Heightened visceral sensation in functional gastrointestinal disease is not site-specific

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Abstract
Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We measured the sensory thresholds for initial perception (IP), desire to defecate (DD), and urgency (U) in response to rectal balloon distension, and the thresholds for initial perception and for discomfort in response to esophageal balloon distension in 12 patients with irritable bowel syndrome (IBS) and 10 patients with functional dyspepsia (FD), in comparison with healthy controls. As expected, IBS patients exhibited lower rectal sensory thresholds than controls (PPPPPPPP<0.0001). Somatic nerve sensory thresholds showed no significant differences between the patient and control groups. Our findings indicate that alterations in visceral sensitivity in functional gastrointestinal disease affect sites in the gut other than the putative organ of symptom origin, supporting the concept of generally enhanced visceral awareness in patients with functional bowel disorders.