Journal
AMERICAN JOURNAL OF GASTROENTEROLOGY
Volume 106, Issue 5, Pages 815-819Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ajg.2010.408
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Funding
- Spanish Ministry of Education (Direccion General de Investigacion, SAF) [SAF 2009-07416]
- Fundacio La Marato TV3 [MARATV3_072010]
- Instituto de Salud Carlos III
- Spanish Ministry of Health (Ayuda para contratos post-Formacion Sanitaria Especializada, ISC III) [03/00051]
- Freiwillige Akademische Gesellschaft (Basel, Switzerland)
- Gottfried und Julia Bangerter-Rhyner-Stiftung (Bern, Switzerland)
- Comision Nacional de Investigacion Cientifica y Tecnologica-Gobierno de Chile
- Pontificia Universidad Catolica de Chile
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OBJECTIVES: The abdomen normally accommodates intra-abdominal volume increments. Patients complaining of abdominal distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in abdominal distension. METHODS: In 20 patients complaining of abdominal bloating and 15 healthy subjects, we increased the volume of the abdominal cavity with a colonic gas load, while measuring abdominal girth and electromyographic activity of the anterior abdominal muscles and of the diaphragm. RESULTS: In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more abdominal distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. CONCLUSIONS: In this experimental provocation model, abnormal accommodation of the diaphragm is involved in abdominal distension.
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