丁酸钠溶液灌肠对大鼠内脏感觉的影响

对于肠易激综合征（IBS）内脏感觉功能异常的研究，需建立合适的动物模型。目的：以丁酸钠溶液灌肠建立大鼠结肠感觉过敏模型，观察其内脏感觉功能和结肠黏膜改变。方法：16只大鼠随机分为实验组和对照组。实验组予1 ml 200mmol／L丁酸钠溶液灌肠，对照组予1 ml 0.9％NaCl溶液灌肠，每天2次，连续3d。分别于灌肠前和实验开始后第3、6、9、12、15、18d行结直肠扩张（CRD），观察腹壁回撤反射（AWR）评分和内脏感觉压力闽值，以反映内脏感觉功能。实验结束后处死大鼠，行结肠黏膜大体形态观察和组织学检查。结果：实验第3-12d．实验组不同CRD压力下AWR评分均显著高于对照组（P〈0.05），疼痛感觉压力阈值显著低于对照组（P〈0.05）；第15-18d，上述指标恢复至初始状态。实验结束后,实验组与对照组结肠黏膜大体形态和组织学改变均无明显差异。结论：丁酸钠溶液反复灌肠可诱导大鼠结肠感觉过敏，内脏感觉功能恢复后，结肠黏膜改变同步恢复。该模型可用于IBS病理生理机制的研究。     

内脏高敏感大鼠结肠5-羟色胺转运体蛋白的表达

目的:探讨5-羟色胺转运体蛋白(SERT)在内脏高敏感性中的作用,为功能性胃肠病的发病机制研究提供理论基础.方法:采用乳鼠醋酸灌肠建立大鼠慢性内脏高敏感动物模型,同时设立对照组.待乳鼠成年后应用直肠内球囊扩张评估腹壁撤离反射(AWR)的方法,评估其内脏敏感性;检测髓过氧化物酶(MPO)评价其肠道黏膜炎症程度;用RT-PCR方法评价大鼠结肠SERT的mRNA水平,免疫组织化学方法评价大鼠结肠SERT的表达:用ELISA方法检测血浆和结肠组织5-HT水平.结果:乳鼠醋酸灌肠建立的大鼠慢性内脏高敏感模型组与对照组相比HE染色显示结肠黏膜未见明显急、慢性炎症改变;两组大鼠结肠组织MPO水平没有显著性差异;在不同容量下的AWR评分慢性内脏高敏感模型组显著高于对照组(P<0.01).血浆5-HT水平慢性内脏高敏感模型组明显高于对照组(95.75±15.99vs 72.17±8.01,P<0.01),而两组结肠组织5-HT含量没有明显差异.免疫组织化学研究显示内脏高敏感模型组结肠上皮SERT表达水平显著低于对照组(0.187±0.010 vs 0.191±0.011,P<0.011,而其结肠SERT mRNA水平显著高于对照组(16.02±3.7 vs 10.05±2.12,P<0.01).结论:内脏高敏感大鼠外周5-HT水平的增高主要来源于其灭活的减少而非合成的增加,与SERT的关系密切.结肠SERT可能具有不同的亚型和功能.     

炎症后内脏高敏感大鼠前扣带回皮质NR2A、NR2B表达变化

背景:研究显示N-甲基-D-天冬氨酸(NMDA)受体参与了伤害性信号的传递,中枢前扣带回皮质(ACC)在内脏高敏感大鼠内脏疼痛反应的调节中起重要作用,该作用是由NMDA受体活性增强介导的。目的:检测炎症后内脏痛觉过敏大鼠ACC区域NMDA受体亚基NR2A、NR2B的表达变化,探讨两者在炎症后内脏高敏感形成中的作用。方法:以去氧胆酸结肠灌注建立炎症后内脏痛觉过敏大鼠模型。造模3周后观察实验组和对照组结肠组织病理学改变,以对结直肠扩张(CRD)的内脏运动反射(VMR)幅值为指标评价内脏痛敏感性的变化,以免疫荧光法和蛋白质印迹法检测ACC区域NR2A、NR2B表达情况。结果:实验组和对照组大鼠结肠组织均未见明显病理学改变。CRD压力为60 mm Hg(伤害性刺激)时,实验组VMR幅值显著高于对照组(P0.05)。与对照组相比,实验组ACC区域NR2A、NR2B荧光强度和蛋白表达量均显著上调(P0.05)。结论:ACC区域NMDA受体亚基NR2A、NR2B表达上调在炎症后内脏高敏感的形成中发挥重要作用。     

