Gastroenterology

Gastroenterology

Volume 122, Issue 7, June 2002, Pages 1771-1777
Gastroenterology

Clinical Research
Rectal distention testing in patients with irritable bowel syndrome: Sensitivity, specificity, and predictive values of pain sensory thresholds,☆☆

https://doi.org/10.1053/gast.2002.33601Get rights and content

Abstract

Background & Aims: Visceral hypersensitivity was detected in patients with functional gastrointestinal disorders and has been proposed as a biological marker of irritable bowel syndrome (IBS). The purpose of this study was to assess the sensitivity, specificity, and the predictive values of pain thresholds evaluated by rectal distention using an electronic barostat in patients with or without IBS and in control subjects. Methods: Patients were diagnosed according to Rome II criteria. Rectal sensory thresholds were determined in 164 patients (86 IBS patients, 26 painless constipation, 21 functional dyspepsia, and 31 miscellaneous conditions) and in 25 normal controls. All subjects underwent a series of rectal isobaric distentions using an electronic barostat. The bag was progressively distended from 0 to 48 mm Hg and, in response to distention, subjects reported on discomfort or pain. Results: Pain thresholds were lower in IBS patients (30.4 ± 6.7 mm Hg) compared with controls (44.5 ± 5), painless constipated (45.4 ± 5.3), functional dyspepsia (39.4 ± 7.8), and miscellaneous patients (43.2 ± 5.5). At the level of 40 mm Hg, the sensitivity of the rectal barostat to identify IBS patients from normal subjects and non-IBS patients was 95.5% and its specificity was 71.8%. The positive predictive value was 85.4%. The negative predictive value was 90.2%. Conclusions: Lowered rectal pain threshold is a hallmark of IBS patients. Rectal barostat testing is useful to confirm the diagnosis of IBS and to discriminate IBS from other causes of abdominal pain.

GASTROENTEROLOGY 2002;122:1771-1777

Section snippets

Materials and methods

This study is a retrospective analysis of the activity in our laboratory between 1997 and 2000.

Characteristics of patients

Characteristics of the study groups are given in Table 1.

. Demographic characteristics of groups

Empty CellControlsIBSFunctional constipationFunctional dyspepsiaMiscellaneousEmpty Cell
Number2586262131
Age (yr)a39 ± 8.144.9 ± 6.645.6 ± 15.244.4 ± 7.843.1 ± 5.5NS
Female/male17/860/2620/617/424/7NS
aMean ± SD.
There was no statistical difference among groups in terms of age or gender. Participants included 25 asymptomatic controls, 86 patients with IBS, 26 painless functional constipation, 21 functional dyspepsia, and 31

Discussion

The aim of this study was to determine the sensitivity, specificity, and the predictive value of pain thresholds to rectal distention evaluated by electronic barostat in 25 normal controls and in 164 patients with different FBDs. Our study showed that: (1) IBS patients displayed lowered pain thresholds in response to rectal distention when compared with normal controls. (2) Rectal pain threshold in IBS patients was significantly lower than in other patients with abdominal pain from various

Acknowledgements

The authors thank Mr. Ovide D'asilva for his assistance in English edition.

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    Address requests for reprints to: Pierre Poitras, M.D., Hôpital Saint-Luc DU chum, 1058, St-Denis Street, Montreal, (QC) - H2X 3J4 Canada. e-mail: [email protected]; fax: (514) 412-7314.

    ☆☆

    Supported by an operating grant from the Medical Research Council of Canada (to P.P.) and by a Research Fellowship (to Mickael Bouin) from the Canadian Association of Gastroenterology, Canadian Institutes of Health Research, and Astra Zeneca Canada Inc.

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