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This Article Full Text Full Text (PDF) All Versions of this Article: 289/4/R970    most recent 00607.2004v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by van der Veek, P. P. J. Articles by Masclee, A. A. M. Search for Related Content PubMed PubMed Citation Articles by van der Veek, P. P. J. Articles by Masclee, A. A. M.

TRANSLATIONAL PHYSIOLOGY

Viscerosensory-cardiovascular reflexes: altered baroreflex sensitivity in irritable bowel syndrome

Departments of ¹Gastroenterology and Hepatology and ²Cardiology, Leiden University Medical Center, Leiden, The Netherlands; ³Leiden Foundation for ECG Analysis, Leiden, The Netherlands, and ⁴Department of Biomedical Engineering, S. Maugeri Foundation-IRCCS, Scientific Institute of Montescano, Montescano, Italy

Submitted 7 September 2004 ; accepted in final form 24 May 2005

ABSTRACT

Animal studies have demonstrated that visceral afferent stimulation alters autonomic cardiovascular reflexes. This mechanism might play an important role in the pathophysiology of conditions associated with visceral hypersensitivity, such as irritable bowel syndrome (IBS). As such, studies in humans are lacking, we measured viscerosensory-cardiovascular reflex interactions in IBS patients and healthy controls. Systolic blood pressure (SBP), heart rate (HR), and arterial baroreflex sensitivity (BRS) were studied in 87 IBS patients and 36 healthy controls under baseline conditions and during mild (15 mmHg) and intense (35 mmHg) visceral stimulation by rectal balloon distension. BRS was computed from continuous ECG and arterial blood pressure signals (Finapres-method) during 5-min periods of 15-min metronome respiration. Baseline SBP and HR were not different between patients and controls. In both groups, SBP increased similarly during rectal stimulation, whereas HR decreased during mild and increased intense stimulation. BRS was significantly higher in patients compared with controls at baseline (7.9 ± 5.4 vs. 5.7 ± 3.7 ms/mmHg, P = 0.03) and increased significantly in both groups during mild stimulation. This increase persisted in controls during intense stimulation, but BRS returned to baseline in patients. BRS was not significantly different between groups during rectal distension. This study demonstrates the presence of a viscerosensory-cardiovascular reflex in healthy individuals and in IBS patients. The increased BRS in IBS patients at baseline may either be a training-effect (frequent challenging of the reflex) or reflects altered viscerosensory processing at the nucleus tractus solitarii.

autonomic nervous system; colonic diseases; functional; blood pressure; heart rate; baroreflex