迷走传入神经功能异常在内脏高敏感形成中的作用

目的:初步探讨迷走传入神经在醋酸诱导的结肠敏感鼠模型内脏高敏感形成中的作用.方法:采用乳大鼠于出生第10天给予0.5%醋酸灌肠,建立慢性内脏高敏感动物模型,观察直肠内球囊扩张(colorectal distension,CRD)下腹壁撤离反射(withdrawal reflex,AWR)及腹外斜肌放电活动(electromyography,EMG)的变化,评估内脏敏感性.采用电生理学方法记录大鼠颈部迷走传入神经自发放电,观察在CRD下模型组与对照组大鼠迷走神经放电活动.免疫组织化学法观察大鼠孤束核及结肠中c-fos分布及表达情况.结果:与对照组相比,模型组AWR评分及EMG幅值显著增高(P<0.05),HE染色及MPO水平显示两组大鼠结肠均无明显炎症表现,结果提示内脏高敏感模型鼠建立;给予直肠内球囊扩张后模型组迷走神经放电活动明显高于对照组(P<0.05);与对照组相比,模型组大鼠孤束核及结肠肌间神经丛中c-fos表达明显增加(孤束核15.00%±1.85%vs47.30%±2.79%,近端结肠1.00%±0.12%%vs1.90%±0.17%,中端结肠1.10%±0.17%vs1.90%±0.18%,远端结肠1.10%±0.12%vs2.10%±0.17%,均P<0.01).结论:乳鼠醋酸灌肠诱导形成的内脏高敏模型大鼠迷走神经活化存在异常.     

大鼠结肠慢性炎性刺激诱导腰骶髓和延髓Fos的表达及其意义

目的　探讨实验性大鼠结肠慢性炎性刺激诱导腰骶髓和延髓中Fos的表达及其意义。方法　成年雄性SD大鼠 ,实验组 (n =1 6 )予三硝基苯磺酸 (TNBS)灌肠诱导结肠炎 ,实验对照组 (n =8)予生理盐水灌肠 ,空白对照组 (n =2 )不予任何刺激 ;分别在灌肠后 3、7、1 4和 2 8d ,采用免疫组化法观察实验组大鼠腰骶髓和延髓中Fos阳性神经元的数量和分布 ,并与对照组进行比较。结果　TNBS灌肠诱导Fos表达多数分布在脊髓背角深层 (Ⅲ～Ⅳ和Ⅴ～Ⅵ层 )和由孤束核、腹外侧区及网状结构形成的延髓内脏带中。TNBS灌肠后 3d ,脊髓和延髓中Fos表达无明显增多。灌肠后 7和 1 4d ,脊髓和延髓中Fos表达明显多于实验对照组 (P <0 .0 5 )。灌肠后 2 8d ,延髓中Fos表达下降 ,与对照组无明显差异 ,部分大鼠脊髓中Fos阳性神经元数 (5 4 .1± 1 6 .3)仍明显多于对照组 (1 2 .2± 2 .6 ,P <0 .0 5 )。结论　脊髓Fos阳性神经元可能在结肠慢性炎性刺激引起的内脏高敏感性中起作用 ,而延髓可能不是内脏高敏感性形成的主要部位。     

