A higher prevalence of cardiac right-to-left shunt through a patent foramen ovale (PFO) has been recently reported in the irritable bowel syndrome (IBS). At the same time, signs of ischemia in medullary cerebral microcirculation and the presence of excess sympathetic activity in peripheral circulation have been identifi ed, both related with change in pain perception and autonomic dysfunction characteristic of IBS. Considering these fi ndings together, the possible etiopathogenic role of PFO in the development of IBS can be proposed, because the paradoxical embolism characteristic of PFO could damage the cerebral and intestinal microcirculation, and that injury would be also amplifi ed by the percentage of venous blood that shunts the pulmonary fi lter, producing an alteration in the metabolism of serotonin, pro-infl ammatory bradykinins or neurotensin, substances with a proven etiopathogenic relationship with IBS. © 2008 Elsevier España, S.L. All rights reserved.
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