Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts

• Published in: Gut Vol. 67; no. 2; pp. 255 - 262
• Main Authors: Simrén, Magnus, Törnblom, Hans, Palsson, Olafur S, van Tilburg, Miranda A L, Van Oudenhove, Lukas, Tack, Jan, Whitehead, William E
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 01.02.2018; BMJ Publishing Group LTD
• Subjects: Abdominal Pain - etiology; Adolescent; Adult; Aged; altered rectal; Anxiety; Anxiety - complications; biological marker; Clinical Medicine; Cohort Studies; Colon; Colon, Descending - physiopathology; Comorbidity; Depression - complications; Dilatation - adverse effects; Dyspepsia; Dyspepsia - complications; Dyspepsia - physiopathology; Dyspepsia - psychology; Female; FUNCTIONAL DYSPEPSIA; Gastric Fundus - physiopathology; gastric sensorimotor function; gastroduodenal disorders; Gastroenterology; gastrointestinal disorders; Gastrointestinal tract; Humans; Hypersensitivity; IRRITABLE BOWEL SYNDROME; Irritable Bowel Syndrome - complications; Irritable Bowel Syndrome - physiopathology; Irritable Bowel Syndrome - psychology; Klinisk medicin; Male; Mental depression; Middle Aged; Neurogastroenterology; Pain; pain sensitivity; Pain Threshold; Patients; perception; postprandial symptoms; Pressure - adverse effects; psychosocial factors; quality-of-life; Rectum; Rectum - physiopathology; Severity of Illness Index; Stomach; Studies; Surveys and Questionnaires; Symptom Assessment; VISCERAL HYPERSENSITIVITY; Young Adult; FUNCTIONAL DYSPEPSIA; IRRITABLE BOWEL SYNDROME; VISCERAL HYPERSENSITIVITY
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2016-312361

ObjectiveOur aim was to evaluate the association between visceral hypersensitivity and GI symptom severity in large cohorts of patients with functional GI disorder (FGID) and to adjust for psychological factors and general tendency to report symptoms.DesignWe included five cohorts of patients with FGIDs (IBS or functional dyspepsia; n=1144), who had undergone visceral sensitivity testing using balloon distensions (gastric fundus, descending colon or rectum) and completed questionnaires to assess GI symptom severity, non-GI somatic symptoms, anxiety and depression. Subjects were divided into sensitivity tertiles based on pain/discomfort thresholds. GI symptom severity was compared between sensitivity tertiles in each cohort and corrected for somatisation, and anxiety and depression.ResultsIn all five cohorts, GI symptom severity increased gradually with increasing visceral sensitivity, with significant differences in GI symptom severity between the sensitivity tertiles (p<0.0001), with small to medium effect sizes (partial η2: 0.047–0.11). The differences between sensitivity tertiles remained significant in all cohorts after correction for anxiety and depression, and also after correction for non-GI somatic symptom reporting in all of the cohorts (p<0.05).ConclusionsA gradual increase in GI symptom severity with increasing GI sensitivity was demonstrated in IBS and functional dyspepsia, which was consistent across several large patient groups from different countries, different methods to assess sensitivity and assessments in different parts of the GI tract. This association was independent of tendency to report symptoms or anxiety/depression comorbidity. These findings confirm that visceral hypersensitivity is a contributor to GI symptom generation in FGIDs.