内脏高敏感大鼠白细胞介素-1β、肿瘤坏死因子α与5-羟色胺转运体的表达

目的 研究内脏高敏感大鼠结肠细胞因子和5-羟色胺(5-HT)转运体(SERT)的表达,为细胞因子和5-HT系统在内脏高敏感性产生机制中的作用提供依据.方法 16只胎龄小于8 d的新生SD大鼠被随机分为2组,每组8只.采用乳鼠醋酸灌肠法建立大鼠慢性内脏高敏感动物模型,以盐水灌肠作为对照组.待乳鼠成年后应用直肠内球囊扩张检测腹碓收缩阈值和弓背抬起阈值的方法评估其内脏敏感性;通过检测髓过氧化物酶(MPO)评价肠道黏膜炎症程度;采用免疫组化的方法检测大鼠结肠组织中IL-1β和TNFα的水平;采用Western blot方法检测大鼠结肠组织SERT的表达水平.结果 两组大鼠体重增长趋势基本一致,HE染色显示结肠黏膜未见明显急、慢性炎症改变;两组大鼠结肠组织MPO水平相比,差异无统计学意义[(0.497±0.570)U/g湿片比(0.623±0.739)U/g湿片,P=0.724];实验组大鼠腹壁收缩阈值和弓背抬起阈值分别为(0.19±0.06)ml和(0.47±0.13)ml,较对照组大鼠[(0.40±0.14)ml和(0.91±0.26)ml]显著减低,P＜0.01;实验组大鼠结肠IL-1β、TNFα的表达水平(0.196±0.002和0.194±0.001)均显著高于对照组(0.185±0.001和0.182±0.001),P＜0.01;实验组大鼠SERT蛋白相对表达水平(0.298±0.038)较对照组(0.634±0.200)显著减低,P＜0.05.结论 内脏高敏感大鼠IL-1β和TNFα的表达升高,SERT的表达水平减低,细胞因子与SERT可相互影响,IL-1β、TNFα和SERT可能在大鼠内脏高敏感性的发生机制中具有一定的作用.     

脱氧胆酸调节环氧合酶-2对结肠癌细胞增殖的影响

目的 通过观察不同浓度脱氧胆酸对结肠腺癌细胞SW1116生长的效应，以及在相应状态下细胞内环氧合酶(COX)-2蛋白表达量的改变，探讨脱氧胆酸钠对结肠癌细胞的作用机制。方法 用MTT法测定细胞增殖活性；免疫组化及Western blot方法检测细胞内COX-2蛋白的表达。结果 10～100μmol／L的脱氧胆酸钠具有明显的促进结肠腺癌细胞生长的作用；大于100μmol／L时则表现出抑制作用。脱氧胆酸钠在10、50和100μmol／L的浓度下均可促进COX-2蛋白的表达，10μmol／L的效应可以持续72h，但后两者在48h后COX-2蛋白表达开始下降。结论 脱氧胆酸对结肠癌细胞SW1116增殖的影响呈双向调节作用，脱氧胆酸促进COX-2蛋白表达可能是其促进结肠癌细胞增殖的作用途径。     

电针刺激足三里对内脏高敏感大鼠的影响及其机制

背景:内脏高敏感是肠易激综合征(IBS)的重要发病机制之一,电针刺激足三里治疗IBS正逐渐应用于临床,然而其对内脏敏感性的影响及其作用机制尚不十分清楚。目的:研究电针刺激足三里对大鼠内脏感觉的影响以及近端结肠、远端结肠和丘脑组织中μ阿片受体蛋白表达的变化,以探讨μ阿片受体在电针治疗IBS中的作用。方法:32只Sprague-Dawley大鼠随机分为正常对照组(NC组)、单纯模型组(M组)、模型+电针组(MEA组)和模型+假电针组(MSE组)。采用直肠灌注乙酸制备内脏高敏感模型。电针(假电针)治疗前后,大鼠行结直肠扩张后记录腹壁肌电。采用蛋白质印迹法检测各组大鼠近端结肠、远端结肠和丘脑组织中μ阿片受体的蛋白表达。结果:与电针刺激前相比,电针刺激后MEA组大鼠在相同结直肠扩张压力(20、40、60、80 mm Hg)下腹外斜肌放电次数均明显减少(P0.001):而MSE组腹外斜肌放电次数无明显差异(P0.05)。与M组相比,MEA组近端结肠、远端结肠和丘脑组织中μ阿片受体蛋白表达明显增加(P0.05),而MSE组无明显差异(P0.05)。结论:电针刺激足三里可降低大鼠内脏高敏感性.其作用机制可能通过上调中枢和外周μ阿片受体蛋白表达而实现的。     

