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Differentiation of Inflammatory Bowel Disease and Irritable Bowel Syndrome
      09/01/05 11:13 AM
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Rectal Mucosal Nitric Oxide in Differentiation of Inflammatory Bowel Disease and Irritable Bowel Syndrome

Clinical Gastroenterology and Hepatology
Volume 3, Issue 8 , August 2005, Pages 777-783

Claudia I. Reinders, Max Herulf;, Tryggve Ljung, Jakob Hollenberg, Eddie Weitzberg§, Jon O. Lundberg, and Per M. Hellström

Division of Pharmacology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
‡Department of Gastroenterology and Hepatology, Karolinska University Hospital Solna, Stockholm, Sweden
§Department of Anaesthesiology and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden


Background & Aims: Differentiating patients with functional bowel disorders from those with inflammatory bowel disease (IBD) can be difficult. Rectal luminal levels of nitric oxide (NO) are greatly increased in IBD. To further evaluate this disease marker, we compared NO in patients with irritable bowel syndrome (IBS) with those found in patients with active IBD and in healthy control subjects. Methods: Rectal NO was measured with chemiluminescence technique by using a tonometric balloon method in 28 healthy volunteers, 39 patients with IBS, 86 with IBD (Crohn's disease and ulcerative colitis), and 12 patients with collagenous colitis. In addition, NO was measured before and after a 4-week treatment period in patients with active ulcerative colitis and repeatedly during 2 weeks in healthy volunteers. Results: NO was low in healthy control subjects (median, 45; 25th–75th percentile, 34–64 parts per billion [ppb]), and variations over time were small. In IBS patients NO was slightly increased (150, 53–200 ppb; P < .001), whereas patients with active IBD or collagenous colitis had greatly increased NO levels (3475, 575–8850 ppb, and 9950, 4475–19,750 ppb, respectively; P < .001). With a cutoff level of 250 ppb, NO had a sensitivity of 95% and a specificity of 91% in discriminating between active bowel inflammation and IBS. Rectal NO correlated with disease activity in IBD and collagenous colitis and decreased markedly in IBD patients responding to anti-inflammatory treatment. Conclusions: Rectal NO is a minimally invasive and rapid tool for discriminating between active bowel inflammation and IBS and a possibly useful add-on for monitoring patients with IBD.

Abbreviations used in this paper: CI, confidence interval; GI, gastrointestinal; HBI, Harvey Bradshaw index; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; NO, nitric oxide; ppb, parts per billion


Supported by grants from the Knowledge Foundation, the Swedish Research Council, and Karolinska Institutet. Eddie Weitzberg and Jon O. Lundberg own shares in Aerocrine AB, a company that manufactures equipment for measurements of nitric oxide.
Address requests for reprints to: Claudia Reinders, MSc, Department of Physiology and Pharmacology, Division of Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden. fax: +46 8 33 22 78.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GGW-4GV2755-K&_user=10&_handle=V-WA-A-W-WC-MsSAYVA-UUW-U-AAWDWECCVA-AAWVYDZBVA-WECDUEZWB-WC-U&_fmt=summary&_coverDate=08%2F31%2F2005&_rdoc=17&_orig=browse&_srch=%23toc%2320161%232005%23999969991%23603702!&_cdi=20161&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f0dd70723cf0e5dc95f617a69215484f

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