Gastroenterology
Volume 134, Issue 7 , Pages 1882-1889 , June 2008

Bloating and Distention in Irritable Bowel Syndrome: The Role of Visceral Sensation

  • Anurag Agrawal

      Affiliations

    • Neurogastroenterology Unit, University of Manchester, Manchester
  • ,
  • Lesley A. Houghton

      Affiliations

    • Neurogastroenterology Unit, University of Manchester, Manchester
    • Corresponding Author InformationAddress requests for reprints to: L. A. Houghton, MD, Neurogastroenterology Unit, University of Manchester, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LR, United Kingdom. fax: (44) 161 291 4184.
  • ,
  • Richard Lea

      Affiliations

    • Neurogastroenterology Unit, University of Manchester, Manchester
  • ,
  • Julie Morris

      Affiliations

    • Department of Medical Statistics, Wythenshawe Hospital, Manchester
  • ,
  • Brian Reilly

      Affiliations

    • Department of Medical Physics, Wythenshawe Hospital, Manchester, United Kingdom
  • ,
  • Peter J. Whorwell

      Affiliations

    • Neurogastroenterology Unit, University of Manchester, Manchester

Received 8 August 2007 ,Accepted 28 February 2008.

References 

  1. Houghton LA, Lea R, Agrawal A, et al. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003–1010
  2. Chang L, Lee OY, Naliboff B, et al. Sensation of bloating and visible abdominal distention in patients with irritable bowel syndrome. Am J Gastroenterol. 2001;96:3341–3347
  3. Lembo T, Naliboff B, Munakata J, et al. Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome. Am J Gastroenterol. 1999;94:1320–1326
  4. Lewis MJ, Reilly B, Houghton LA, et al. Ambulatory abdominal inductance plethysmography: towards objective assessment of abdominal distension in irritable bowel syndrome. Gut. 2001;48:216–220
  5. Reilly BP, Bolton M, Lewis MJ, et al. A device for 24-hour ambulatory monitoring of abdominal girth using inductive plethysmography. Physiol Meas. 2002;23:661–670
  6. Houghton LA, Whorwell PJ. Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders. Neurogastroenterol Motil. 2005;17:500–511
  7. Azpiroz F, Malagelada JR. Abdominal bloating. Gastroenterology. 2005;129:1060–1078
  8. Mertz H, Naliboff B, Munakata J, et al. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109:40–52
  9. Bouin M, Plourde V, Boivin M, et al. Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology. 2002;122:1771–1777
  10. Hammonds R, Houghton LA, Whorwell PJ. Urge and no-urge constipation predominant irritable bowel syndrome (IBS): sensory dysfunction of the whole gut. Gastroenterology. 2000;118(Suppl 2):830
  11. Harraf F, Schmulson M, Saba L, et al. Sub-types of constipation predominant irritable bowel syndrome based on rectal perception. Gut. 1998;43:388–394
  12. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(Suppl 2):1143–1147
  13. Whitehead WE, Delvaux M Working Team. Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. Dig Dis Sci. 1997;42:223–241
  14. Thumshirn M, Camilleri M, Choi M-G, et al. Modulation of gastric sensory and motor functions by nitrergic and α-2 adrenergic agents in humans. Gastroenterology. 1999;116:573–585
  15. Houghton LA, Lea R, Jackson N, et al. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut. 2002;50:471–474
  16. Lembo T, Munakata J, Mertz H, et al. Evidence for hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. Gastroenterology. 1994;107:1686–1696
  17. Jackson NA, Houghton LA, Whorwell PJ, et al. Does the menstrual cycle affect anorectal physiology?. Dig Dis Sci. 1994;39:2607–2611
  18. Lea R, Houghton LA, Calvert E, et al. Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:635–642
  19. Lasser RB, Bond JH, Levitt MD. Role of intestinal gas in functional abdominal pain. N Engl J Med. 1975;293:524–526
