Colonic motor activity in slow‐transit idiopathic constipation as identified by 24‐h pancolonic ambulatory manometry

Abstract

Colorectal motor activity in slow-transit idiopathic constipation has not been fully evaluated under physiological conditions. The aim of this study was to evaluate colorectal motor activity in chronic idiopathic constipation using 24-h ambulant pancolonic manometry. Ten healthy volunteers (six females) 19-31 years of age, and eight females 25-46 years of age with slow-transit idiopathic constipation were studied. Motor activity was measured using two custom-made silicone-coated catheters, each with five solid-state pressure transducers. Bowel preparation or sedation was not used. Frequency of high-amplitude propagated contractions was reduced in chronic idiopathic constipation, median 1.9/24 h vs 6/24 h (P = 0.01). Contractile frequency of low-amplitude complexes was reduced throughout the colon in slow-transit idiopathic constipation (P < 0.0001). The interval between contractile complexes was reduced in the transverse colon and splenic flexure (P < 0.0001). This study demonstrates that colonic motor activity is abnormal in slow-transit idiopathic constipation; decreased motor activity leads to a reduction in propulsion of intraluminal contents.

Characterization of motor patterns in isolated human colon: are there differences in patients with slow-transit constipation?

“…They are presumed to underlie the propulsion of colonic content, but this has not been demonstrated. It is important to note that a previous study of human colon found CMCs also occurred less frequently (9). Whether the CMCs we recorded in vitro are the same phenomena as the CMCs recorded in vivo is not known.…”

“…classification of CMCs described in dog colon (22) and human colon (9,23). CMCs in both dog and human colon in vivo occur repetitively and cyclically and can originate at any site along the colon, while being able to propagate in either an oral or anal direction.…”

“…There is evidence that a population of patients with STC have reduced numbers of high-amplitude propagating contractions (2,11). There is also evidence that the interval between CMCs is reduced in the transverse colon and splenic flexure (9). Other studies have demonstrated reductions in specific neurochemical classes of myenteric neurons in STC patients (4,15,21,32), in addition to reduced density of pacemaker cells (16) or specific types of neuromuscular transmission (31).…”

Overexpression of progesterone receptor B increases sensitivity of human colon muscle cells to progesterone

“…G proteins; cyclooxygenase enzymes; prostaglandins IDIOPATHIC CONSTIPATION is prevalent in young women and is characterized by slow transit time (3,16,41). Female sex hormones have been suggested as possible etiologic factors in the pathogenesis of slow-transit constipation (STC) because of the higher incidence of constipation in young women than in men (29,35) as well as during the last two trimesters of pregnancy, when the levels of progesterone (P 4 ) are highest (2,5,11,13,26,28,42).…”

The Physiology of Human Defecation

“…These typically have amplitude \50 mmHg [156], occur 40-120 times in a 24 h period [117,147,157], and propagate for distances \22.5 cm [121]. Studying the relation between frequency of PSs and constipation, some authors have found a reduced frequency in obstructed defecation [122] and slow transit constipation [155]; others have found no difference [151]. In healthy individuals, propagating sequences display a spatio-temporal or ''regional linkage'' (where two consecutive PSs, originating from different colonic regions overlap) [120,158].…”