肠道炎症诱导的内脏和躯体痛觉过敏

背景：慢性腹痛是功能性胃肠病患者常见症状之一,此类患者亦可同时具有较明显的躯体症状。内脏和躯体症状并存极大影响了患者的生活质量,并增加就医负担。目的：观察肠道炎症后大鼠内脏和躯体痛觉,探究两者间的联系和可能的共同发病机制。方法：80只雄性Sprague—Dawley大鼠随机分为模型组、溶剂对照组和阴性对照组,分别给予20mgTNBS／乙醇混合液、50％乙醇和0．9％NaCl溶液灌肠。灌肠8周后,行不同压力结直肠扩张（CRD）诱导内脏运动反射（VMR）以评估大鼠内脏痛觉。以机械缩足反射阈值（MWT）和甩尾反射潜伏期（TFL）评估躯体痛觉。结果：造模8周后模型组大鼠结肠黏膜病理表现与两组对照组相比无明显差异,未见明显溃疡和炎性细胞浸润。与两组对照组相比,32．5％的模型组大鼠内脏痛觉阈值明显下降（P〈0．001）,且这部分内脏痛觉高敏感的模型组大鼠MWT和TFL均明显降低（P〈0．001）。结论：本研究建立的动物模型模拟了感染后肠易激综合征状态,TNBS诱导的肠道炎症同时导致了大鼠内脏和躯体痛觉过敏,有助于进一步探究内脏和躯体痛觉过敏的共同发病机制。     

胆囊切除后粪胆汁酸代谢状况的研究

目的探讨胆囊切除后粪胆汁酸的代谢变化。方法利用薄层层析方法,检测了40例胆囊切除后病人和16例正常人粪胆酸(CA)、鹅脱氧胆酸(CDCA)、脱氧胆酸(DCA)和石胆酸(LCA)的浓度。结果胆囊切除后 CA、LCA 明显高于对照组(P<0.01)。同时,石胆酸与脱氧胆酸的比值(LCA/DCA)也显著高于对照组(P<0.01)。结论胆囊切除后存在胆汁的代谢紊乱,粪胆汁酸浓度升高可能为胆囊切除后患结肠癌危险性增加的原因之一。     

肠易激综合征患者直肠肛门动力学研究

为了研究肠易激综合征患者肛门运动功能，我们测定了５０例ＩＢＳ患者在１１例正常人直肠肛门压力衣排便功能；发现：（１）直肠静息压，肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组，便秘组及正常对照组组均无显著差异。（２）肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。（３）直肠壶腹部的感觉阈值，最大耐受量等，在ＩＢＳ腹泻组均显著低于正常对照组。（４）ＩＢＳ便秘组感觉阈值与正常对照组差异，但其最大     

