Role of anger in antral motor activity in irritable bowel syndrome.

There is considerable evidence indicating that patients with irritable bowel syndrome respond to emotional and environmental stimulation with increased colon motor activity. It has been suggested also that increased colon motor activity is not confined to the colon and may be representative of a broader disorder affecting the rest of the gastrointestinal tract in this population. The results of our current study suggest that anger may have a significant, although differential effect on antral motor activity in IBS patients compared to normal controls. We found that while antral motor activity did not differ significantly in our groups during rest, anger decreased antral motor activity in IBS patients and increased antral motor activity in normal controls. The difference was not attributable to a difference in anger levels since the groups did not differ in their response to the standardized anger stressor. Rather, the difference in the antral motor response appears to be qualitative and a possible marker for irritable bowel syndrome. Our data further suggest that increased colon motor activity in IBS patients during emotional stress is not a result of a rise in motor activity throughout the gastrointestinal tract, but a phenomenon that may be unique to the colon in this patient population.

Clinical value of anorectal manometry index in neurogenic fecal incontinence.

PURPOSE: The present communication is an endeavor to assess the value of a simple motility index to separate patients with neurogenic or idiopathic fecal incontinence from those patients with the secondary form of the disease. METHODS: Study population consisted of 23 patients with idiopathic fecal incontinence and 13 patients with fecal incontinence secondary to surgical or obstetric trauma. They all had a standard anorectal manometric study after a 12-hour fast. A motility index was then prepared taking into consideration the peak sphincter pressure values, contractility endurance, and rectal sensory threshold. RESULTS: Despite differences in the mean peak squeeze pressure and sensory threshold between the two groups, there were significant overlaps for all parameters of standard anorectal manometry in both groups. However, patients with idiopathic incontinence had an index of smaller than 28, and the group with the secondary form of incontinence had indexes higher than 30. CONCLUSIONS: 1) None of the four parameters of a conventional anorectal manometry can accurately separate patients with neurogenic incontinence from those with secondary forms of the disorder. 2) The anorectal motility index presented here can accurately separate the two groups. 3) This index is superior to the standard anorectal manometry in evaluating patients with fecal incontinence.

Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome.

The present investigation was designed to study the effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Patients with irritable bowel syndrome were compared with normal controls during resting and two anger stressors: criticism of performance on an intelligence test and during a delay of assistance for a diagnostic procedure. At rest patients with irritable bowel syndrome had higher motor and spike potential activity than normal subjects; however, the difference was only significant for spike activity. Anger significantly increased colon motor and spike potential activity in the groups compared with the resting state. Patients with irritable bowel syndrome produced significantly higher motor and spike potential activity when angered. They also reported themselves to be more hostile and appeared angrier than normal controls after the study. However, they did not report themselves to be more anxious or depressed, suggesting that the observed changes in colonic function of both groups were due to anger. Patients with irritable bowel syndrome scored significantly higher than controls on the Minnesota Multiphasic Personality Inventory scales of hypochondriasis, hysteria, and depression, but these personality factors did not significantly influence their anger level before the study. The results are discussed in terms of the role of learning in the colon and the abnormal reinforcement of bowel behavior in patients with irritable bowel syndrome.

The effect of stress on colon motor and electrical activity in irritable bowel syndrome.

The present investigation was designed to study the role of stress on the physiologic mechanisms of the colon in irritable bowel syndrome (IBS). Patients with IBS were compared with normal controls during resting and stress (mental arithmetic, cold pressor, and fear stressor). The results indicated that IBS patients had significantly higher motor activity than normals in the resting state but did not differ from them in the mean dominant frequency of the basal electrical rhythm (BER) or the proportion of the time they had 2-4 cycles per minute (cpm) slow-wave activity. Stress significantly increased motor activity in both groups although they did not differ significantly from each other during stress. Stress increased the proportion of 2-4 cpm slow-wave activity in IBS patients, but decreased in the controls. The type of stressor, however, did not influence either motor or electrical activity. Although IBS patients were significantly older than the controls and scored higher on the MMPI scales of Hypochondriasis, Hysteria, and Depression, these factors did not significantly influence differences in motor or electrical activity between the groups. The results are discussed in terms of the role of learning in the colon.

Experimental modification of digestive pathology.

Two experiments using human volunteers with gastric disorders were performed. The pH level of the subjects' stomach contents was measured with special electrodes in a nasogastric tube. In each experiment, some of the subjects received true feedback (TFG), while others received reverse, or false, feedback (RFG) about the pH of their stomach contents. In the first experiment, giving feedback of pH increases to 27 subjects during the first training session did not result in an alteration of stomach pH or acid concentration. It did, however, result in decreased volume of acid secretion in the TFG (9 subjects). In the second experiment, 10 training sessions were conducted with 12 subjects. 7 in the TFG, 5 in the RFG. The TFG showed increased stomach pH and decreased acid secretion volume, but no changes in acid concentration compared to the RFG.