Irritable Bowel Syndrome–a Neurological Spine Problem

Abstract

Aim: To investigate if patients with Irritable bowel syndrome (IBS) have more findings in the physical examination indicating nerve involvement from spine segments Th7-L1 than people without gastrointestinal disorder. Study Design: Clinical randomized blinded case-control diagnostic study. Place and Duration of Study: Torvalla back and sports medical clinic and CeFAM at Karolinska Institutet, Stockholm, Sweden, Mars-May 2012. Methodology: Ten patients with IBS and six age-matched controls were randomly scheduled to a physical examination by two independent examiners who were blinded to the status of the person they examined. The physical examination followed a pre-determined protocol focused on neurological examination and palpation of the abdomen and the spine. Fischer´s exact test and Cohen’s kappa (K) test were used to analyze prevalence respectively inter-examiner reliability of examination findings. Results: Disturbed sensibility to pain in one or more of dermatomes T7-L1 was more prevalent in patients with IBS than controls (p=0.007 for both examiners). Tenderness on palpation of one or more of spinal processes T7-L1 was more prevalent in patients with IBS than controls (p=0.001 for examiner 1, p=0.008 for examiner 2). Inter-examiner reliability in the physical examination test for sensibility to pain and palpation of the abdomen was 100% (K=1.0). Conclusion: Patients with IBS have significantly more findings in the physical examination indicating nerve involvement from spine segments Th7-L1 than people without gastrointestinal disorder. Further work in larger cohorts and with added diagnostic methods is required to confirm our findings and if confirmed may open up for new treatment strategies of IBS.