Differences in serum tumor markers between colon and rectal cancer

PURPOSE: We investigated whether there are differences in serum levels of CA 242 and carcinoembryonic antigen (CEA) between patients with colon and rectal cancer. METHODS: Preoperative serum levels of CA 242 and CEA were determined in 153 patients with colon cancer and in 107 patients with rectal cancer. RESULTS: At the recommended cut-off levels for CA 242 and CEA, the overall sensitivity of CA 242 was 39 percent for both colon and recta! cancer, whereas the sensitivity of CEA was 40 percent for colon and 47 percent for rectal cancer. A combination of CA 242 and CEA increased overall sensitivity to 57 percent in colon cancer and to 62 percent in rectal cancer, whereas specificity decreased by 10 percent, compared with CEA alone. In colon cancer either or both markers were elevated in 38, 46, 56, and 84 percent of patients with Dukes Stages A, B, C, and D, respectively. Corresponding figures for rectal cancer were 52, 46, 71, and 87 percent, respectively. CONCLUSIONS: CA 242 showed equal sensitivity for colon and rectal cancer. In Stages A, C, and D, sensitivity of CEA and of a combination of CEA and CA 242 was higher in rectal than in colon cancer, but the difference was not significant. Concomitant use of markers increased sensitivity sharply compared with use of a single marker both in colon and rectal cancer.Supported by grants from Finska Läkaresällskapet and Stiftelsen Dorothea Olivia, Karl Walter and Jarl Walter Perkle'ns minne and Medicinska Understödsföreningen Liv och Hälsa. CA 242 test kits were supplied by Wallac Oy.     

Effect of a second-generation alpha2delta ligand (pregabalin) on visceral sensation in hypersensitive patients with irritable bowel syndrome

BACKGROUND: Visceral hypersensitivity is an important pathophysiological factor in irritable bowel syndrome (IBS). Pre-clinical studies suggest that the alpha(2)delta ligand pregabalin reduces both visceral allodynia and hyperalgesia, but is inactive on basal sensitivity. AIM: To assess the effect of pregabalin on the perception of rectal distension in hypersensitive IBS patients. METHODS: Twenty-six patients with Rome-II-defined IBS (aged 18-46 years, 7 male) were included in a randomized, double-blind, placebo-controlled, parallel-group study in which they received either 3 weeks oral pregabalin (titrated: 50 mg tid days 1-3, 100 mg tid days 4-7, 150 mg tid days 8-11; fixed 200 mg tid days 12-21 +/-4) or placebo control. Rectal sensitivity was assessed using a barostat technique, in which sensory thresholds were determined using the ascending method of limits, followed by tracking both before and after treatment. Only patients with a pain threshold of 相似文献   

直肠癌术前磁共振水成像检查的意义

目的:探讨磁共振(MRI)水成像(MRH)对直肠癌术前诊断和分期的价值.方法:对临床确诊为直肠癌的患者34例进行MRI水成像检查,检查前经直肠注入生理盐水300 mL左右,先作盆腔常规轴位平扫,再作磁共振直肠水成像扫描,扫描完后再作轴位、矢状位和冠状位增强扫描.结果:34例直肠癌均能显示原发病灶,三维成像病变部位肠腔内不规则充盈缺损32例.19例病变远侧端呈"袖口征"及"截断征".轴位30例表现为腔内软组织肿块,26例表现为肠壁不规则增厚,肠腔环形狭窄.MRI水成像检查对T1,T2,T3,T4期肿瘤的准确度分别为66.7%(2/3),76.9%(10/13),86.7%(13/15),100%(3/3),总准确性为82.4%(284);判断淋巴结转移的敏感性、特异性和准确性分别为69.2%(18/26),62.5%(5/8),67.6%(23/34);对邻近组织脏器浸润、远处转移判断的准确度分别为94.1%(32/34)、97.1%(33/34).结论:MRI水成像加常规平扫加增强扫描对直肠癌的诊断和分期有较大价值,可以较准确地判断肿瘤在肠壁的浸润深度及盆腔内淋巴结的转移.     

