2012•Zeitschrift für GastroenterologieRequires access
Correlation of abdominal pain with fecal cystein-protease activity in irritable bowel syndrome patients with constipation (IBS-C)
R Róka, Anita Annaházi, Valérie Bézirard, Laurent Ferrier, Hélène Eutamène, Orsolya Inczefi, Krisztina Barbara Gecse, Andras I. Rosztoczy, T Molnár, Y. Ringel, Tamar Ringel‐Kulka, Thierry Piche, Vassillia Theodorou, Tibor Wittmann, Lionel Buéno
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Abstract
Introduction: Previously we have shown that fecal cystein-protease activity is significantly elevated in IBS-C patients compared to control subjects. In animal experiments, colorectal infusion of fecal supernatants from IBS-C patients increase gut paracellular permeability and provokes a visceral hypersensitivity to distension. This increase is linked to the enzymatic digestion of the tight junction proteins by the cystein-proteases contained in these fecal supernatants. Aims: Our aims were to explore if there is a correlation between fecal cystein-protease activity and symptoms in IBS-C patients. Materials and methods: Fecal samples were collected from IBS-C patients (n=44) diagnosed by the Rome III criteria in three different centers, Szeged (Hungary), Nice (France) andChapel Hill (USA). Cystein-protease activity was assayed using a selective substrate and controlled by a selective cystein-protease inhibitor, E64. The questionnaire of Francis et al. was filled in on the day of fecal sample collection. Correlation was examined between fecal cystein-protease activity and pain-dyscomfort, frequency of defecation and stool consistency (Bristol scale). Results: In IBS-C patients, the mean cystein-protease activity was 1788.5Δfluo/mg protein (vs. 166.2 in control subjects), without significant differences between the countries. There was a significant correlation between this activity and the pain score (EVA 1–10) noted by the patients on the day of the interview (r2=0.5805, p<0.001). Although the composite score also correlated significantly with the cystein-protease activity (r2=0.5706, p<0.001), there was no correlation between the cystein-protease activity and the stool frequency or consistency. Conclusion: In IBS-C patients, fecal cystein-protease activity correlates with abdominal pain. These results are in agreement with observations from animal experiments, suggesting a major role of cystein-protease activity in the pathomechanism of IBS-C. References: Francis et al. Aliment Pharmacol Ther 1997; 11: 395.