  20. Maxton DG, Martin DF, Whorwell PJ, et al. Abdominal distension in female patients with irritable bowel syndrome: exploration of possible mechanisms. Gut. 1991;32:662–664
  21. Serra J, Azpiroz F, Malagelada JR. Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut. 2001;48:14–19
  22. Serra J, Azpiroz F, Malagelada JR. Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation. Am J Physiol Gastrointest Liver Physiol. 2001;281:G138–G143
  23. Tremolaterra F, Villoria A, Serra J, et al. Intestinal tone and gas motion. Neurogastroenterol Motil. 2006;18:905–910
  24. Salvioli B, Serra J, Azpiroz F, et al. Origin of gas retention and symptoms in patients with bloating. Gastroenterology. 2005;128:574–579
  25. McManis PG, Newall D, Talley NJ. Abdominal wall muscle activity in irritable bowel syndrome with bloating. Am J Gastroenterol. 2001;96:1139–1142
  26. Tremolaterra F, Villoria A, Azpiroz F, et al. Impaired viscerosomatic reflexes and abdominal-wall dystony associated with bloating. Gastroenterology. 2006;130:1062–1068
  27. Francis CY, Houghton LA, Whorwell PJ, et al. Enhanced sensitivity of the whole gut in patients with irritable bowel syndrome (abstr). Gastroenterology. 1995;108:601
  28. Marcus SN, Heaton KW. Irritable bowel type symptoms in spontaneous and induced constipation. Gut. 1987;28:156–159
  29. Heaton KW, Parker D, Cripps H. Bowel function and irritable bowel syndrome after hysterectomy and cholecystectomy—a population-based study. Gut. 1993;34:1108–1111
  30. Varma JS, Smith AN. Abnormalities of colo-rectal function in intractable constipation following hysterectomy. Gut. 1985;26:581–582
  31. Prior A, Stanley KM, Smith AR, et al. Effect of hysterectomy on anorectal and urethrovesical physiology. Gut. 1992;33:264–267
  32. Roe AM, Bartolo DCC, McMortensen NJ. Slow transit constipation (Comparison between patients with or without previous hysterectomy). Dig Dis Sci. 1988;33:1159–1163
  33. Muller-Lissner SA, Fumagalli I, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655–1666
  34. Novick J, Miner P, Krause R, et al. A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2002;16:1877–1888
  35. Whorwell PJ, Ruegg P, Earnest D, et al. Tegaserod significantly improves bloating in female irritable bowel syndrome patients with constipation. Gastroenterology. 2004;126:A643
  36. Houghton LA, Fell C, Whorwell PJ, et al. Effect of a second-generation α2δ ligand (pregabalin) on visceral sensation in hypersensitive patients with irritable bowel syndrome. Gut. 2007;56:1218–1225
  37. Poitras P, Riberdy Poitras M, Plourde V, et al. Evolution of visceral sensitivity in patients with irritable bowel syndrome. Dig Dis Sci. 2002;47:914–920
  38. Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 1984;2:1232–1234
  39. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large scale audit of a clinical service with an examination of factors influencing responsiveness. Am J Gastroenterol. 2002;97:954–961
  40. Gonsalkorale WM, Miller V, Afzal A, et al. Long-term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52:1623–1629
  41. Rainville P, Duncan GH, Price DD, et al. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science. 1997;277:968–971

 Supported in part by an educational grant from Novartis Pharmaceuticals, Basal, Switzerland.Conflicts of interest and financial disclosure: Professor P. J. Whorwell and Dr L. A. Houghton have received remuneration for advice, and their department has also received financial support from Novartis Pharmaceuticals, GlaxoSmithKline, Pfizer, Solvay Pharmaceuticals, Rotta Research, Procter and Gamble, Danone Research, Astellas Pharma, and Tillots Pharma. Dr A. Agrawal, Dr R. Lea, J. Morris, and B. Reilly have no conflicts of interest to disclose.

PII: S0016-5085(08)00433-2

doi: 10.1053/j.gastro.2008.02.096

Gastroenterology
Volume 134, Issue 7 , Pages 1882-1889 , June 2008