Irritable Bowel Syndrome: Enck P

Enck P, Klosterhalfen S, Zipfel S, Martens U. · No affiliation provided · J Psychosom Res. · Pubmed #18501255 No free full text.

This publication has no abstract.

Rapps N, van Oudenhove L, Enck P, Aziz Q. · Department of Internal Medicine VI-Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany. · J Psychosom Res. · Pubmed #18501260 No free full text.

Abstract: From experience, most people know about a link between psychological processes and gastrointestinal sensory and motor functions. Cognitive processes (e.g., attention) as well as affective processes (e.g., fear) play a role in gastrointestinal sensations in healthy controls and patients with irritable bowel syndrome (IBS) alike. However, the exact nature of this relationship has not been completely understood yet. Brain imaging techniques allow for the study of brain-gut interactions in vivo. Accordingly, positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have been widely used to study neural mechanisms underlying visceral sensations. This article will summarize the results of functional brain imaging studies in healthy controls and selected studies assessing the influence of psychological processes on gastrointestinal functions. Subsequently, this article will deal with those brain areas activated by visceral stimulation in IBS patients. Special attention will be paid to recently published studies concerning psychological factors and novel research questions.

Musial F, Häuser W, Langhorst J, Dobos G, Enck P. · Complementary and Integrative Medicine, University of Duisburg-Essen, Department of Internal Medicine, Kliniken Essen-Mitte, Germany. · J Psychosom Res. · Pubmed #18501259 No free full text.

Abstract: The psychophysiology of visceral pain as it relates to gastrointestinal motility, visceral sensitivity, and putative mechanisms of the processing of visceral stimuli by the central and peripheral nervous systems are discussed. Peripheral mechanisms may include low-grade mucosal inflammation, and it is likely that central nervous mechanisms such as neuronal plasticity at the level of the spinal cord and attentional bias at the cortical level are relevant for the chronification of visceral pain. From a psychophysiological perspective, visceral pain therefore remains a complex symptom because behavioral variables, such as the way an individual deals with stress, may be as important for the etiology of visceral pain as, for example, a history of inflammation.

Enck P, Martens U. · Psychosomatic Medicine, University Hospitals Tübingen, Tübingen. · Z Gastroenterol. · Pubmed #18253901 No free full text.

Abstract: The publication of the Rome III consensus on functional bowel disorders one year ago has raised the question of whether a revision of the 1999 Celle consensus on the irritable bowel syndrome is necessary and who should be involved in this consensus. Therefore, the this review article attempts to reconstruct the history of the Rome criteria (and its predecessor, the Manning criteria) and contrasts this with the parallel history of the DSM/ICD classification in primary care and psychiatry/psychosomatics. The formulation of a common consensus between all medical societies (primary care, gastroenterology/neurogastroenterology, psychiatry/psychosomatics) is proposed instead of another consensus of gastroenterologists alone, in order to avoid the tendency--at both national and international levels--towards isolation between the medical subspecialties.

Teufel M, Biedermann T, Rapps N, Hausteiner C, Henningsen P, Enck P, Zipfel S. · Department of Internal Medicine VI-Psychosomatic Medicine and Psychotherapy, University of Tubingen, Osianderstrasse 5, D-72076 Tubingen, Germany. · World J Gastroenterol. · Pubmed #17659692 links to  free full text

Abstract: One fifth of the population report adverse reactions to food. Reasons for these symptoms are heterogeneous, varying from food allergy, food intolerance, irritable bowel syndrome to somatoform or other mental disorders. Literature reveals a large discrepancy between truly diagnosed food allergy and reports of food allergy symptoms by care seekers. In most studies currently available the characterization of patient groups is incomplete, because they did not distinguish between immunologic reactions and other kinds of food reactions. In analysing these adverse reactions, a thorough physical and psychological diagnostic approach is important. In our qualitative review, we present those diagnostic measures that are evidence-based as well as clinically useful, and discuss the various psychological dimensions of adverse reactions to food. It is important to acknowledge the complex interplay between body and mind: Adults and children suffering from food allergy show impaired quality of life and a higher level of stress and anxiety. Pavlovian conditioning of adverse reactions plays an important role in maintaining symptoms. The role of personality, mood, or anxiety in food reactions is debatable. Somatoform disorders ought to be identified early to avoid lengthy and frustrating investigations. A future task will be to improve diagnostic algorithms, to describe psychological aspects in clearly characterised patient subgroups, and to develop strategies for an optimized management of the various types of adverse reactions to food.

