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Role of colonic fermentation in the perception of colonic distention in irritable bowel syndrome and functional bloating.
Clin Gastroenterol Hepatol. 2006 Oct; 4(10):1242-7.CG

Abstract

BACKGROUND & AIMS

Bloating represents a frequent gastrointestinal symptom, but the pathophysiologic mechanism responsible for its onset is still largely unknown. Patients very frequently attribute the sensation of bloating to the presence of excessive bowel gas, but not all patients with gas-related symptoms exhibit increased intestinal production of gas. It is therefore possible that other still unrecognized mechanisms might contribute to its pathophysiology. Our aim was to evaluate whether a subgroup of patients affected by functional abdominal bloating presents hypersensitivity to colonic fermentation.

METHODS

Sixty patients affected by functional gastrointestinal disorders (11 functional bloating, 36 constipation-predominant, and 13 diarrhea-predominant irritable bowel syndrome) and moderate to severe bloating took part in the study. Twenty sex- and age-matched healthy volunteers were enrolled as a control group. All the subjects underwent a preliminary evaluation of breath hydrogen excretion after oral lactulose. Then, on a separate day, an evaluation of sensitivity thresholds at rectal level was performed with a barostat before and after the induction of colonic fermentation with oral lactulose. A control test with electrolyte solution was also performed.

RESULTS

Both breath hydrogen excretion and mouth-to-cecum transit time did not differ between the 4 groups studied. Neither electrolyte solution nor lactulose modified sensitivity thresholds in healthy volunteers. In low hydrogen producers, basal perception and discomfort thresholds were similar to high hydrogen producers, but after lactulose both perception and discomfort thresholds were significantly reduced only in low hydrogen producers.

CONCLUSIONS

A subgroup of patients with functional gastrointestinal disorders and moderate to severe bloating might have hypersensitivity to products of colonic fermentation.

Authors+Show Affiliations

Department of Medicine, IRCCS S. Matteo Hospital, University of Pavia, Pavia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16979386

Citation

Di Stefano, Michele, et al. "Role of Colonic Fermentation in the Perception of Colonic Distention in Irritable Bowel Syndrome and Functional Bloating." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 4, no. 10, 2006, pp. 1242-7.
Di Stefano M, Miceli E, Missanelli A, et al. Role of colonic fermentation in the perception of colonic distention in irritable bowel syndrome and functional bloating. Clin Gastroenterol Hepatol. 2006;4(10):1242-7.
Di Stefano, M., Miceli, E., Missanelli, A., Mazzocchi, S., Tana, P., & Corazza, G. R. (2006). Role of colonic fermentation in the perception of colonic distention in irritable bowel syndrome and functional bloating. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 4(10), 1242-7.
Di Stefano M, et al. Role of Colonic Fermentation in the Perception of Colonic Distention in Irritable Bowel Syndrome and Functional Bloating. Clin Gastroenterol Hepatol. 2006;4(10):1242-7. PubMed PMID: 16979386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of colonic fermentation in the perception of colonic distention in irritable bowel syndrome and functional bloating. AU - Di Stefano,Michele, AU - Miceli,Emanuela, AU - Missanelli,Antonio, AU - Mazzocchi,Samanta, AU - Tana,Paola, AU - Corazza,Gino Roberto, Y1 - 2006/09/18/ PY - 2006/9/19/pubmed PY - 2007/1/11/medline PY - 2006/9/19/entrez SP - 1242 EP - 7 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 4 IS - 10 N2 - BACKGROUND & AIMS: Bloating represents a frequent gastrointestinal symptom, but the pathophysiologic mechanism responsible for its onset is still largely unknown. Patients very frequently attribute the sensation of bloating to the presence of excessive bowel gas, but not all patients with gas-related symptoms exhibit increased intestinal production of gas. It is therefore possible that other still unrecognized mechanisms might contribute to its pathophysiology. Our aim was to evaluate whether a subgroup of patients affected by functional abdominal bloating presents hypersensitivity to colonic fermentation. METHODS: Sixty patients affected by functional gastrointestinal disorders (11 functional bloating, 36 constipation-predominant, and 13 diarrhea-predominant irritable bowel syndrome) and moderate to severe bloating took part in the study. Twenty sex- and age-matched healthy volunteers were enrolled as a control group. All the subjects underwent a preliminary evaluation of breath hydrogen excretion after oral lactulose. Then, on a separate day, an evaluation of sensitivity thresholds at rectal level was performed with a barostat before and after the induction of colonic fermentation with oral lactulose. A control test with electrolyte solution was also performed. RESULTS: Both breath hydrogen excretion and mouth-to-cecum transit time did not differ between the 4 groups studied. Neither electrolyte solution nor lactulose modified sensitivity thresholds in healthy volunteers. In low hydrogen producers, basal perception and discomfort thresholds were similar to high hydrogen producers, but after lactulose both perception and discomfort thresholds were significantly reduced only in low hydrogen producers. CONCLUSIONS: A subgroup of patients with functional gastrointestinal disorders and moderate to severe bloating might have hypersensitivity to products of colonic fermentation. SN - 1542-3565 UR - https://www.unboundmedicine.com/medline/citation/16979386/Role_of_colonic_fermentation_in_the_perception_of_colonic_distention_in_irritable_bowel_syndrome_and_functional_bloating_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(06)00715-4 DB - PRIME DP - Unbound Medicine ER -