Original Contribution | Published:

Functional GI

Impaired Small Bowel Gas Propulsion in Patients with Bloating During Intestinal Lipid Infusion

The American Journal of Gastroenterology volume 101, pages 18531857 (2006) | Download Citation

Subjects

Abstract

OBJECTIVE:

In healthy individuals, intraluminal lipids delay intestinal gas clearance, and this reflex is exaggerated in patients with irritable bowel syndrome (IBS). Our aim was to determine the site of action of abnormal lipid-induced reflexes in IBS.

METHODS:

In six patients with (IBS) predominantly complaining of bloating and in six healthy subjects, a mixture of gas (N2, O2, and CO2 in venous proportions to minimize diffusion) was infused (12 mL/min) either into the jejunum or into the ileum for 2 h, with simultaneous perfusion of lipids (0.5 kcal/min) into the proximal duodenum. Rectal gas evacuation was measured by a barostat. Abdominal perception (by a 0–6 scale) and girth changes were measured at 15-min intervals. The effects of jejunal versus ileal gas infusion were compared by paired tests in random order on separate days.

RESULTS:

IBS patients exhibited significant gas retention during infusion of gas into the jejunum (398 ± 90 mL vs −210 ± 105 mL in health, p < 0.05) but not during ileal infusion (−79 ± 87 mL vs −79 ± 78 mL in health, NS; p < 0.05 vs jejunal infusion). Gas retention during jejunal gas infusion in IBS patients was associated with significant abdominal distension (11 ± 3 mm girth increment vs 0 ± 1 mm during ileal gas infusion and 1 ± 1 mm in health, p < 0.05 for both) and abdominal symptoms (3.6 ± 0.6 score vs 2.6 ± 0.7 score during ileal gas infusion and 1.6 ± 0.5 score in health, p < 0.05 for both).

CONCLUSIONS:

In IBS patients intraluminal lipids impair intestinal gas clearance because of upregulated reflex inhibition of small bowel transit, without appreciable colonic effects.

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Acknowledgements

This study was supported in part by the Spanish Ministry of Education (Dirección General de Enseñanza Superior del Ministerio de Educación y Cultura, BFI 2002-03413), the National Institutes of Health, USA (Grant DK 57064), and the Instituto Carlos III (grants PJ051250 and C03/C02); Dr. Salvioli was supported by a scholarship from the University of Bologna. The authors thank Maite Casaus and Anna Aparici for technical support and Gloria Santaliestra for secretarial assistance.

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Affiliations

  1. Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain

    • Beatrice Salvioli
    • , Jordi Serra
    • , Fernando Azpiroz
    •  & Juan-R Malagelada

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Correspondence to Fernando Azpiroz.

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DOI

https://doi.org/10.1111/j.1572-0241.2006.00702.x

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