Matheis A, Martens U, Kruse J, Enck P. · Department of Sychosomatic Medicine and Psychotherapy University Hospitals Tubingen, Frondsbergstrasse 23, Tubingen 72076, Germany. · World J Gastroenterol. · Pubmed #17659691 links to  free full text

Abstract: Irritable bowel syndrome (IBS) and chronic pelvic pain (CPP) are both somatoform disorders with a high prevalence within the population in general. The objective was to compare both entities, to find the differences and the similarities related to epidemiology and psychosocial aspects like stressful life events, physical and sexual abuse, illness behaviour and comorbidity. The technical literature was reviewed systematically from 1971 to 2006 and compared. According to literature, IBS and CPP seem to be one rather than two different entities with the same localisation of pain. Both syndromes also are similar concerning prevalence, the coexistence of mental and somatoform disorders, the common history of sexual and physical abuse in the past and their health care utilization. It could be shown that there were many similarities between IBS and CPP. Nevertheless both are traded as different clinical pictures as far. Therefore it seems to be reasonable and necessary to generate a common diagnosis algorithm and to bring gynaecologists and gastroenterologists into dialogue.

Musial F, Klosterhalfen S, Enck P. · Department of Internal Medicine, Integrative and Complementary Medicine, Kliniken Essen-Mitte, Knappschafts-Krankenhaus, Am Deimelsberg 34a, Essen 45276, Germany. · World J Gastroenterol. · Pubmed #17659688 links to  free full text

Abstract: Over the last several years there has been a growing interest in placebo, not only as an inert control in clinical trials, but also in the placebo effect as a group effect as well as a reaction in individual subjects. Methodological factors such as regression to the mean and natural history of the disease play a role in the evaluation of a possible placebo effect. In this report, we discuss several factors including Pavlovian conditioning, beliefs outcome, expectations, and other factors as potential mediators of the placebo response. Placebo effects are common in gastrointestinal diseases and there seems to be no clear difference between placebo effects in functional gastrointestinal diseases (functional dyspepsia and irritable bowel syndrome) and organic gastrointestinal disease (duodenal ulcer and inflammatory bowel disease).

Enck P, Martens U, Klosterhalfen S. · University Hospitals Tubingen, Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, Osianderstrasse 5, Tubingen 72076, Germany. · World J Gastroenterol. · Pubmed #17659685 links to  free full text

Abstract: Research on gut-brain interactions has increased over the last decade and has brought about a number of new topics beyond "classical" subjects, such as "stress" and "personality", which have dominated the psychosomatic literature on gastrointestinal disorders over the past century. These novel topics include brain imaging of intestinal functions, placebo responses in gastroenterology, learning of gastrointestinal symptoms, quality of life in patients with intestinal complaints, and psychotherapy and familial aggregation of functional intestinal disorders. Currently, these new topics appear with a frequency of 1% to 3% in leading gastroenterological journals, either as data presentation or review papers. Increasing focus underlines the importance of enhancing our understanding on how the psyche and the brain communicate in order to better meet the needs of our patients.

Enck P, Klosterhalfen S. · Department of Internal Medicine VI/Psychosomatics, University Hospitals Tuebingen, Tuebingen, Germany. · Neurogastroenterol Motil. · Pubmed #15916619 No free full text.

