals↗
PubMed1999

Abdominal symptoms are not related to anorectal function in the irritable bowel syndrome.

BACKGROUND: The pathophysiologic significance of altered intestinal motility and perception in irritable bowel syndrome (IBS) is unclear, as a consistent association with abdominal symptoms has not been proved. Our aim was to investigate the association between abdominal symptoms and anorectal function in IBS. METHODS: Fifty-two patients recorded their symptoms daily for I week. At the end of the week anorectal function was investigated by manovolumetry before and after a standardized fatty meal. Cluster analysis of daily recorded symptoms and both pre- and postprandial manovolumetric data was performed to identify symptom and physiologic subgroups. RESULTS: Symptom subgroups did not differ with regard to anorectal function. Physiologic subgroups did not differ with regard to daily recorded symptoms. Postprandially, the thresholds eliciting maximal tolerable distention were decreased in 22 of the patients. This increase in rectal sensitivity was not related to symptoms and may have been caused by the preprandial anorectal measurement, since thresholds for maximal tolerable distention decreased significantly in nine patients retested without an intervening meal. CONCLUSIONS: Abdominal symptoms and anorectal function are not related in IBS.

Adult↗
PubMed1994

Clinical implications of visceral hyperalgesia.

Based on clinical experience and our understanding of chronic pain, both affective and sensory pathways may be involved in the visceral hyperalgesia seen in most patients with functional bowel disorders. This new awareness has changed the focus of treatment.

Colonic Diseases, Functional↗
PubMed1998

The constipated stomach. An underdiagnosed problem in patients with abdominal pain?

The number of dyspeptic patients with upper abdominal pain that are referred for investigation is increasing and will undoubtedly continue to increase, because these days peptic ulcer disease is increasingly becoming a primary care management issue, the specialist being left to deal with the patients who cannot be helped by antibiotics and antisecretory drugs prescribed by their general practitioner. Many of these patients are referred for an upper endoscopy to rule out organic disease. Carefully taken history, however, shows that a great number of those dyspeptics, on the basis of their clinical manifestations, do have a functional gastrointestinal disorder, representing the 'irritable gut'. A probable better term reflecting the direct relation is the syndrome of 'the constipated stomach'. In our opinion these patients are an important and increasing clinical problem for general practitioners, gastroenterologists, surgeons and physicians. The aim of this article is to make the practitioner aware of advancements in understanding pathophysiologic and psychosocial processes, as well as to give an overview of the great overlap between many functional gastrointestinal disorders, the important role of history-taking and some insights into the functional rectal outlet syndrome.

Abdominal Pain↗
PubMed1995

Impact of functional dyspepsia on quality of life.

Little information on functional status and well-being is available in patients with functional gastrointestinal disease. We aimed to evaluate whether quality of life is poorer in patients with functional dyspepsia. A consecutive sample of 73 patients with functional dyspepsia completed a validated questionnaire prior to endoscopy. Organic disease controls comprised 658 outpatients attending endoscopy. Quality of life was measured using the validated Medical Outcomes Survey (which assessed physical, role, and social functioning; mental health; health perception; and any bodily pain) and the Brief Symptom Inventory (for current anxiety and depression); additional specific gastrointestinal items were also included. A stepwise logistic regression analysis was used to assess the association between diagnostic group and the quality of life measures, adjusting for potential confounders. Patients who reported more interruptions in their daily activities due to abdominal pain and who had fewer limitations of physical functioning were more likely to have functional dyspepsia (vs other disease, P < 0.01). Mental health, social functioning, and health perception also tended to be poorer in functional dyspepsia. We conclude that quality of life may be more impaired in patients with functional dyspepsia than in patients with other conditions who present for upper endoscopy.

Activities of Daily Living↗