Background: Visceral hypersensitivity has been evidenced in patients with irritable bowel syndrome (IBS) but its mechanisms remain poorly elucidated. We investigated the spinal transmission of nociceptive signals in I...Background: Visceral hypersensitivity has been evidenced in patients with irritable bowel syndrome (IBS) but its mechanisms remain poorly elucidated. We investigated the spinal transmission of nociceptive signals in IBS patients by analysing the effects of rectal distensions on electromyographic recordings of the somatic nociceptive flexion (RIII) reflex, an objective index of spinal nociceptive processes. Methods: Fourteen IBS and 10 healthy volunteers were included in the study. Slow ramp (40 ml/min) and rapid phasic (900 ml/min, 10, 20, 30, and 40 mm Hg) rectal distensions were randomly performed while the RIII reflex evoked by electrical stimulation of the sural nerve at the ankle was continuously recorded from the ipsilateral biceps femoris. Results: In healthy volunteers, significant progressive inhibition of the RIII reflex was observed during slow ramp distension (61 (13)%of control values) while biphasic effects (facilitation and inhibition) were observed during rapid distensions. In contrast, in IBS patients, the RIII reflex was significantly facilitated during slow ramp distension (139 (15)%of control values) and inhibitions induced by rapid distensions were significantly reduced. Volumes of distension and rectal compliance were similar in both groups. Conclusions: Our results provide direct evidence that a hyperexcitability of spinal nociceptive processes is present in a large subgroup of IBS patients.展开更多
Background and Purpose: Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time,using radioisotope ...Background and Purpose: Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time,using radioisotope scintigraphy,in patients operated for ARA and experiencing constipation in the follow-up. The results were compared with transit time from children with true functional constipation. Methods: Twelve or 32 patients operated for ARA during the period 1994-2003 experienced mild or severe constipation (6 with high or intermediate form of ARA and 6 with low type) at follow-up. The mean age of this group was 5.8 years. Eighteen patients,mean age 6.7 years,with true functional constipation were studied as well. Colonic transit times were investigated using radioisotope scintigraphy. Normal values for colonic transit time were derived from historical controls. Radioisotope diethylenetriamine pentaacetic acid labelled with indium 111 was administered orally to determine a segmental colonic transit. Images of the abdomen have been taken at 6,24,48,and again at 72 hours,if radioactivity was not cleared from the colon. To quantify colonic transit,we calculated the geometric centre (GC) dividing the colon into anatomic regions. Results: According to normal controls,2 different type of delayed transit can be observed: (a) slow-transit constipation if GC at 48 hours is less than 4.1; (b) functional rectosigmoid obstruction (FRSO) if GC at 48 hours is 4.1 or more but less than 6.1 at 72 hours. Patients with functional constipation were divided into 2 groups: (a)-slow-transit constipation in 12 patients with a GC at 48 hours of 3.7 ± 0.5; (b) FRSO in 6 patients with a GC of 4.7 ± 0.04 and 5.02 at 48 and 72 hours,respectively. Patients operated for high ARA had values characteristic of FRSO with GC at 48 hours of 5.1 ± 0.8 and 4.75 ± 0.5 at 72 hours. In low ARA,the transit times were similar to the ones observed in patients with high ARA at 48 hours with a GC of 4.9 ± 0.5. Conclusions: Patients with ARA frequently have functional sequelae in the postoperative period such as constipation. According to our results,constipation seems to be secondary to segmental motility disorders limited to the rectosigmoid area,similar to constipated children with FRSO. No evidence of more gener-alised motility disturbance,as previously postulated,could be recorded.展开更多
文摘Background: Visceral hypersensitivity has been evidenced in patients with irritable bowel syndrome (IBS) but its mechanisms remain poorly elucidated. We investigated the spinal transmission of nociceptive signals in IBS patients by analysing the effects of rectal distensions on electromyographic recordings of the somatic nociceptive flexion (RIII) reflex, an objective index of spinal nociceptive processes. Methods: Fourteen IBS and 10 healthy volunteers were included in the study. Slow ramp (40 ml/min) and rapid phasic (900 ml/min, 10, 20, 30, and 40 mm Hg) rectal distensions were randomly performed while the RIII reflex evoked by electrical stimulation of the sural nerve at the ankle was continuously recorded from the ipsilateral biceps femoris. Results: In healthy volunteers, significant progressive inhibition of the RIII reflex was observed during slow ramp distension (61 (13)%of control values) while biphasic effects (facilitation and inhibition) were observed during rapid distensions. In contrast, in IBS patients, the RIII reflex was significantly facilitated during slow ramp distension (139 (15)%of control values) and inhibitions induced by rapid distensions were significantly reduced. Volumes of distension and rectal compliance were similar in both groups. Conclusions: Our results provide direct evidence that a hyperexcitability of spinal nociceptive processes is present in a large subgroup of IBS patients.
文摘Background and Purpose: Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time,using radioisotope scintigraphy,in patients operated for ARA and experiencing constipation in the follow-up. The results were compared with transit time from children with true functional constipation. Methods: Twelve or 32 patients operated for ARA during the period 1994-2003 experienced mild or severe constipation (6 with high or intermediate form of ARA and 6 with low type) at follow-up. The mean age of this group was 5.8 years. Eighteen patients,mean age 6.7 years,with true functional constipation were studied as well. Colonic transit times were investigated using radioisotope scintigraphy. Normal values for colonic transit time were derived from historical controls. Radioisotope diethylenetriamine pentaacetic acid labelled with indium 111 was administered orally to determine a segmental colonic transit. Images of the abdomen have been taken at 6,24,48,and again at 72 hours,if radioactivity was not cleared from the colon. To quantify colonic transit,we calculated the geometric centre (GC) dividing the colon into anatomic regions. Results: According to normal controls,2 different type of delayed transit can be observed: (a) slow-transit constipation if GC at 48 hours is less than 4.1; (b) functional rectosigmoid obstruction (FRSO) if GC at 48 hours is 4.1 or more but less than 6.1 at 72 hours. Patients with functional constipation were divided into 2 groups: (a)-slow-transit constipation in 12 patients with a GC at 48 hours of 3.7 ± 0.5; (b) FRSO in 6 patients with a GC of 4.7 ± 0.04 and 5.02 at 48 and 72 hours,respectively. Patients operated for high ARA had values characteristic of FRSO with GC at 48 hours of 5.1 ± 0.8 and 4.75 ± 0.5 at 72 hours. In low ARA,the transit times were similar to the ones observed in patients with high ARA at 48 hours with a GC of 4.9 ± 0.5. Conclusions: Patients with ARA frequently have functional sequelae in the postoperative period such as constipation. According to our results,constipation seems to be secondary to segmental motility disorders limited to the rectosigmoid area,similar to constipated children with FRSO. No evidence of more gener-alised motility disturbance,as previously postulated,could be recorded.
