Colonic response to laxative ingestion as assessed by <scp>MRI</scp> differs in constipated irritable bowel syndrome compared to functional constipation

Lam, Ching; Chaddock, Gemma; Marciani, Luca; Costigan, Carolyn; Paul, J.; Cox, Eleanor; Hoad, Caroline L.; Menys, Alex; Pritchard, Susan E.; Garsed, Klara; Taylor, Stuart A.; Atkinson, David; Gowland, Penny; Spiller, Robin C.

doi:10.1111/nmo.12784

Cited by 55 publications

(85 citation statements)

References 28 publications

(84 reference statements)

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“…The study by Lam et al . in this issue of the journal identifies three additional physiological measures that are proposed as biomarkers to separate FC from IBS‐C, namely the time to first evacuation, volume of water in the small intestine, and volume of the ascending colon following ingestion of a liter of an osmotic laxative (polyethylene glycol). A novel aspect of the Lam study is that the authors assessed the response to a provocative stimulus (ingestion of an osmotic laxative) rather than attempting to find physiological differences under baseline conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies in Table compared whole gut transit (WGT) in FC vs IBS‐C. The hypothesis was that transit time would be slower in FC than in IBS‐C, and this was found in 3/8 studies . In five other studies there was no statistically significant difference between FC and IBS‐C, even though some of these studies found trends of differences between the groups in the expected direction.…”

Section: Review Of Studies Comparing Ibs‐c To Fcmentioning

confidence: 99%

“…The study in this issue of Neurogastroenterology and Motility by the Nottingham group may be remembered as a turning point in the controversy over whether FC and IBS‐C are two distinct disorders or parts of a spectrum of symptoms related to a shared pathophysiology. This study was able to show significant differences between well‐characterized groups of patients with FC and IBS‐C in whole gut transit time, colonic motility, water content in the small intestine, and colon volumes using validated, novel, non‐invasive magnetic resonance imaging (MRI) techniques.…”

mentioning

confidence: 99%

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Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation

Whitehead

Palsson

Simrén

2016

Neurogastroenterology Motil

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Treatments for functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) differ, but symptom criteria do not reliably distinguish between them; some regard FC and IBS-C as parts of a single constipation spectrum. Our goal was to review studies comparing FC and IBS-C to identify possible biomarkers that separate them. A systematic review identified 15 studies that compared physiologic tests in FC vs IBS-C. Pain thresholds were lower in IBS-C than FC for 3/5 studies and not different in 2/5. Colonic motility was decreased more in FC than IBS-C for 3/3 studies, and whole gut transit was delayed more in FC than IBS-C in 3/8 studies and not different in 5/8. Pelvic floor dyssynergia was unrelated to diagnosis. Sympathetic arousal, measured in only one study, was greater in IBS-C than FC. The most reliable separation of FC from IBS-C was shown by a novel new magnetic resonance imaging technique described in this issue of the journal. These authors showed that drinking one liter of polyethylene glycol laxative significantly increased water content in the small intestine, volume of contents in the ascending colon, and time to first evacuation in FC vs IBS-C; and resulted in less colon motility and delayed whole gut transit in FC compared to IBS-C. Although replication is needed, this well-tolerated, non-invasive test promises to become a new standard for differential diagnosis of FC vs IBS-C. These data suggest that FC and IBS-C are different disorders rather than points on a constipation spectrum.

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Section: Discussionmentioning

confidence: 99%

Section: Review Of Studies Comparing Ibs‐c To Fcmentioning

confidence: 99%

mentioning

confidence: 99%

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Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation

Whitehead

Palsson

Simrén

2016

Neurogastroenterology Motil

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“…Moreover, the transit in the macrogol period was similar to our previous study where PR oxycodone was administered alone. In a study by Lam et al, 25 the authors used MRI scans to measure intestinal volumes, transit, and motility in response to a single dose of macrogol in patients with either functional constipation or irritable bowel syndrome with constipation. Functional constipation patients showed slower transit and greater ascending colon volumes.…”

Section: Segmental Colorectal Volumesmentioning

confidence: 99%

Colorectal Transit and Volume During Treatment With Prolonged-release Oxycodone/Naloxone Versus Oxycodone Plus Macrogol 3350

