Ambulatory 24-Hour Colonic Manometry in Slow-Transit Constipation

Rao, Satish S.; Sadeghi, Pooyan; Beaty, Jennifer; Kavlock, Renae

doi:10.1111/j.1572-0241.2004.40453.x

Cited by 167 publications

(220 citation statements)

References 34 publications

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“…30 Similar studies in slow transit constipation patients have found a reduced daily frequency of high amplitude propagating sequences (also recognised as mass movements and responsible for a significant proportion of propulsive activity in the colon), and that all high amplitude propagating sequences originate in the proximal colon. 29,31,32 It is therefore plausible that the prolonged colonic transit times during oxycodone treatment in this study share-at least partly-pathophysiological characteristics with slow transit constipation, and that further development of the 3D-Transit software could elucidate this neglected, yet important aspect of GI motility. Along the same line, the increased transit in the rectosigmoid colon during oxycodone treatment could indicate that not only transit, but possibly also defecation, is affected.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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Background/AimsTo employ an experimental model of opioid-induced bowel dysfunction in healthy human volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility assessed by questionnaires and regional GI transit times using the 3-dimensional (3D)-Transit system. MethodsTwenty-five healthy males were randomly assigned to oxycodone or placebo for 5 days in a double blind, crossover design. Adverse GI effects were measured with the bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptom questionnaire, and Bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system, and segmental transit times in the colon were determined using a custom Matlab ® graphical user interface. ResultsGI symptom scores increased significantly across all applied GI questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 hours (P < 0.001), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 hours (P = 0.012), rectosigmoid colon transit from 2.7 to 9.0 hours (P = 0.044), and colorectal transit time from 18.6 to 38.6 hours (P = 0.001). No associations between questionnaire scores and segmental transit times were detected. ConclusionsSelf-assessed GI adverse effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of constipation.

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Section: Discussionmentioning

confidence: 99%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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“…As a result our understanding of normal pressure/flow relationships is still relatively simplistic [3]. Therefore while abnormal contractility is implicated in FGIDs [4][5][6], how these abnormalities relate to impaired flow remains largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Investigating the relationships between peristaltic contraction and fluid transport in the human colon using Smoothed Particle Hydrodynamics

Sinnott¹,

Cleary²,

Arkwright³

et al. 2012

Computers in Biology and Medicine

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The gastrointestinal tract comprises of several distinct organs in sequence, extending over 7 meters in the human abdomen. Controlled propulsion and mixing of content along the digestive tract is essential for a normal life. This is achieved by a rich assortment of motor patterns that ensure that movements and propulsion are appropriate for the breakdown of food, absorption of nutrients and excretion of waste. These movements (motility) are due to coordinated contractions and relaxations of circular and longitudinal smooth muscle layers. For oesophageal FGIDs the combined technical advances in recording abnormal contractility, via oesophageal manometry, and relating these abnormalities to impaired flow [2] has seen a dramatic improvement in our understanding of the problem and therefore our ability to treat the patient.However, this is not the case for FGIDs in regions below the stomach. The small and large intestines are relatively inaccessible and obtaining detailed manometric recordings and visualizing the movement of digesta is difficult. As a result our understanding of normal pressure/flow relationships is still relatively simplistic [3]. Therefore while abnormal contractility is implicated in , how these abnormalities relate to impaired flow remains largely unknown.Computational modeling of gastrointestinal systems has the potential to help understand these complex relationships. Many mathematical models of peristaltic pumping in flexible tubes have been developed over the last decades and the reader is referred to [7,8] for comprehensive reviews of 3/37 this research. The vast majority of these models do not take into account the solid wall mechanics of the flexible tube in predicting the transient wall deformation. Instead the wall shape is fully prescribed. Some exceptions to this include Carew and Pedley [9] who developed a model of peristaltic flow in the ureter with an active contracting wall coupled to the internal resistance from the intra-luminal pressures in an infinitely long tube. Such models are based on lubrication theory and are therefore limited to simple geometry systems with low inertial flows and long waves. They are well suited to studying the dynamics of the ureter. However, the development of intestinal flow models for studying the effect of single and multiple wave trains on transport requires an active wall model that can accommodate more realistic geometry and non-linear wall mechanics.More recently detailed computational models of oesophageal motility [10,11] have helped to define relationships between motility and flow. In addition CFD models have started to consider the effect of peristaltic motor patterns in the small intestine [12] and the stomach [13,14]. While these studies in the stomach and small bowel have sourced anatomically accurate wall geometries from MRI, they have not attempted a 2-way coupling of the motor activity in the wall with the fluid content.Instead motor patterns are prescribed as a sequence of fixed geometric changes to the boundary.Physiologically real...

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“…For the purposes of manometric measurements, the colon was divided into six segments, namely, the proximal (1) and distal transverse colon (2), splenic flexure (3), descending colon (4), sigmoid colon (5) and rectum (6). These transducers were so placed that they lay in the middle of each colonic segment and at approximately 70, 55, 40, 25, 15, and 7cms, respectively, from the anus (Figure 1).…”

Section: Manometry Assemblymentioning

confidence: 99%

“…Using this technique, we have described seven different motor patterns in the colon of normal healthy subjects, as well as diurnal variation and a characteristic increase in motor activity after awakening and food ingestion. 5 This technique has also been used for studying colonic motor activity in patients with idiopathic slow-transit constipation, 6 irritable bowel syndrome, 7 fecal incontinence 8 and inflammatory diarrhea. 9 Colonic manometry may provide a better understanding of physiology and pathophysiology of colonic motor function and defecation disorders.…”

Section: Introductionmentioning

confidence: 99%

“…Although anchoring the manometry catheter to the colonic mucosa with hemostatic clips has been described, there has been no systematic evaluation of the efficacy of this technique. 6,16 Here, we assessed the utility of endoscopic mucosal clipping as a method of improving spatiotemporal resolution of transducers and maintaining sensor location in the colon, by a randomized case-control study in healthy subjects undergoing prolonged ambulatory colonic manometry.…”

Section: Introductionmentioning

confidence: 99%

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