水囊扩张法3D经直肠腔内超声在低位直肠癌术前分期中的应用

目的评价水囊扩张法3D经直肠腔内超声（ERUS）检查在低位直肠癌术前分期中的灵敏度和特异度。 方法采用水囊扩张法对海军军医大学附属长海医院收治的72例低位直肠癌患者行术前腔内超声检查,进行术前T分期,并与手术后病理T分期进行比较,分析超声术前分期的灵敏度、特异度、过深分期和过浅分期百分比。 结果共72例患者入组,其中超声T1期直肠癌16例,T2期直肠癌23例,T3期直肠癌25例,T4期直肠癌8例。术前腔内超声诊断早期直肠癌T1、T2、T3、T4期诊断灵敏度和特异度分别为93.3%和96.5%,87.0%和93.9%,84.0%和91.5%,71.4%和95.4%。过深分期百分比为5.6%,过浅分期百分比为11.1%。 结论水囊扩张法3D经直肠腔内超声检查对低位直肠癌术前分期和手术治疗具有重要的指导意义。     

应用SELDI-TOF-MS技术建立直肠癌筛选血清蛋白质指纹图谱模型

目的:建立直肠癌筛选血清蛋白质指纹图谱模型并初步验证. 方法:用表面加强激光解析电离飞行时间质谱技术(SELDI- TOF-MS)及WCX2蛋白芯片获得新发直肠癌、直肠息肉患者和正常人血清的蛋白质指纹图谱,用计算机软件进行比较分析,建立直肠癌的筛选模型,并对其进行了盲法验证．结果:直肠癌组与对照组共有26个蛋白质有显著性差异(P<0．05);以其中4个蛋白质生物标志物(质／荷比9 295,3 730,3 938和4 095)组建的筛选模型检测正确率为 96．8％(93／96),经盲法验证,其灵敏度为95．0％(38／40),特异性为93．4％(45／48)．结论:建立的血清蛋白质指纹图谱模型能够区分直肠癌与非直肠癌患者,SELDI-TOF-MS在直肠癌的诊断及肿瘤特异性蛋白质生物标志分子的筛选等方面具有一定价值．     

Stimulation of defecation: effects of coffee use and nicotine on rectal tone and visceral sensitivity

OBJECTIVE: Coffee and cigarette use is believed to induce bowel movements, although the literature is controversial and precise measurements of rectal tone and sensitivity with a barostat have never been performed. The aim of this study was to assess the effects of coffee and nicotine on rectal tone, compliance and sensitivity. MATERIALS AND METHODS: Sixteen healthy volunteers were recruited for the coffee (n = 8) and nicotine (n = 8) experiments. The experiments were randomly performed in a placebo-controlled crossover design on separate days. In the coffee experiment, 280 ml strong coffee or warm water was drunk and in the nicotine experiment, nicotine (2 mg) or placebo was given sublingually. A rectal barostat procedure was carried out. A flaccid bag, mounted on a catheter, was inserted in the rectum. Continuous pressure distension was exerted to register basal visceral sensitivity and compliance. After rectal adaptation, the stimulus was given. Rectal tone was measured for 1 h, after which continuous pressure distension was repeated. RESULTS: Rectal tone increased by 45% 30 min after coffee intake (p = 0.031) and by 30% after water intake (p = 0.032), but the effects of coffee and water were not significantly different. Rectal tone did not change significantly after administration of nicotine (7%) or placebo (10%). There was no difference in compliance and visceral sensitivity between coffee and water or nicotine and placebo. CONCLUSIONS: Both coffee and warm water have an effect on defecation by increasing rectal tone, but nicotine (2 mg) did not affect rectal tone. Coffee and nicotine did not influence sensitivity or compliance.     

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

AIM： To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging （MRI） and endorectal ultrasonography （ERUS） in the preoperative staging of rectal carcinoma.
METHODS： Thirty-four patients （15 males, 19 females） with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma.
RESULTS： The pathological T stage of the tumors was： pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was： pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70% （27 out of 34）. The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29% （24 out of 34）. The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases using phased-array MRI gave an accuracy of 74.50% （21 out of 34）. The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47% （18 out of 34） was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively.
CONCLUSION： ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion （T stage） and has same value in detecting lymph node metastases （N stage） as compared to ERUS.     

Effect of red chillies on small bowel and colonic transit and rectal sensitivity in men with irritable bowel syndrome.

