Rectal Hypersensitivity in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Author:

Roberts Christopher12,Albusoda Ahmed1,Farmer Adam D1345,Aziz Qasim1

Affiliation:

1. Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

2. University Hospital Southampton, Southampton, UK

3. Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark

4. Institute of Applied Clinical Sciences, University of Keele, Keele, UK

5. Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK

Abstract

Abstract Abdominal pain is a key symptom of inflammatory bowel disease (IBD), particularly in active IBD, but also occurs in patients with quiescent disease suggesting that mechanisms other than active inflammation may be responsible. Putative hypothesis to explain chronic abdominal pain in patients with quiescent IBD includes crossover with irritable bowel syndrome where rectal hypersensitivity is common and has pathophysiological implications. In contrast, in IBD, the role of rectal hypersensitivity has not been established. We aimed to determine if rectal hypersensitivity was more common in IBD compared to a healthy control population. We searched MEDLINE and EMBASE databases (1970–2018). Prospective studies that measured pain/discomfort thresholds to mechanical rectal stimuli in IBD and healthy controls were included. Data were pooled for meta-analysis and effect sizes were calculated with 95% confidence intervals (CIs). Our search strategy identified 222 citations of which 8 met the inclusion criteria, covering 133 individuals with IBD (67 men), aged between 10 and 77 compared to 99 healthy controls (55 men), aged between 10 and 67. The prevalence of rectal hypersensitivity in IBD compared to healthy controls was similar with an effect size of 0.59 (95% CIs: −0.27 to 1.44, P = .16, I2 = 87.3%). Subgroup analysis did show a significant effect size for patients compared to healthy controls with active disease (1.32) but not for quiescent disease (−0.02). These results suggest that reduced rectal pain thresholds to experimental stimulation are not seen in IBD populations except during active flares of the disease. Further research is required to understand the pathophysiology of chronic abdominal pain in quiescent IBD populations with and without chronic abdominal pain to identify appropriate management strategies.

Funder

European Union’s Seventh Framework Programme

West Midlands Clinical Research Network Scholarship

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology

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