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. 2009 Nov;146(1-2):41-6.
doi: 10.1016/j.pain.2009.06.017.

Intestinal Membrane Permeability and Hypersensitivity in the Irritable Bowel Syndrome

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Free PMC article

Intestinal Membrane Permeability and Hypersensitivity in the Irritable Bowel Syndrome

QiQi Zhou et al. Pain. .
Free PMC article

Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the underlying pathophysiology is poorly understood; however, increased intestinal permeability in diarrhea-predominant IBS patients has been reported. Here we demonstrate that diarrhea-predominant IBS (D-IBS) patients display increased intestinal permeability. We have also found that increased intestinal membrane permeability is associated with visceral and thermal hypersensitivity in this subset of D-IBS patients. We evaluated 54 D-IBS patients and 22 controls for intestinal membrane permeability using the lactulose/mannitol method. All subjects ingested 5g of lactulose and 2g of mannitol in 100ml of water after which their urine was collected. We also evaluated the mean mechanical visual analogue scale (M-VAS) pain rating to nociceptive thermal and visceral stimulation in all subjects. All study participants also completed the FBDSI scale. Approximately 39% of diarrhea-predominant IBS patients had increased intestinal membrane permeability as measured by the lactulose/mannitol ratio. These IBS patients also demonstrated higher M-VAS pain intensity reading scale. Interestingly, the IBS patients with hypersensitivity and increased intestinal permeability had a higher FBDSI score (100.8 + or - 5.4) than IBS patients with normal membrane permeability and sensitivity (51.6 + or - 12.7) and controls (6.1 + or - 5.6) (p<0.001). A subset of D-IBS patients had increased intestinal membrane permeability that was associated with an increased FBDSI score and increased hypersensitivity to visceral and thermal nociceptive pain stimuli. Thus, increased intestinal membrane permeability in D-IBS patients may lead to more severe IBS symptoms and hypersensitivity to somatic and visceral stimuli.

Figures

Figure 1
Figure 1
Frequency distribution of lactulose / mannitol ratio in controls and IBS patients. Black circles represent the controls. IBS patients with a lactulose / mannitol ratio of <0.07 are illustrated with black filled triangles. Empty triangles represent IBS patients with a lactulose / mannitol ratio of ≥0.07.
Figure 2
Figure 2
Frequency distribution of FBDSI score in controls and IBS patients. Black circles represent the controls. IBS patients with a lactulose / mannitol ratio in the normal range are illustrated with black filled triangles. Empty triangles represent IBS patients with a lactulose / mannitol ratio that is elevated.
Figure 3
Figure 3
Frequency distribution of VAS score for visceral sensitivity in controls and IBS patients. Black circles represent the controls. IBS patients with a lactulose / mannitol ratio in the normal range are illustrated with black filled triangles. Empty triangles represent IBS patients with a lactulose / mannitol ratio that is elevated.
Figure 4
Figure 4
Frequency distribution of VAS score for thermal sensitivity in controls and IBS patients. Black circles represent the controls. IBS patients with a lactulose / mannitol ratio in the normal range are illustrated with black filled triangles. Empty triangles represent IBS patients with a lactulose / mannitol ratio that is elevated.

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