Abstract: The nature and determinants of the placebo response are widely unknown, as are the underlying psychological and biological mechanisms. High placebo response rates in functional bowel disorders (functional dyspepsia, irritable bowel syndrome) are similar to those in non-intestinal diseases (depression, pain, Parkinson's disease) and not too dissimilar to other organic gastrointestinal diseases (duodenal ulcer, inflammatory bowel diseases). Methodological reasons (regression to the mean, shift in signal detection through manipulation of expectations) and psycho-biological mechanisms (Pavlovian conditioning of biological processes) are proposed to explain a large component of the response variance in clinical trials. Psychobiological mechanisms of the placebo response in functional and organic diseases can also be identified in brain function studies (such as imaging).

Hollerbach S, Elsenbruch S, Enck P. · Medizinische Universitätsklinik, Knappschaftskrankenhaus, Klinikum der Ruhr-Universität Bochum. · Dtsch Med Wochenschr. · Pubmed #11360454 No free full text.

This publication has no abstract.

Hotz J, Enck P, Goebell H, Heymann-Mönnikes I, Holtmann G, Layer P. · Klinik für Gastroenterologie, Allgemeines Krankenhaus Celle. · Z Gastroenterol. · Pubmed #10494603 No free full text.

This publication has no abstract.

Enck P, Zimmermann K, Rusch K, Schwiertz A, Klosterhalfen S, Frick JS. · Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Frondsbergstr. 23, 72076 Tübingen. · Z Gastroenterol. · Pubmed #19606407 No free full text.

Abstract: BACKGROUND: The composition of the fecal mircoflora and its changes on ageing have rarely been investigated in large samples of both patients and volunteers. METHODS: We analysed the fecal flora by conventional microbiological testing (Kyberstatus, Institute of Microecology, Herborn, Germany) of stool samples from 35 292 adults (age: 46.3 +/- 0.08 [18 to 96] years, 9564 males, 24 784 females; remaining = missing data) with different intestinal and non-intestinal diagnoses for total colony-forming units (CFU) (per g stool) as well as relative abundance of Bifidobacteria, Bacteroides spp., Escherichia coli, Enterococcus spp., and Lactobacillus spp. with respect to age, gender, and clinical data available (e. g., stool consistency and pH). RESULTS: The total CFU was stable and showed no age- or gender-related changes. Individual bacterial species constantly and significantly increased with age (E. coli, Enterococci spp.), or decreased at higher age (Bacteroides spp.), or were stable throughout the life span (Lactobacilli, Bifidobacteria). Gastrointestinal diagnoses (Crohn's disease, n = 198; ulcerative colitis, n = 515; irritable bowel syndrome, n = 7765; other GI diagnoses, n = 10 478) tended to exhibit some specificity of the bacterial profile, and when GI diagnoses were excluded, the age-related bacterial profile of the remaining group (n = 15 619, m:f = 4197:11 422) was not different. CONCLUSION: Conventional microbiological investigations of the fecal microbiota showed both bacteria-specific as well as a general pattern of ageing of the colonic microbiota, with the last decades (more than 60 years) demonstrating the most profound changes. It remains to be shown whether these changes reflect direct changes of the gut microbiota, the mucosal innate immunity, or indirect consequences of age-related altered nutrition.

Enck P, Zimmermann K, Menke G, Klosterhalfen S. · Internal Medicine VI, University Medical Hospital, Tübingen, Germany. · Z Gastroenterol. · Pubmed #19197823 No free full text.

