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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
Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
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.

Place, publisher, year, edition, pages
1998. Vol. 10, no 5, 415-421 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-79967DOI: 10.1097/00042737-199805000-00011PubMedID: 9619389OAI: oai:DiVA.org:liu-79967DiVA: diva2:544891
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Abdominal symptoms and anorectal function in outpatients with the irritable bowel syndrome (IBS)
Open this publication in new window or tab >>Abdominal symptoms and anorectal function in outpatients with the irritable bowel syndrome (IBS)
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:nbn:se:liu:diva-28626 (URN)13782 (Local ID)91-7219-752-8 (ISBN)13782 (Archive number)13782 (OAI)
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

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