Alternative procedure to shorten rectal barostat procedure for the assessment of rectal compliance and visceral perception: a feasibility study

S A L W Vanhoutvin, F J Troost, T O C Kilkens, P J Lindsey, D M A E Jonkers, K Venema, A Masclee, R-J M Brummer, S A L W Vanhoutvin, F J Troost, T O C Kilkens, P J Lindsey, D M A E Jonkers, K Venema, A Masclee, R-J M Brummer

Abstract

Background: Barostat methodology is widely used for assessing visceral perception. Different barostat protocols are described with respect to the measurement of rectal compliance and visceral perception. The choice of protocols affects the duration, which is normally 60-90 min, and accuracy of the procedure. This study aimed to shorten the procedure by using the semi-random distension protocol for both compliance and visceral perception measurement and a correction based on rectal capacity (RC) instead of minimal distension pressure (MDP).

Methods: Twelve irritable bowel syndrome (IBS) patients (7 females) and 11 healthy controls (8 females) underwent a barostat procedure. Compliance was determined during both a staircase distension and a semi-random protocol. Visceral perception data were compared as a function of pressure or relative volume, corrected for MDP or RC, respectively.

Results: Compliance measurement using the semi-random protocol instead of the staircase distension protocol resulted in an overestimation in healthy volunteers, but not in IBS patients. The overall conclusion that IBS patients had a lower compliance compared to controls was not different between protocols. Data presentation of the visceral perception scores as a function of corrected volume instead of pressures corrected for MDP did not alter the conclusion that sensation scores in IBS patients were higher as compared to healthy controls.

Conclusions: This study showed that barostat procedures may be shortened by approximately 20 min, without losing the ability to discriminate between healthy controls and IBS patients. A correction for RC instead of MDP may improve the accuracy of the procedure.

Figures

Fig. 1
Fig. 1
Barostat protocol that was applied in this study. It contained 5 consecutive distension protocols (I–V). Protocol I was designed for balloon unfolding, protocol II for determination of minimal distension pressure (MDP-1) and first sensation (FS-1), protocol III for compliance 1 and RC measurement, protocol IV for visceral perception and compliance 2, and protocol V for the assessment of MDP-2 and FS-2
Fig. 2
Fig. 2
Perception scores for pain, discomfort and urge presented as either a function of index volume (a, c, e, respectively) or as a function of pressure (b, d, f, respectively) in IBS patients and in healthy controls. In all cases, IBS patients showed higher sensation scores compared to healthy controls
Fig. 3
Fig. 3
Individual measurements (two missing values) of RC and MDP. No significant correlation was found
Fig. 4
Fig. 4
Compliance curves for healthy controls and IBS patients, both calculated in the staircase distension protocol (compliance 1) and in the semi-random protocol (compliance 2)

