[Effect of psychological factors on visceral sensation of patients with irritable bowel syndrome].Zhonghua Yi Xue Za Zhi. 2002 Mar; 82(5):308-11.ZY
To investigate the features of selective attention in patients with irritable bowel syndrome (IBS) and the effect of psychological hint on visceral sensation in IBS patients.
A set of 36 modified investigation cards originally developed for depression patients and including 12 cards describing gastrointestinal (GI) symptoms, 12 cards describing respiratory symptoms, and 12 cards with neutral terms, was used to investigate selective attention. 36 patients with diagnosis of IBS based on Rome II criteria, 23 patients with asthma, and 26 healthy volunteers, all without hemorrhoid, were asked to select one card from the set and put it in an envelop. A rectal balloon was inserted into the rectum of the examinees, then the balloon was inflated by pumping air so as to distend the rectum and the thresholds of initial filling sensation, evacuation sensation, urgent evacuation sensation, and utmost tolerance sensation were recorded. The examinees were asked to talk about something so as to divert their attention, and then examination of thresholds of rectal sensation and the time needed for diverting attention were recorded. After a rest for 5 approximately 10 minutes, the examinees were asked to fill the contents of selective attention they still remembered in a recording card. Then pictures of anatomy and pathology of colon were shown and conversation about gastrointestinal diseases was made to the examinees (as malignant stimuli) the changes of thresholds were recorded again.
More terms about GI diseases were selectively recalled by the IBS patients than by asthma patients and healthy controls (all P < 0.001). During rectal distention, IBS patients had lower thresholds of initial sensation (21 +/- 5 mm Hg), evacuation sensation (36 +/- 9 mm Hg), urgent evacuation sensation (51.3 +/- 14.2 mm Hg), and utmost tolerance sensation (67 +/- 17 mm Hg) in comparison with the other two groups (both P < 0.001). After diverting the examinees' attention by talking and reading, the thresholds of the above mentioned different kinds of sensation in different groups increased significantly as compared with the basic values (all P < 0.05), in particular, the threshold of initial sensation in IBS patients increased markedly (P < 0.01). Focusing the examinees' attention on GI stimuli by reading pictures of malignant gastrointestinal diseases significantly decreased the sensation thresholds in IBS patients (P < 0.05). However, no remarkable change in the thresholds was recorded in the nonpatients.
Selective attention of GI symptoms is the cognitive-behavioral characteristic of patients with IBS. Diverting the examinees' attention may decrease their response to stimuli. Psychological hint exerts significant influence on the rectal pain sensitivity of IBS patients. Psychotherapy may be helpful in treatment of IBS.