# Lipid-Induced Intestinal Gas Retention in Irritable Bowel Syndrome



## Jeffrey Roberts (Apr 15, 1987)

http://www.medscape.com/viewarticle/442086#a2 Lipid-Induced Intestinal Gas Retention in Irritable Bowel SyndromeSerra J, Salvioli B, Azpiroz F, Malagelada J-RGastroenterology. 2002;123(3):700-706What is the relationship between intraluminal lipid, transit of lipids, and the overall relevance in patients with irritable bowel syndrome (IBS)?As shown previously by gas challenge, in normal (healthy) individuals, intestinal gas is essentially propelled through and expelled from the jejunum at the same rate at which it is infused. Additionally, demonstration of impaired transit or motor dysfunction in patients with IBS was found to result in gas retention within the gut and the subsequent development of abdominal symptoms.AbstractBackground & Aims: We hypothesized that lipids, which induce various motor and sensory effects on the gut, modulate intestinal gas dynamics and that alteration of this regulatory mechanism may result in impaired gas transit in patients with irritable bowel syndrome (IBS).Methods: In 45 healthy subjects and 30 patients with IBS, evacuation of gas infused into the jejunum (at 12 mL/min) was measured for 2 hours. The effect of simultaneous duodenal perfusion of lipids at 0 kcal/min (saline), 0.5 kcal/min, and 1 kcal/min was tested in groups of 15 subjects each.Results: In healthy subjects, duodenal lipids at 1 kcal/min but not at 0 kcal/min or 0.5 kcal/min produced significant gas retention (281 ï¿½ 53 mL vs. 22 ï¿½ 64 mL at 0 kcal/min and ï¿½65 ï¿½ 72 mL at 0.5 kcal/min; P .lt. 0.05 for both). Patients with IBS exhibited gas retention during saline perfusion (259 ï¿½ 85 mL at 0 kcal/min; P .lt. 0.05 vs. healthy subjects) and were hypersensitive to duodenal lipids (505 ï¿½ 61 mL retention at 0.5 kcal/min; P .lt. 0.05 vs. saline and vs. healthy subjects). The ï¿½gas plus lipidsï¿½ challenge test discriminated patients with 100% sensitivity and 93% specificity.Conclusions: Physiologic concentrations of intestinal lipids exert an inhibitory control on intestinal gas transit, and this mechanism is up-regulated in patients with IBS. Hence, impaired gas propulsion, shown by the gas challenge test, may be useful as a diagnostic test if replicated in a larger series of patients.Medscape Gastroenterology 4(2), 2002. ï¿½ 2002 Medscape


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