References

    1. Kilkens TO, Honig A, van Nieuwenhoven MA, Riedel WJ, Brummer RJ. Acute tryptophan depletion affects brain-gut responses in irritable bowel syndrome patients and controls. Gut. 2004;53(12):1794–1800. doi: 10.1136/gut.2004.041657.
    1. Kilkens TO, Honig A, Fekkes D, Brummer RJ. The effects of an acute serotonergic challenge on brain-gut responses in irritable bowel syndrome patients and controls. Aliment Pharmacol Ther. 2005;22(9):865–874. doi: 10.1111/j.1365-2036.2005.02660.x.
    1. Ritchie J. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut. 1973;14(2):125–132. doi: 10.1136/gut.14.2.125.
    1. Penning C, Steens J, van der Schaar PJ, Kuyvenhoven J, Delemarre JB, Lamers CB, et al. Motor and sensory function of the rectum in different subtypes of constipation. Scand J Gastroenterol. 2001;36(1):32–38. doi: 10.1080/00365520150218039.
    1. Steens J, Van Der Schaar PJ, Penning C, Brussee J, Masclee AA. Compliance, tone and sensitivity of the rectum in different subtypes of irritable bowel syndrome. Neurogastroenterol Motil. 2002;14(3):241–247. doi: 10.1046/j.1365-2982.2002.00332.x.
    1. Whitehead WE, Holtkotter B, Enck P, Hoelzl R, Holmes KD, Anthony J, et al. Tolerance for rectosigmoid distention in irritable bowel syndrome. Gastroenterology. 1990;98(5 Pt 1):1187–1192.
    1. Kanazawa M, Palsson OS, Thiwan SI, Turner MJ, van Tilburg MA, Gangarosa LM, et al. Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits. Am J Gastroenterol. 2008;103(10):2550–2561. doi: 10.1111/j.1572-0241.2008.02066.x.
    1. Krogh K, Ryhammer AM, Lundby L, Gregersen H, Laurberg TS. Comparison of methods used for measurement of rectal compliance. Dis Colon Rectum. 2001;44(2):199–206. doi: 10.1007/BF02234293.
    1. Fox M, Thumshirn M, Fried M, Schwizer W. Barostat measurement of rectal compliance and capacity. Dis Colon Rectum. 2006;49(3):360–370. doi: 10.1007/s10350-005-0295-2.
    1. Park JH, Baek YH, Park DI, Kim HJ, Cho YK, Sohn CI, et al. Analysis of rectal dynamic and static compliances in patients with irritable bowel syndrome. Int J Colorectal Dis. 2008;23(7):659–664. doi: 10.1007/s00384-008-0469-1.
    1. Whitehead WE, Delvaux M. Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. The Working Team of Glaxo-Wellcome Research, UK. Dig Dis Sci. 1997;42(2):223–241. doi: 10.1023/A:1018885028501.
    1. Gladman MA, Dvorkin LS, Lunniss PJ, Williams NS, Scott SM. Rectal hyposensitivity: a disorder of the rectal wall or the afferent pathway? An assessment using the barostat. Am J Gastroenterol. 2005;100(1):106–114. doi: 10.1111/j.1572-0241.2005.40021.x.
    1. Vanhoutvin SA, Troost FJ, Kilkens TO, Lindsey PJ, Hamer HM, Jonkers DM, et al. The effects of butyrate enemas on visceral perception in healthy volunteers. Neurogastroenterol Motil. 2009;21(9):952–e76.
    1. Hammer HF, Phillips SF, Camilleri M, Hanson RB. Rectal tone, distensibility, and perception: reproducibility and response to different distensions. Am J Physiol. 1998;274(3 Pt 1):G584–G590.
    1. Ludidi S, Conchillo JM, Keszthelyi D, Koning CJ, Vanhoutvin SA, Lindsey PJ, et al. Does meal ingestion enhance sensitivity of visceroperception assessment in irritable bowel syndrome? Neurogastroenterol Motil. 2012;24(1):47–53, e3.
    1. Akaike H. Information theory and an extension of the maximum likelihood principle. In: Second international symposium on inference theory (Tsahkadsor, 1971), 1973. p. 267–81.
    1. Lindsey PJ, Kaufmann J. Analysis of a longitudinal ordinal response clinical trial using dynamic models. J R Stat Soc Ser C Appl Stat. 2004;53:523–537. doi: 10.1111/j.1467-9876.2004.04882.x.
    1. Nozu T, Kudaira M, Kitamori S, Uehara A. Repetitive rectal painful distention induces rectal hypersensitivity in patients with irritable bowel syndrome. J Gastroenterol. 2006;41(3):217–222. doi: 10.1007/s00535-005-1748-z.
    1. Simren M, Agerforz P, Bjornsson ES, Abrahamsson H. Nutrient-dependent enhancement of rectal sensitivity in irritable bowel syndrome (IBS) Neurogastroenterol Motil. 2007;19(1):20–29. doi: 10.1111/j.1365-2982.2006.00849.x.
    1. van der Veek PP, Steenvoorden M, Steens J, van der Schaar PJ, Brussee J, Masclee AA. Recto-colonic reflex is impaired in patients with irritable bowel syndrome. Neurogastroenterol Motil. 2007;19(8):653–659. doi: 10.1111/j.1365-2982.2007.00921.x.
    1. Dorn SD, Palsson OS, Thiwan SI, Kanazawa M, Clark WC, van Tilburg MA, et al. Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. Gut. 2007;56(9):1202–1209. doi: 10.1136/gut.2006.117390.
    1. Bouin M, Plourde V, Boivin M, Riberdy M, Lupien F, Laganiere M, et al. Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology. 2002;122(7):1771–1777. doi: 10.1053/gast.2002.33601.

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