| Background and Objective Irritable bowel syndrome (IBS) is currently viewed as a common functional bowel disorder in which abdominal pain and/or discomfort are associated with altered bowel habits. The diagnosis is based on Rome III criteria, the symptom based criteria. It's necessary to understand the symptom characteristics for IBS diagnostic criteria. IBS with diarrhea is the most common subgroup of IBS, in which patients the symptoms often varied with the time, including alternation with onset and remission, or persistence without remission. It is not clear that the pathogenesis of IBS episodic symptoms or persistence. The aims of this study are: (1)to investigate the predominant symptoms of IBS-D and symptoms related to defecation, and measure characteristic symptoms for IBS-D; (2)to evaluate the change of anorectal functions during different status of IBS-D by manometry, and the relationship between symptoms onset and anorectum measures; and (3)to understand whether the numbers of EC cells and 5-HT in colon mucosa are one of the crucial factors which alter the symptom onset or remission for IBS-D patients.Materials and Methods A total of 113 consecutive IBS-D patients diagnosed in GI outpatient Clinic of Peking Union Medical College Hospital were enrolled in this study, among them 71 are male and 42 are female. All patients fulfilled IBS questionnaire by trained physicians. Fifty four patients also underwent anorectal manometry, and the biopsy samples from sigmoid colon in 53 cases were obtained for the detection of EC cells by immunohistochemistry staining with 5-HT and Chromogranin A.Results About 45.1% patients with IBS-D in this group had pain and/or discomfort in the "silent status"(no defecation), usually the symptoms are mild or moderate, and in 97.3% of IBS-D patients, the abdominal pain and/or discomfort did occur or aggravate with defecation. For the majority of patients, the pain or discomfort improved more than 1/2 in degree or complete in less than 10 min after defecation. tool frequency of these IBS-D increased when patients presented no symptoms. In 93.8% of the patients, the onset of abdominal pain and/or discomfort is associated with a change in stool frequency from 1.9 times per day to 3.8 times per day, as well as with a change in the stool form, usually from type 4,5 in Bristol scale to type 5,6, or 7. Symptoms such as urgency (85.8%), feeling of incomplete bowel movement (69.9%), passage of mucus (69.0%) are very common in IBS-D patients, with moderate or severe in degree.There was no significant difference in motility and sensation measures in anorectal manometry between the episodic group(n=26), remission group(n=15) and persistent group(n=13). A negative correlation was found between the max volume of anorectum sensation and the improvement of abdominal pain and/or discomfort after defecation(r=-0.274, p=0.047). No significant difference was found in the number of EC cells and EC cells with 5-HT positive staining for patients with symptom onset, remission or persistent.Conclusions In IBS-D patients, the abdominal pain and/or discomfort, which occur or worsen before defecation were more common, more severe than that in the "silent status". The symptom improvement after defecation is quite well for the most patients, and it is necessary to judge the changes in stool frequency and form with comparison to the basal bowel habits. The relationships between the motility and sensation in anorectum, EC cells and symptoms onset or persistent for IBS-D patients are uncertain.
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