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Abdominal symptoms and anorectal function in outpatients with the irritable bowel syndrome (IBS)
Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Two samples of outpatients with the irritable bowel syndrome and 12 healthy controls were studied regarding abdominal symptoms and pre- and postprandial anorectal function. Symptoms were assessed using diary cards and anorectal function by manovolumetfY. Our aim was to study the temporal relationship between pain and eating or defecation, what patients mean by constipation and diarrhoea, symptom variation, the relation between symptoms and anorectal function, to identify symptom subgroups and to compare patients with healthy controls regarding symptoms and anorectal function.

Sixty-three patients (Sample I) recorded their symptoms daily over a period of six weeks. At fortnightly follow-up visits they were asked to define their bowel habits as constipation, diarrhoea, normal or any combination of these the preceding fortnight. These statements were compared with the diary cards. According to the diary cards about 50% of each patient's pain episodes became worse after eating and about 10% were relieved by defecation. Constipation was defined as hard stools and diarrhoea as loose stools and urgency. Stool frequency was similar. Pain decreased slightly but other symptoms remained unchanged. Fifty-two patients (Sample II) and 12 healthy controls kept daily records of their symptoms over a period of one week. At the end of this week anorectal function was investigated before and after a standardised fatty meal.

Cluster analysis of the diary cards detected similar subgroups in both samples. Two pain/bloating subgroups, one characterised by a considerable and the other by a low burden of pain and bloating. Three bowel habit subgroups, one characterised by hard stools, variable stool consistency and frequent straining and feeling of incomplete evacuation, the second by loose and urgent stools and the third by normal consistency stools and the least disturbed stool passage. There was no association between the degree of bloating and the type of bowel habit. Stool frequency was within the normal range in the subgroups of both samples.

Thiny-seven of the 63 patients from Sample I repeated symptom recording over a period of two weeks seven years later. During the seven-year period and at follow up the majority of patients were symptomatic. According to the daily records pain and straining decreased while normal stools increased between study periods. Abdominal symptoms remained otherwise unchanged. The symptom subgroups (clusters) were similarly distinguished from each other in both study periods.

Irrespective of subgroup placement the patients from Sample II recorded more pain, bloating and stools with straining and feeling of incomplete evacuation than the controls. About 50% of the patients had a lower baseline (preprandial) threshold for maximal tolerable distension than the controls. This rectal hypersensitivity was most prevalent in the bowel habit subgroup characterised by hard stools, variable stool consistency, straining and feeling of incomplete evacuation. Otherwise no relationship between abdominal symptoms and anorectal function was found. The threshold for maximal tolerable distension showed a significant and similar postprandial decrease in the patients and controls. Other manovolumetric variables remained unchanged.

These studies show that pain is temporally related to eating but not to defecation. Patients define constipation and diarrhoea on the basis of stool consistency, not frequency, which is within the normal range in the majority of patients. Patients can be divided into subgroups and the symptoms remain fairly unchanged over time. Compared with controls the patients are distinguished by pain, bloating and stools with straining and feeling of incomplete evacuation. Baseline rectal hypersensitivity is associated with constipation-like bowel habits. Postprandial decrease in maximal tolerable distension is a normal phenomenon and seem to play no role in the genesis of symptoms.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 40 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 651
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28626Local ID: 13782ISBN: 91-7219-752-8 (print)OAI: oai:DiVA.org:liu-28626DiVA: diva2:249437
Public defence
2000-11-24, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-08-16Bibliographically approved
List of papers
1. Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS): Patients' description of diarrhoea, constipation and symptom variation during a prospective 6-week study
Open this publication in new window or tab >>Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS): Patients' description of diarrhoea, constipation and symptom variation during a prospective 6-week study
1998 (English)In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 10, no 5, 415-421 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the intensity and variation of pain and its temporal relation to eating and defaecation. Furthermore, what irritable bowel (IBS) patients mean by constipation and diarrhea and how bowel symptoms vary.

DESIGN: Prospective daily symptom recording over 6 weeks.

SETTING: The primary catchment area of University Hospital of Linköping.

PARTICIPANTS: Eighty consecutive patients fulfilling the Rome criteria; 63 finished the study.

RESULTS: Fifty-nine of 63 patients recorded an average of 29 pain periods and 24 days with pain during the 6 weeks. Over-all pain burden decreased slightly over the study period. At inclusion 38 (64%) patients claimed that pain was relieved by defaecation. However, on average, only 10% of each patient's recorded pain periods were relieved by defaecation. At inclusion 29 (49%) patients claimed postprandial worsening of pain. On average, 50% of each patient's recorded pain periods worsened postprandially. The patients defined constipation as hard stools and diarrhea as loose stools and urgency. Stool frequency did not differ. Bowel symptoms varied within, but not between, fortnightly periods.

CONCLUSIONS: Postprandial worsening of pain should be included as a criterion in the clinical definition of IBS while the criterion 'pain relieved by defaecation' should be re-evaluated. IBS patients can probably be divided into subgroups based on stool consistency, not frequency. Daily records are superior to structured clinical interviews or questionnaires for a detailed study of symptoms in IBS.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79967 (URN)10.1097/00042737-199805000-00011 (DOI)9619389 (PubMedID)
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2017-12-07Bibliographically approved
2. Division of the Irritable Bowel Syndrome into Subgroups on the Basis of Daily Recorded Symptoms in Two Outpatient Samples
Open this publication in new window or tab >>Division of the Irritable Bowel Syndrome into Subgroups on the Basis of Daily Recorded Symptoms in Two Outpatient Samples
1999 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 34, no 10, 993-1000 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: If subgroups exist in a sample of patients with irritable bowel syndrome (IBS), they may represent different etiologic and pathophysiologic entities. Our aim was to identify subgroups on the basis of symptoms in IBS.

