Basic Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jul 28, 2023; 15(7): 226-233
Published online Jul 28, 2023. doi: 10.4329/wjr.v15.i7.226
Can the change of vasomotor activity in irritable bowel syndrome patients be detected via color Doppler ultrasound?
Omer Kazci, Fahrettin Ege, Huseyin Aydemir, Saliha Kazci, Sonay Aydin
Omer Kazci, Department of Radiology, Ankara Training and Research Hospital, Ankara 06600, Turkey
Fahrettin Ege, Department of Neurology, VM Medicalpark Hospital, Ankara 06600, Turkey
Huseyin Aydemir, Sonay Aydin, Department of Radiology, Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Erzincan 24400, Turkey
Saliha Kazci, Department of Epidemiology, Ankara University Faculty of Medicine, Ankara 06600, Turkey
Author contributions: Kazci O, Ege F, and Kazci S contributed equally to this work; Aydemir H wrote the manuscript; Aydin S, Kazci S, and Kazci O performed the experiments; Aydemir H and Ege F provided technical support and suggestions; Aydin S participated in writing and modifying the manuscript; Kazci O designed the study; All authors approved the final manuscript.
Institutional review board statement: The studies adhered to the most recent edition of the Declaration of Helsinki, and the Ankara City Hospital No. 2 Clinical Research Ethics Committee authorized the procedures, No. E2-22-1307.
Informed consent statement: The participants signed a declaration form declaring that all participants and/or their legal guardians granted informed permission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sonay Aydin, MD, PhD, Academic Editor, Associate Professor, Department of Radiology, Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Başbağlar, Hacı Ali Akın Cd. No. 32, 24100 Erzincan Merkez/Erzincan, Erzincan 24400, Turkey. sonay.aydin@erzincan.edu.tr
Received: April 25, 2023
Peer-review started: April 25, 2023
First decision: June 19, 2023
Revised: June 20, 2023
Accepted: July 7, 2023
Article in press: July 7, 2023
Published online: July 28, 2023
Processing time: 89 Days and 23.6 Hours
Abstract
BACKGROUND

Irritable bowel syndrome (IBS) is one of the most frequently referred conditions to the gastrointestinal outpatient clinic. The pathophysiology of IBS has not been determined with certainty. Visceral hypersensitivity is indicated as one of the pathophysiologies. The sympathetic nervous system is primarily in charge of controlling the arteries, and its effect is vasospasm in the medium and large arteries, resulting in decreased blood flow.

AIM

To demonstrate, using Doppler evaluation of the brachial artery, that sympathetic activity impairs vasomotor performance due to autonomic neuropathy, which we believe is associated with IBS.

METHODS

There were 58 participants in the study. The control group consisted of 29 healthy patients, while the remaining 29 patients had been diagnosed with IBS. Patients who met the Rome IV criteria and had IBS were included in the study. People with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial, as were those with essential hypertension, diabetes mellitus, cardiovascular disease, or peripheral arterial disease, and patients diagnosed with anxiety or depression. Those with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial. A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa. The Doppler probe remained stationary throughout the experiment, allowing for continuous measurements. Then, to activate the sympathetic fibers, an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level via the bipolar stimulus electrode. The artery diameter and flow rates were measured again immediately following the fifth stimulus.

RESULTS

In healthy persons with no history of chronic illness, there was a statistically significant decrease in flow rate after stimulation (P < 0.001). In addition, stimulation resulted in a statistically significant reduction in the diameter of the brachial artery (P < 0.001). Patients diagnosed with IBS had statistically significant vasodilation and an increase in flow rate.

CONCLUSION

Sympathetic stimulation causes a reduction in vascular diameter and blood flow, whereas it has the reverse effect on IBS patients. In investigating the involvement of autonomic neuropathy in the development of IBS, significant changes in brachial artery Doppler parameters were observed before and after stimulation of the median nerve with low-current sensory stimulation. This method is thought to be more user-friendly and comfortable than other methods described in the literature.

Keywords: Irritable bowel syndrome, Doppler ultrasonography, Brachial artery, Median nerve, Peripheral neuropathy, Autonomic neuropathy

Core Tip: It has been noted that the autonomic activity of individuals who suffer from irritable bowel syndrome (IBS) differs from that of healthy people. Colored Doppler ultrasonography can be utilized as a noninvasive diagnostic tool that can be performed at any age and at any age, is comfortable for the patient, and does not require further patient compliance to show autonomic dysfunction in patients with IBS.