Reflex control of intestinal gas dynamics and tolerance in humans

Intestinal transit of gas is normally adapted to the luminal gas load, but in some patients impaired transit may lead to gas retention and symptoms. We hypothesized that intestinal gas transit is regulated by reflex mechanisms released by segmental distension at various gut levels. In 24 healthy sub...

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Published in:American journal of physiology: Gastrointestinal and liver physiology 2004-01, Vol.286 (1), p.G89-G94
Main Authors: Harder, Hermann, Serra, Jordi, Azpiroz, Fernando, Malagelada, Juan-R
Format: Article
Language:English
Subjects:
Abdomen - anatomy & histology
Administration, Rectal
Adult
Anal Canal - physiology
Duodenum - physiology
Energy Intake - physiology
Female
Gases - metabolism
Humans
Intestines - physiology
Jejunum - physiology
Lipids - administration & dosage
Lipids - pharmacology
Male
Muscle Tonus - physiology
Perception - physiology
Reflex - physiology
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Summary:Intestinal transit of gas is normally adapted to the luminal gas load, but in some patients impaired transit may lead to gas retention and symptoms. We hypothesized that intestinal gas transit is regulated by reflex mechanisms released by segmental distension at various gut levels. In 24 healthy subjects, we measured gas evacuation and perception of jejunal gas infusion (12 ml/min) during simultaneous infusion of duodenal lipids mimicking the postprandial caloric load (Intralipid, 1 kcal/min). We evaluated the effects of proximal (duodenal) distension (n = 8), distal (rectal) distension (n = 8), and sham distension, as control (n = 8). Duodenal lipid infusion produced gas retention (366 +/- 106 ml) with low abdominal perception (1.5 +/- 0.8 score). Distension of either the duodenum or rectum during lipid infusion expedited gas transit and prevented retention (-120 +/- 164 and -124 +/- 162 ml retention, respectively; P < 0.05 vs. control). However, the tolerance to the intestinal gas load differed markedly, depending on the site of distension; perception remained low during rectal distension (2.6 +/- 0.7 score; not significant vs. control) but increased during duodenal distension (4.4 +/- 0.7 score; P < 0.05 vs. control). We conclude that focal gut distension, either at proximal or distal sites, accelerates gas transit, but the symptomatic response depends on the site of stimulation.
ISSN:0193-1857
1522-1547
DOI:10.1152/ajpgi.00174.2003