Novel techniques to study visceral hypersensitivity in irritable bowel syndrome |
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Authors: | Trinh T Truong Bruce D Naliboff Lin Chang |
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Institution: | (1) Center for the Neurobiology of Stress, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, CA 90073, USA |
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Abstract: | Visceral hypersensitivity has emerged as a key hypothesis in explaining the painful symptoms of irritable bowel syndrome (IBS),
and it has been proposed as a “biologic marker” for the condition. Visceral hypersensitivity can be influenced by peripheral
and central mechanisms affecting pain perception. The optimal method for its assessment in humans has not been determined.
Current techniques include stimulation via the computerized barostat and electrical stimulation, response measures including
the lower limb reflex, and brain imaging modalities such as functional MRI and positron emission tomography. It has been shown
that IBS patients have decreased sensory thresholds to colonic and rectal balloon distention by barostat. Studies using electrical
stimulation and the RIII lower limb reflex have further confirmed enhanced visceral perception in IBS. Evidence from more
recent neuroimaging studies suggests that IBS patients have abnormal activation of brain circuits involved in emotional and
cognitive modulation of sensory information, resulting in ineffective pain modulation; these circuits may have a pathophysiologic
role in enhancing visceral perception. There are few effective pharmacologic treatments that relieve IBS symptoms, and improved
understanding of brain-gut interactions and factors relating to enhanced visceral perception may guide us in developing more
efficacious treatments. |
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