BACKGROUND: Altered motility and threshold for pain have been incriminated in the pathogenesis of the irritable bowel syndrome (IBS). Capsaicin affects visceral sensory perception and chillies, which contain capsaicin, have been shown to accelerate gut transit. AIMS: To evaluate the effect of red chillies on small bowel transit (SBT) and colonic transit (CT) and rectal sensitivity in normal men and men with IBS. METHODS: Twenty-nine men with IBS diagnosed using Manning's criteria, and 21 healthy men, were studied before and after ingestion of 10 g red chilli powder (capsaicin equivalent 14 mg). SBT time was measured as the time taken for 99mTc-sulfur colloid to reach the cecum after leaving the stomach. Total and segmental CT times were assessed using radio-opaque markers. Rectal sensitivity and pain threshold to intrarectal balloon distension were measured. RESULTS: The median (range) bowel frequency in patients and healthy men was 2 (1-6) and 1 (1-3) per day (p=0.03), respectively. After ingestion of chillies, it increased to 3 (1-8) per day and 2 (1-4) per day (p=0.01), respectively. There was no difference in transit times between patients and healthy men; chilli ingestion did not alter SBT time, total or segmental CT time. IBS patients had a lower threshold to balloon distension for both discomfort and pain in the basal state (p<0.01). Chillies increased this threshold in healthy men (p<0.01). CONCLUSIONS: Men with IBS do not have SBT or CT abnormalities, but have a lower rectal balloon sensitivity threshold. Chilli powder does not alter either SBT or CT in men with IBS or healthy men; however, it increases the rectal threshold for pain in the latter.     

Role of serology and routine laboratory tests in childhood inflammatory bowel disease

INTRODUCTION: Serology is reported to be helpful in evaluating children for inflammatory bowel disease (IBD), and distinguishing chronic ulcerative colitis (CUC) from Crohn's disease (CD). The markers include perinuclear staining antineutrophil cytoplasmic antibody (pANCA) for CUC and anti-Saccharomyces cerevisiae antibody (ASCA) for CD. In the clinical setting, hemoglobin (Hgb) and erythrocyte sedimentation rate (ESR) are commonly performed for screening symptomatic children for IBD. We examined whether there was an additional benefit of serology in addition to specific symptoms and routine laboratory tests in screening for IBD. METHOD: Medical record data was reviewed on children investigated for IBD from February 1999 to April 2001. Children were included if they had blood analyzed for pANCA and ASCA, Hgb, ESR, and colonoscopy as part of their assessment. RESULTS: Of 177 cases reviewed, 51 were diagnosed with CUC, 39 with CD, and 26 other inflammatory conditions. Visible rectal bleeding was the most discriminating symptom (occurred in 60/90 cases of IBD and 5/61 without IBD). There was a significant difference between the proportion with CUC positive for pANCA (42/51) and those with abnormal Hgb and ESR (30/51) (p < 0.05), but not between children with CD who were ASCA positive (18/39) and those with abnormal Hgb and ESR (26/39) (p = 0.27). The sensitivity and specificity of combined pANCA and ASCA was 68% and 92%, respectively. For the combination of Hgb, ESR, and the presence of rectal bleeding the respective values were 86% and 67%. Serology combined with Hgb and ESR and rectal bleeding as independent factors significantly (p < 0.05) improved sensitivity (89%) but reduced specificity (60%). Screening with the combination of rectal bleeding, Hgb, and ESR identified 86% (77/90) patients with IBD prior to an endoscopic procedure. A further 3 of 90 (3.3%) screened positive with the addition of serology. CONCLUSION: Serology tests have a high degree of specificity for IBD while routine laboratory test have a higher sensitivity. When serology is combined with rectal bleeding, Hgb, and ESR, the sensitivity of screening children for IBD is significantly improved. However the large majority of children with IBD can be identified with a clinical history and routine laboratory tests as needing an endoscopic procedure with little benefit of adding serology.