Discrimination of irritable bowel syndrome by non-linear analysis of 24-h jejunal motility

Conventional analysis of ambulatory longterm manometry of the small intestine has revealed abnormalities in patients with the irritable bowel syndrome (IBS). The aim was to use methods from non-linear dynamics, in particular the concepts of symbolic dynamics and entropy, in order to discriminate motility in IBS from healthy subjects. 24-h jejunal motility was recorded in 30 IBS patients and 30 healthy subjects. Computerized analysis of contraction amplitudes and intercontractile intervals was performed. Both time series were analysed by symbolic dynamics and entropy to quantify the degree of randomness inherent in the signal. During phase II IBS patients exhibited significantly increased entropies for the intercontractile intervals (IBS: 0.978 +/- 0.016, C: 0.965 +/- 0.020, P = 0.004) and for the contraction amplitudes (IBS: 0.978 +/- 0.008, C: 0.970 +/- 0.026, P = 0.05) compared with healthy subjects. In addition, a significantly increased mean contraction amplitude (mmHg) was found in patients (IBS: 25.2 +/- 4.8, C: 22.2 +/- 3.1, P = 0.003). Considering a combination of both parameters, a diagnostic accuracy of 82% was achieved. We conclude that phase II motility of the small intestine is more random in IBS than in health. Symbolic dynamics seems to be a promising new concept for the analysis of long-term gastrointestinal motility recordings.