Abstract: BACKGROUND: Therapy trials with bacterial compounds in irritable bowel syndrome (IBS) have produced conflicting results and, so far, an E.-coli preparation has not been used. METHODS: Two hundred and ninety-eight patients with lower abdominal symptoms diagnosed as IBS were treated for 8 weeks by the compound Symbioflor-2 (Symbiopharm GmbH, Herborn, Germany), an Escherichia coli product (N = 148), or placebo (n = 150) in a double-blinded, randomized fashion. Patients were seen weekly by the physician, who assessed the presence of core IBS symptoms. Both an abdominal pain score (APS) as well as a general symptom score (GSS) were used as primary endpoints. Responders had to have complete absence of IBS core symptoms at > or = 1 visit during treatment. RESULTS: The responder rate in GSS to the drug was 27 / 148 (18.2 %) in comparison to placebo with 7 / 150 (4.67 %) (p = 0.000397). The improvement in APS was 28 / 148 (18.9 %) and 10 / 150 (6.67 %) for placebo (p = 0.001649). The response was reached from visit 3 onwards with both medication and placebo. Post-hoc analysis revealed no significant differences in efficacy of the drug between the gender and different age groups. CONCLUSION: Treatment of IBS with the probiotic Symbioflor-2 is effective and superior to placebo in reducing typical symptoms of IBS patients seen by general practitioners and by gastroenterologists.

Enck P, Zimmermann K, Menke G, Müller-Lissner S, Martens U, Klosterhalfen S. · Department of Internal Medicine VI, University Hospital of Tübingen, Tübingen, Germany. · Neurogastroenterol Motil. · Pubmed #18565142 No free full text.

Abstract: Therapy trials with bacterial compounds in irritable bowel syndrome (IBS) have produced conflicting results. This study was performed in 1988 and 1989, and was re-analysed according to current IBS standards. Two hundred ninety-seven patients with lower abdominal symptoms diagnosed as IBS were treated for 8 weeks by the compound ProSymbioflor((R)) (Symbiopharm GmbH, Herborn, Germany), an autolysate of cells and cell fragments of Enterococcus faecalis and Escherichia coli, or placebo in a double-blinded, randomized fashion. Patients were seen weekly by the physician, who assessed the presence of core IBS symptoms. Responders had at least a 50% decrease in global symptom score (GSS) and in abdominal pain score (APS) reports at >/=1 visit during treatment. The responder rate in GSS to the drug was 102/149 (68.5%) in comparison to placebo with 56/148 (37.8%) (P < 0.001), the improvement in APS was 108/149 (72.5%) and 66/148 (44.6%) respectively (P = 0.001). The number-needed-to-treat was 3.27 for GSS and 3.59 for the APS report. Kaplan-Meier analysis revealed a mean response time of 4-5 weeks for active treatment and more than 8 weeks for placebo (P < 0.0001). Treatment of IBS with the bacterial lysate ProSymbioflor is effective and superior to placebo in reducing typical symptoms of IBS patients seen by general practitioners.

Schneider A, Weiland C, Enck P, Joos S, Streitberger K, Maser-Gluth C, Zipfel S, Bagheri S, Herzog W, Friederich HC. · University Medical Hospital Heidelberg, Department of General Practice and Health Services Research, Vossstrasse 2, 69117 Heidelberg, Germany. · Complement Ther Med. · Pubmed #18054727 No free full text.

Abstract: OBJECTIVES: Quality of life (QoL) improvement in patients with irritable bowel syndrome (IBS) during acupuncture (AC) treatment seems to be due to a placebo effect. The aim was to explore if acupuncture has some specific influence on the neuroendocrinic and autonomic nervous system (ANS). DESIGN/SETTING: Patients with IBS were randomly assigned to receive either acupuncture (AC) or sham acupuncture (SAC) using the so-called "Streitberger needle". QoL was measured with the functional quality of life diseases quality of life questionnaire (FDDQL) and SF-36. The effect on ANS was evaluated by measuring salivary cortisol and by cardiovascular responses on a tilt table before and after 10 AC treatments. Complete data sets of tilt table and salivary morning cortisol were available for 9 patients in the AC and 12 in SAC group. RESULTS: QoL increased in both groups (p=0.001) with no group differences. Salivary cortisol decreased in all groups (F=10.55; p=0.006). However, the decrease was more pronounced in the AC group (F=4.07; p=0.033) (ANOVA repeated measures model). Heart rate response decreased during orthostatic stress in the AC group while it increased in the SAC group (F=9.234; p=0.005), indicating an increased parasympathetic tone in the AC group. Improvement of pain was positively associated with increased parasympathetic tone in the AC group (F=10.1; p=0.006), but not in the SAC group. CONCLUSIONS: The acupuncture specific physiological effects are in contrast to the unspecific improvement of QoL in both AC and SAC groups. Thus, different mechanisms seem to be involved in placebo and real-acupuncture driven improvements. The specific mechanism of action of acupuncture on the ANS remains unclear and deserves further evaluation.