METHODS: Two independent groups of 56 (sample I) and 52 (sample II) outpatients recorded their abdominal symptoms daily for 6 weeks and 1 week, respectively. The daily records were assessed by using cluster analysis.

RESULTS: Similar subgroups appeared in both samples. Three bowel habit subgroups were identified. The first was distinguished by hard stools, varying stool consistency, and highly disturbed stool passage, the second by loose stools and urgency, and the third by normal stools and the least disturbed stool passage. Two pain/bloating subgroups were identified, one distinguished by little and the other by considerable pain and bloating. No relation was found between pain/bloating and bowel habit subgroup membership. Most patients had stool frequency within the normal range regardless of subgroup. In sample I the subgroups had stable symptoms during the study, and subgroup placement was not related to the presence of dyspepsia, smoking habits, or use of bulk agent and/or sporadic intake of loperamide. The degree of pain and bloating was inversely related to illness duration.

CONCLUSIONS: Subgroups exist in IBS. Division of IBS into bowel habit subgroups should be based on stool consistency, not frequency. Mechanisms mediating pain and bloating may be different from those mediating symptoms at defecation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25858 (URN)10.1080/003655299750025093 (DOI)10563669 (PubMedID)10295 (Local ID)10295 (Archive number)10295 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved
3. Long term changes in abdominal symptoms in irritable bowel syndrome (IBS): A 7-year follow-up study in 37 outpatients
Open this publication in new window or tab >>Long term changes in abdominal symptoms in irritable bowel syndrome (IBS): A 7-year follow-up study in 37 outpatients
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background The natural course of abdominal symptoms in IBS is sparsely known. Our aim was to study the long-term change in daily symptoms in a sample of outpatients.

Methods Sixty-three outpatients kept a record of daily symptoms over a 6-week period. Several years later they were asked to repeat the recordings during one fortnight and to answer questions regarding their health between the studies. The dairy cards were analysed by cluster analysis to identify symptom subgroups. Changes in symptoms were assessed by analysis of variance.

Results The median follow-up time was 7 years. Thirty-seven patients participated. One patient claimed to be symptom-free between studies while the others were symptomatic. At the present study 31 patients claimed to suffer abdominal symptoms consistent with IBS while 6 patients were asymptomatic. According to the daily records pain and straining decreased while normal stools increased. Gender and illness duration, use of medication and subgroup placement did not affect these changes and the subgroups were similarly distinguished from each other in both study periods. During baseline the six symptom-free patients all belonged to the pain subgroup characterised by little pain and bloating and four of them to the bowel habit subgroup characterised by normal stools and the least disturbed stool passage.

Conclusions The abdominal symptoms remained fairly unchanged. The clinical course and prognosis is possibly predicted according to subgroup.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79968 (URN)
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2012-08-16Bibliographically approved
4. Abdominal Symptoms Are Not Related to Anorectal Function in the Irritable Bowel Syndrome
Open this publication in new window or tab >>Abdominal Symptoms Are Not Related to Anorectal Function in the Irritable Bowel Syndrome
1999 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 34, no 3, 250-258 p.Article in journal (Refereed) Published
Abstract [en]

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 1 week. At the end of the week anorectal function was investigated by manovolumetry before and after a standardized fatty meal. Cluster anlysis 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25857 (URN)10.1080/00365529950173645 (DOI)10232868 (PubMedID)10294 (Local ID)10294 (Archive number)10294 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved
5. Abdominal Symptoms and Anorectal Function in Health and Irritable Bowel Syndrome
Open this publication in new window or tab >>Abdominal Symptoms and Anorectal Function in Health and Irritable Bowel Syndrome
2001 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 36, no 8, 833-842 p.Article in journal (Refereed) Published
Abstract [en]

Background: It is unclear how the quality and quantity of abdominal symptoms and anorectal function differ between irritable bowel syndrome (IBS) patients and healthy controls, and whether different anorectal function in patients is associated with abdominal symptoms in IBS.

Methods: Fifty-two outpatients with IBS and 12 healthy controls kept daily symptom records over 1 week. At the end of the week, anorectal function was assessed by manovolumetry before and after a standard fatty meal. Patients were divided into symptom and manovolumetric subgroups using a cluster analysis and also into those below (hypersensitive) and those within (normosensitive) the 95% confidence interval of the controls' mean for maximal tolerable distension (MTD).

Results: Regardless of subgroup, the patients were distinguished from the controls by pain, bloating, straining and incomplete evacuation. Compared with controls, MTD was lower in the pain/bloating subgroup characterized by considerable pain and the bowel habit subgroup characterized by hard stools, variable stool consistency and heavily disturbed stool passage. Preprandial rectal hypersensitivity was highly prevalent in this bowel habit subgroup. No similar association with the pain/bloating subgroup was found. Patients and controls showed a significant and similar postprandial decrease in MTD.

Conclusions: IBS is distinguished from health by pain, bloating, straining and a feeling of incomplete evcuation. Baseline rectal hypersensitivity is associated with constipation-like bowel habit. Increased rectal sensitivity after a meal and/or preceding distension is a normal reaction unimportant in the genesis of symptoms in IBS.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25856 (URN)10.1080/00365520117328 (DOI)11495079 (PubMedID)10293 (Local ID)10293 (Archive number)10293 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved

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