Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome

<p>Abstract</p> <p>Background</p> <p>Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed to test the hypothesis that FAPS would show altered visceral sensation compared to healthy controls or IBS. The present study determined the rectal perceptual threshold, intensity of sensation using visual analogue scale (VAS), and rectal compliance in response to rectal balloon distention by a barostat in FAPS, IBS, and healthy controls.</p> <p>Methods</p> <p>First, the ramp distention of 40 ml/min was induced and the thresholds of discomfort, pain, and maximum tolerance (mmHg) were measured. Next, three phasic distentions (60-sec duration separated by 30-sec intervals) of 10, 15 and 20 mmHg were randomly loaded. The subjects were asked to mark the VAS in reference to subjective intensity of sensation immediately after each distention. A pressure-volume relationship was determined by plotting corresponding pressures and volumes during ramp distention, and the compliance was calculated over the linear part of the curve by calculating from the slope of the curve using simple regression.</p> <p>Results</p> <p>Rectal thresholds were significantly reduced in IBS but not in FAPS. The VAS ratings of intensity induced by phasic distention (around the discomfort threshold of the controls) were increased in IBS but significantly decreased in FAPS. Rectal compliance was reduced in IBS but not in FAPS.</p> <p>Conclusion</p> <p>An inconsistency of visceral sensitivity between lower and higher pressure distention might be a key feature for understanding the pathogenesis of FAPS.</p

The Accuracy of Ankle Eccentric Torque Control Explains Dynamic Postural Control During the Y-Balance Test

# Background The Y-Balance Test (YBT), especially the posteromedial (PM) reach direction (PM-YBT), is able to identify dynamic postural control deficits in those who have ankle instability. However, there still exists a need to understand how sensorimotor function at the ankle explains the performance during the PM-YBT. # Hypothesis/Purpose The purpose of this study was to determine whether the ability to accurately control eccentric ankle torque explained PM-YBT performance. It was hypothesized that eccentric dorsiflexion/plantarflexion torque control would be positively related to the maximum reach distance (MRD) of PM-YBT. # Study Design Cross-sectional study # Methods Twelve healthy subjects performed the PM-YBT, maximum voluntary isometric contractions (MVIC) for both dorsiflexion and plantarflexion muscle strength, and then the torque control testing of the ankle. The torque control testing provided a target torque level on a screen in front of the subject and passive rotations of the ankle joint in the sagittal plane at 10 deg/sec between plantarflexion to dorsiflexion. Subjects were then instructed to eccentrically contract the dorsiflexors and plantar flexors to generate torque while the ankle joint rotated. The accuracy of torque control during eccentric dorsiflexion and plantarflexion by calculating absolute errors, the area between the target torque and the produced torque were evaluated. Tibialis anterior and soleus muscle activities were simultaneously recorded during testing. A step-wise linear regression model was used to determine the best model predicted the MRD of the PM-YBT (PM-MRD). # Results A step-wise linear regression developed a model explaining only eccentric dorsiflexion torque control predicted higher PM-MRD score (R^2^ = 44%, F~1,10~ = 7.94, β = -0.67, p = 0.02). # Conclusion The accuracy of torque control during eccentric dorsiflexion predicts better performance in the PM-YBT. # Level of Evidence 3

Characteristics in patients with headache in an outpatient clinic in Japan

<p>Abstract</p> <p>Background</p> <p>Little is known about the prevalence of primary and secondary headache in clinics in Japan. The aim of this study is to characterize patients with headache in an outpatient unit where primary care physicians are working in Japan.</p> <p>Methods</p> <p>Consecutive outpatients who newly visited the Department of General Medicine, Asahikawa Medical College Hospital, Asahikawa, Japan between April 2005 and March 2009 were analyzed. Each parameter such as age, sex or diagnosis was investigated.</p> <p>Results</p> <p>Out of 4693 patients, 418 patients visited to our department because of headache. Primary headache was found in 167 patients (39.9%). The rate of tension-type headache (TTH) (30.8%) was highest, followed by migraine (9.1%). Approximately 3 times higher rate of migraine was observed in female patients when compared with male patients. In female patients, migraine was observed more frequently in younger patients. On the other hands, TTH was observed in almost all aged patients in males and females, and the rate of TTH peaks between the ages of 40 and 49 years in both sex. The present study also demonstrated that 8.4% of patients who chiefly complained of headache had been diagnosed as depression while 1.7% of remained patients had been diagnosed as depression, indicating 5-times higher rate of depression in patients with headache.</p> <p>Conclusion</p> <p>All these results suggest that primary headache, especially TTH, is highly observed and depression should be considered in patients with headache in an outpatient clinic where primary care physicians are working in Japan.</p

The rate of polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a clinic where primary care physicians are working in Japan

We analyzed the rate of polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, both characterized as seronegative inflammatory arthritis in elderly, in an outpatient unit where primary care physicians are working in Japan to better understand the epidemiological characteristics of the diseases in Japan. Consecutive outpatients who newly visited at Department of General Medicine, Asahikawa Medical University Hospital, Japan, between April 2004 and March 2010 were analyzed. Each parameter such as age, sex, diagnosis, and biochemical examination was investigated. During the 6 years, 10 or 3 patients were diagnosed as PMR or RS3PE syndrome, respectively. The patients with PMR were 7 women and 3 men, and the average age at diagnosis was 69. Out of all patients aged over 50 (n = 3,347), the rate of PMR was 0.22% in men or 0.36% in women, respectively. On the other hand, RS3PE syndrome was diagnosed in 3 men (76, 76, and 81 years old). The rate of patients with RS3PE syndrome was 0.09% among outpatients aged over 50 indicating that the rate of PMR in an outpatient clinic in Japan is not far from previous findings reported from western countries. When compared with PMR, the rate of RS3PE syndrome was approximately one-third, providing for the first time the rate of RS3PE syndrome when compared with PMR. These epidemilogical data might help us pick up the diseases in primary care setting in Japan

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Pioglitazone improves visceral sensation and colonic permeability in a rat model of irritable bowel syndrome

Visceral hypersensitivity and impaired gut barrier with minor inflammation are considered to play an important role in the pathophysiology of irritable bowel syndrome (IBS). Since pioglitazone is known to have anti-inflammatory property, we hypothesized that pioglitazone is beneficial for treating IBS. In this study, the effect was tested in rat IBS models such as lipopolysaccharide or repeated water avoidance stress-induced visceral allodynia and increased colonic permeability. Pioglitazone blocked these visceral changes, and GW9662, a peroxisome proliferator-activated receptor gamma (PPAR-γ) antagonist fully reversed the effect by pioglitazone. These results suggest that PPAR-γ activation by pioglitazone may be useful for IBS treatment. Keywords: Pioglitazone, Visceral sensation, Gut permeabilit

【機能性消化管障害(FGID):診断と治療の進歩】 代表的疾患の診療の現況と将来展望 機能性腹痛症候群

著者最終原稿版要旨 機能性腹痛症候群は，消化管機能と関連が乏しい慢性の腹痛を来す疾患である．うつや不安障害などの精神疾患を合併し，ドクターショッピングを繰り返すQOLが高度に障害された症例が多い．病態として，中枢性の内臓知覚過敏の存在が推測されている．精神科的な治療が中心となるが，内科を受診することが多く，良好な医師患者関係の構築が疾患対応として特に重要である．内科医は本疾患の概念を理解し，適切に対応しなければいけない