Gastroenterology

Gastroenterology

Volume 122, Issue 7, June 2002, Pages 1748-1755
Gastroenterology

Clinical Research
Prokinetic effects in patients with intestinal gas retention,☆☆,

https://doi.org/10.1053/gast.2002.33658Get rights and content

Abstract

Background & Aims: We have previously shown that patients with irritable bowel syndrome (IBS) have impaired transit of intestinal gas loads. Because abnormal gas retention can be experimentally reproduced in healthy subjects by pharmacological inhibition of gut motility, we hypothesized that impaired gas transit and retention can be reciprocally corrected by pharmacologically stimulating intestinal propulsion. Methods: In 28 patients with abdominal bloating (14 IBS, 14 functional bloating) and in 14 healthy subjects, gas evacuation and perception of jejunal gas infusion (12 mL/min) were measured. After 2 hours, in 20 patients we tested the effect of intravenous neostigmine (0.5 mg) vs. intravenous saline administered blindly and randomly at a 1-hour interval. Results: After 2 hours of gas infusion, patients with IBS and functional bloating alike exhibited significant gas retention (418 ± 86 mL), abdominal symptoms (2.7 ± 0.5 score), and objective distention (8 ± 2 mm girth increment), in contrast to healthy controls, who experienced none (46 ± 102 mL retention, 0.4 ± 0.3 symptom score, and 3 ± 1 mm distention; P < 0.05 for all). Neostigmine produced immediate clearance of gas retained within the gut (603 ± 53 mL/30 minutes vs. 273 ± 59 mL/30 minutes after saline; P < 0.05) and by 1 hour reduced gas retention (by 373 ± 57 mL), abdominal symptoms (by 1.1 ± 0.5 score), and distention (by 6 ± 1 mm; P < 0.05 for all), whereas intravenous saline produced no effects. Conclusions: In patients with intestinal gas retention, pharmacological stimulation of intestinal propulsion improves gas transit, abdominal symptoms, and distention.

GASTROENTEROLOGY 2002;122:1748-1755

Section snippets

Participants

Twenty-eight patients with abdominal bloating as their predominant symptom and 14 healthy individuals without gastrointestinal symptoms (9 women and 5 men; age range, 21–35 years) participated in the study after giving written informed consent. Fourteen patients (12 women and 2 men; age range, 24–66 years) fulfilled criteria for IBS and the other 14 (11 women and 3 men; age range, 31–56 years) for functional bloating.4 All patients were symptomatic at the time of the study. The protocol for the

Gas transit and evacuation

In healthy subjects, evacuation of infused gas began within 30 minutes after starting the infusion. The initial gas retention progressively decreased, so that, by the end of the 2-hour infusion period, the volume of gas retained became nonsignificant (Figure 1).

. Responses to a gas challenge test in patients with abdominal bloating and healthy controls. Gas retained (infused minus evacuated), perception of abdominal symptoms (score from 0 to 6, but only represented up to score 4), and abdominal

Discussion

We have shown that, in patients with impaired gas transit featuring gas retention, abdominal symptoms, and distention, a potent prokinetic stimulus improved intestinal gas propulsion and evacuation. Furthermore, gas clearance was paralleled by improvement of both abdominal distention and symptoms.

In previous studies, we showed that gas retention can be experimentally produced in healthy subjects either by impairing intestinal propulsion, i.e., by IV glucagon, or by creating a high-resistance

Acknowledgements

The authors thank Nuria Ferrer and Isidre Casals, Serveis Cientifico-Tecnics of the Central University of Barcelona, for help in gas infrared absorbance analysis; Maite Casaus and Anna Aparici for technical support; and Gloria Santaliestra for secretarial assistance.

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    Address requests for reprints to: Fernando Azpiroz, M.D., Digestive System Research Unit, Hospital General Vall d'Hebron, 08035-Barcelona, Spain. e-mail: [email protected]; fax: (34) 93 489 44 56.

    ☆☆

    Supported in part by the Spanish Ministry of Science and Technology (grant BSA 2001-2584) and the National Institutes of Health (grant DK 57064). Dr. Caldarella was supported by a scholarship from the University of Chieti.

    Dr. Caldarella's present address is: Department of Internal Medicine, Hospital SS. Annunziata, 66100 Chieti, Italy.

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