Poulsen

Mark

Brock

et al. 2018

J Neurogastroenterol Motil

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Background/AimsOpioid-induced constipation (OIC) is the most common gastrointestinal (GI) side effect to opioid treatment. Opioid receptor antagonists against OIC have been introduced, but their efficacy has not been directly compared to conventional laxatives. Our aim was to compare symptoms and objective parameters of gut function in an experimental model of OIC during treatment with the opioid antagonist naloxone and oxycodone in prolonged-release (PR) formulation versus oxycodone plus macrogol 3350. MethodsIn this randomized, double-blind, crossover trial 20 healthy men received a 5-day treatment of combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350. Regional GI transit times and segmental colorectal transit were assessed with the Motilis 3D-Transit electromagnetic capsule system. Colorectal volumes were determined by MRI. OIC symptoms were assessed with validated questionnaires, along with stool frequency and consistency. ResultsTotal colorectal volume did not change after 5 days' treatment with PR oxycodone/naloxone (941 vs 1036 mL; P = 0.091), but increased significantly after PR oxycodone plus macrogol treatment (912 vs 1123 mL; P < 0.001). Neither regional GI transit times nor segmental colorectal transit differed between the treatments (all P > 0.05). The Patient Assessment of Constipation Symptom Questionnaire abdominal symptoms score was lower during PR oxycodone/naloxone compared to PR oxycodone plus macrogol (0.2 vs 3.2; P = 0.002). Stool frequency was lower during PR oxycodone/naloxone compared to PR oxycodone plus macrogol (4.2 vs 5.4; P = 0.035). ConclusionsPR oxycodone plus macrogol increases colorectal volume, but does not improve GI transit compared to PR oxycodone/naloxone. However, PR oxycodone/naloxone results in a lower abdominal symptom burden, despite higher stool frequency during macrogol treatment.

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“…ALTERED COLONIC FUNCTION is a common cause of chronic abdominal pain and often leads to burdensome symptoms. Colonic content and motility are relevant factors when investigating treatments of a number of disorders, such as constipation and irritable bowel syndrome . Knowledge of the distribution of intestinal gas content throughout the gastrointestinal (GI) tract has helped to understand the cause of abdominal symptoms such as bloating and abdominal distension …”

mentioning

confidence: 99%

MRI analysis of fecal volume and dryness: Validation study using an experimental oxycodone‐induced constipation model

Mark

Bodker

Grønlund

et al. 2019

Magnetic Resonance Imaging

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Background Opioids are known to affect gastrointestinal motility, but their effect on fluid absorption and secretion is poorly understood in humans. Purpose To investigate the effect of oxycodone on colonic fecal volume and stool dryness by using a novel MRI‐based technique. Study Type Prospective, randomized, double‐blinded, crossover study. Subjects Twenty‐five healthy male volunteers (median age: 24 years [range: 21–56]; mean body mass index [BMI]: 23.9 kg/m2 [range: 22.9–25.0]) without known gastrointestinal disease. Field Strength/Sequence T2‐weighted and two‐point Dixon MRI scans of the abdomen at 1.5 T. Assessment Subjects were treated for 5 days with prolonged‐release oxycodone or a placebo. Imaging was performed on the first and last study day in each period. Images of the colon were analyzed with semiautomatic k‐means‐based segmentation software. Regional colonic fecal volumes were quantified excluding gas volume and colon wall. Two‐point Dixon and T2‐weighted MRI signal intensity were assessed as a proxy of colonic stool dryness. Data were obtained in a previously reported study. Statistical Tests Intraclass correlation coefficients were used to test the reliability of measurements between days, while repeated measures mixed models were applied to test treatment effects. Results After oxycodone treatment, total colonic fecal volume was significantly increased compared with placebo (mean change 100 mL vs. –13 mL; P = 0.001), with the largest increase (24%) observed in the ascending colon/cecum (P = 0.001). Dixon signal increased (less water in colon content) after oxycodone treatment compared with placebo (mean 0.09 vs. –0.02; P < 0.001). T2‐weighted signal decreased (less water in colon content) after oxycodone treatment compared with placebo (mean –0.03 vs. 0.03; P = 0.002). Data Conclusion The 5‐day oxycodone treatment increased colonic fecal volume and increased stool dryness compared with placebo. This imaging‐based method for noninvasive analysis of colon content has the potential to characterize gastrointestinal symptoms in general, such as in constipation. Level of Evidence: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;50:733–745.

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Colonic response to laxative ingestion as assessed by MRI differs in constipated irritable bowel syndrome compared to functional constipation

Cited by 55 publications

References 28 publications

Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation

Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation

Colorectal Transit and Volume During Treatment With Prolonged-release Oxycodone/Naloxone Versus Oxycodone Plus Macrogol 3350

MRI analysis of fecal volume and dryness: Validation study using an experimental oxycodone‐induced constipation model

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