Enck P, Kowalski A, Martens U, Klosterhalfen S. · Department of Psychosomatic Medicine and Psychotherapy, University Hospitals Tübingen, Tübingen. Germany. · Eur J Gastroenterol Hepatol. · Pubmed #17099374 No free full text.

Abstract: OBJECTIVES: We wished to determine the value of an open-access internet questionnaire for assessment of upper and lower gastrointestinal symptoms and health-related quality of life. METHODS: Between January 2002 and June 2005, a symptom scale for upper gastrointestinal and lower gastrointestinal symptoms was placed on a genuine website (www.gesundheits-umfrage.de) and linked to the website of the German irritable bowel syndrome patient group (www.Reizdarmselbsthilfe.de). Patients were asked to report gastrointestinal symptoms that had occurred during the last month. Patients who finished this symptoms questionnaire and acknowledged more than two of a total of eight upper gastrointestinal symptoms and/or more than two of 16 lower gastrointestinal symptoms were immediately offered the assessment of their health-related quality of life by a validated general quality of life scale--the patient general well-being inventory--a 22-item scale with six subscales (anxiety, depression, general well-being, self-control, health, and vitality) and a global scale. Total patient general well-being inventory scores and subscale values were correlated to upper gastrointestinal and lower gastrointestinal symptom scores including the Rome I definition of the irritable bowel syndrome, and to social variables. RESULTS: Five thousand two hundred and fifty-six individuals completed symptom assessment. Out of these, 4431 had three or more upper gastrointestinal symptoms, the mean number of upper gastrointestinal symptoms reported was 3.2+/-2.0; 4456 had three or more lower gastrointestinal symptoms (mean: 10.3+/-3.3), and 3187 met the Rome I criteria for irritable bowel syndrome. A total of 3316 individuals completed the patient general well-being inventory assessment (1156 men, 2160 women, mean age: 37.7+/-12.3 years). Upper gastrointestinal, lower gastrointestinal, and total symptom score were higher in women than in men (P < 0.001), and significantly correlated to the global quality of life assessment. Family status affected the symptom scores (higher in singles) and quality of life scores (lower in people living in partnership for health, but higher for vitality and depression). Age correlated negatively with upper gastrointestinal, lower gastrointestinal, and with total symptom scores as well as with some patient general well-being inventory scores. CONCLUSION: Symptom and quality of life assessment using an open internet questionnaire is feasible and generates data which are, in large, comparable to those from other sources of assessment, despite the fact that the population addressed is, on average, moderately younger than previously studied cohorts.

Müller MH, Liu CY, Glatzle J, Weiser D, Kelber O, Enck P, Grundy D, Kreis ME. · Ludwig-Maximilians University, Department of Surgery, Munich, Germany. · Phytomedicine. · Pubmed #16713220 No free full text.

