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Postprandial changes in small bowel water content in healthy subjects and patients with irritable bowel syndrome.

Gastroenterology. 2009 Nov 9;

Authors: Marciani L, Cox EF, Hoad CL, Pritchard S, Totman JJ, Foley S, Mistry A, Evans S, Gowland PA, Spiller RC

BACKGROUND & AIMS:: Postprandial symptoms are common in patients with irritable bowel syndrome with diarrhea (IBS-D) and could be diet related. We studied postprandial changes in distribution of water in the upper gastrointestinal tract of healthy volunteers (HV) and patients with IBS-D after contrasting meals. METHODS:: In Study 1, 11 HV consumed 350-ml test meals with 5% mannitol (unabsorbable) or 5% glucose (readily absorbed). In Study 2, 17 HV consumed a 331 kcal meal, with or without 15g bran. In Study 3, 26 patients with IBS-D consumed the Study 2 diet with bran meal. All subjects underwent serial magnetic resonance imaging analysis. RESULTS:: In Study 1, subjects' small bowel water content (SBWC) increased after the mannitol, but not glucose meals, reaching 381 ml (343 ml-491 ml) and 47 ml (18 ml-78ml) respectively, 40 min after eating ( P < .001). In Study 2, SBWC initially decreased after both meal types and then increased, plateauing at 180 min-405 min and was greater after the bran meal ( P = .02). In Study 3, fasting and postprandial SBWC was lower in IBS-D than HV ( P < .05 and P < .0001 respectively). Patients with IBS-D had faster oro-cecal transit times (135 min; 90 min-180 min) compared with HV (225 min; 203 min-293 min; P < .0001) and reduced terminal ileum diameter ( P < .003). CONCLUSIONS:: Postprandial SBWC initially decreases, because of rapid, nutrient-driven fluid absorption, and then increases after a mixed liquid/solid meal. IBS-D patients have reduced fasting and postprandial SBWC with faster transit, possibly indicating increased small intestinal tone.

PMID: 19909743 [PubMed - as supplied by publisher]

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