Has the identification of rectal hypersensitivity any implication in the clinical outcome of irritable bowel syndrome?

BACKGROUND Sixty percent of patients with irritable bowel disease (IBS) are hypersensitive to rectal distension. It is uncertain to what extend the identification of this abnormality has an impact in the clinical outcome. OBJECTIVE to evaluate if rectal hypersensitivity is associated with a different clinical outcome, prognosis and use of medical resources. MATERIAL AND METHODS Patients with IBS (Rome II criteria) who underwent a rectal distension study at least one year before were eligible if they have not been included in any research protocol since then. We reviewed how many times in the last year they came to emergency room, underwent an endoscopy, and consulted a gastroenterologist or other medical physician for any reason. Also, a telephone interview was done by a gastroenterology fellow using a structured questionnaire to evaluate the frequency and severity of their symptoms in the last year and last month. RESULTS A total of 52 patients were eligible and 38 were included. Fourteen were not included because inability to made a phone contact or did not consent to phone interview. Twenty six patients were hypersensitive and 12 normosensitive. Both groups had similar symptoms (frequency and severity) but hypersensitive patients visited less to the gastroenterologist (1.2 +/- 0.2 vs. 2.9 +/- 0.6 times yearly, p < 0.01). CONCLUSION Identification of rectal hypersensitivity to distension is associated to less consultation to gastroenterologist, although severity and frequency of symptoms are not modified. Finding of an objective explanation of the symptoms seems to help patients to understand their disease, leading to a decrease in resources use.