Abstract: INTRODUCTION: A limited number of drugs are available for the treatment of functional dyspepsia and irritable bowel syndrome. The efficacy of STW 5 (Iberogast) was previously shown in clinical trials. Since visceral hypersensitivity seems to be the prime pathomechanism of functional gastro-intestinal disorders, the aim of this study was to explore whether STW 5 reduces intestinal afferent sensitivity in the upper gastrointestinal tract. METHODS: Two groups of male Wistar rats were pretreated with either the herbal preparation STW 5 or its vehicle (30.8% ethanol). Then, after 2h, general anesthesia was induced by pentobarbitone (60 mg kg(-1)i.p.) and extracellular multi-unit afferent recordings were obtained from mesenteric afferents innervating the proximal jejunum. The intestinal afferent nerve response to increasing doses of 5-HT and bradykinin were quantified as well as afferent discharge following a ramp distension of the adjacent intestinal loop from 0 to 60 cm H(2)O. RESULTS: Afferent discharge to 5-HT and bradykinin increased dose-dependently. Following the different doses of 5-HT, the peak in afferent nerve discharge was always reduced after pretreatment with STW 5 compared to controls with a response of 110+/-5 imp s(-1) after STW 5 and 128+/-3 in vehicle controls at the maximum dose (40 microg kg(-1); p<0.05; mean+/-SEM). For bradykinin, afferent responses were reduced following STW 5 at the 20 and 40 microg kg(-1) dose but not at 10 microg kg(-1) (40 microg kg(-1)176+/-7 imp s(-1) following STW 5 versus 200+/-6 imp s(-1) in controls; p<0.05). The ramp distension of the intestinal loop stimulated a rise in intestinal afferent nerve discharge that was always lower in the STW 5 pretreated group compared to vehicle controls with the exception of the discharge rate at the pressure level of 0 and 20 cm H(2)O (all other pressures up to 60 cm H(2)O p<0.05). CONCLUSIONS: Sensitivity of intestinal afferents to mechanical and chemical stimuli is reduced following treatment with the herbal preparation STW 5. This mechanism may help to explain why STW 5 relieves dyspeptic and bowel symptoms in patients.

Schneider A, Enck P, Streitberger K, Weiland C, Bagheri S, Witte S, Friederich HC, Herzog W, Zipfel S. · Department of General Practice and Health Services Research, University Medical Hospital, University of Heidelberg, Vossstrasse 2, 69120 Heidelberg, Germany. · Gut. · Pubmed #16150852 links to  free full text

Abstract: BACKGROUND AND AIMS: Despite occasional positive reports on the efficacy of acupuncture (AC) on functions of the gastrointestinal tract, there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome (IBS). PATIENTS AND METHODS: Forty three patients with IBS according to the Rome II criteria were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the so-called "Streitberger needle". Treatment duration was 10 sessions with an average of two AC sessions per week. The primary end point was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36), compared with baseline assessments. QOL measurements were repeated three months after treatment. RESULTS: Both the AC and SAC groups improved significantly in global QOL, as assessed by the FDDQL, at the end of treatment (p = 0.022), with no differences between the groups. SF-36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F = 6.746, p = 0.003) in a stepwise regression model. CONCLUSIONS: Acupuncture in IBS is primarily a placebo response. Based on the small differences found between the AC and SAC groups, a study including 566 patients would be necessary to prove the efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients.

Enck P, Klosterhalfen S, Kruis W. · Medizinische Klinik VI: Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen. · Dtsch Med Wochenschr. · Pubmed #16123895 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The determinants of the placebo effect are not well established. Goal of this study was to explore likely predictive factors in an already published data set. METHODS: We re-analysed data from a study in 120 patients with the irritable bowel syndrome (IBS) that were randomly assigned to three arms of the study to receive (double-blind) either a drug (mebeverin) (n = 40) or placebo (n = 40), or (in an open trial) dietary treatment (fibre) (n = 40) for up to 16 week. Treatment was conducted by 3 different doctors (A, B, C) with 44, 27, and 18 patients, resp. A fourth group (n = 31) was treated by different varying physicians. Symptoms were assessed every 4 weeks, and the degree of patient compliance and the number of drop-outs, the number of patients improved/not improved (in %), symptom severity (Kruis Score) at enrolment, and age and gender as covariates were included into the analysis. RESULTS: Drop-out rate was 30 % for placebo, 30 % for mebeverin, and 15 % for the diet. For the patients remaining in the study, average compliance was 75 % with placebo, but 89 % for the drug and 82 % for the diet. Response rates were 39 % for placebo, but 20 % for the drug; response rate for the diet (open trial) was 43 % under all doctors. Response rates for drug and placebo combined were 32 % for doctor A (female,43 years), but 19 % for doctors B and C together (both males, 32 and 40 years)); this effect was not significant. Placebo responders were more often women (47 %) than men (28 %), while age effects were only found with dietary treatment: responders were younger. Placebo responders had an overall lower Kruis Score than non-responders (45 vs 52 points), but this was also true for drug (52 vs. 62 points) and diet responders (56 vs 68 points). CONCLUSION: The major factors contributing to the placebo response are the treating physician (gender, training), and the patients gender (female). Patients with lower Kruis score (more likely non-functionally disordered) may be prone to higher (placebo) response rates.

Schikowski A, Thewissen M, Mathis C, Ross HG, Enck P. · Physiologisches Institut, Heinrich-Heine-Universität, Düsseldorf, Germany. · Neurogastroenterol Motil. · Pubmed #12061906 No free full text.

Abstract: It has been suggested that serotonin (5-hydroxytryptamine) type-4 (5-HT4) receptors modulate the sensitivity of intrinsic afferents of the intestinal mucosa. We studied the involvement of 5-HT4receptors in the modulation of extrinsic afferent sensitivity of the intestinal wall. During distension ramps, mechanoreceptive rectal afferents in sacral dorsal roots were examined in decerebrate anaesthesia-free cats using the selective 5-HT4receptor partial agonist, tegaserod (HTF 919), and the 5-HT4receptor antagonist, SB 203186. The static discharge rate of the afferents evoked by rectal distension decreased after intravenous (i.v.) administration of tegaserod at intraluminal pressures above 30 mmHg, with the most effective reduction occurring at 50 mmHg. The effect was dose-dependent, with maximal reduction occurring at 1.2 mg kg-1 bodyweight, and could be partly reversed by i.v. administration of SB 203186. Tegaserod did not alter the pressure-volume relationship (compliance) of the rectum. It is tentatively concluded that 5-HT4receptor activation has an inhibitory effect on intramural mechanoreceptors in the cat's rectum. Our results are in line with the observation that tegaserod relieves the sensory symptoms of patients suffering from irritable bowel syndrome.

Icks A, Haastert B, Enck P, Rathmann W, Giani G. · Dept. of Biometrics & Epidemiology, German Diabetes Research Institute, Düsseldorf, Germany. · Z Gastroenterol. · Pubmed #11901451 No free full text.

Abstract: OBJECTIVES: There are few population-based studies on prevalence of functional bowel disorders (FBD) and related health care seeking. The aim of the present study was to evaluate the prevalence of FBD in a population-based sample and to assess FBD-related health care seeking and medication in Germany. MATERIAL: Cross-sectional study, based on an age- and sex-stratified random sample of 2,400 subjects aged 21-80 years in Düsseldorf, Germany (about 500,000 population). Assessment was performed using a postal written questionnaire. METHODS: Prevalence of gastrointestinal pain or discomfort in the past 12 months was assessed, in particular, lower abdominal pain and irritable bowel syndrome (IBS). Furthermore, health care seeking and medication (prescribed and over-the-counter) due to FBD was assessed. Multiple logistic regression (survey estimated) was performed to evaluate associations of FBD with age, sex, and the socioeconomic status (SES). RESULTS: 1,281 subjects (53.4 %) were analyzed. Standardized prevalences were 22.6 % (95 %-CI: 20.3 - 25.1 %) for lower abdominal pain and 12.5 % (10.7-14.5 %) for IBS. Both lower abdominal pain and IBS were significantly less frequent in the older population compared to younger subjects. No significant differences were found for gender and SES. Among subjects with lower abdominal pain and IBS, 55.1 % and 49.3 % reported health care seeking due to their GI disorders, and 63.9 % and 56.2 % reported use of medication, respectively. ONCLUSIONS: A high prevalence of functional bowel disorders was found in this population-based study in Germany. Only about half of the subjects reported health care seeking due to their bowel disorders. Self-medication with over-the-counter agents was frequently performed.