Dynamic scanning defines a colonic defect in severe idiopathic constipation.

Kamm, Michael A.; Lennard‐Jones, J. E.; Thompson, D G; Sobnack, R.; Garvie, N. W.; Granowska, M.

doi:10.1136/gut.29.8.1085

Cited by 63 publications

(19 citation statements)

References 18 publications

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“…These observations are very similar to the events reported during spontaneous physiological events, suggesting the presence of a specific motor pattern controlled by a peculiar enteric neural program, which allows the effective transport and expulsion of colonic contents [31]. However, it must be kept in mind that in severely constipated patients both spontaneous and bisacodyl-elicited HAPCs probably have an impaired propulsive function with respect to those observed in healthy subjects [13, 39]. …”

Section: Discussionsupporting

confidence: 60%

Endoluminal Instillation of Bisacodyl inPatients with Severe (Slow Transit Type)Constipation Is Useful to Test Residual ColonicPropulsive Activity

Bassotti

Chiarioni²,

Germani

et al. 1999

Digestion

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Background: Chronic constipation is a frequent symptom among the general population, and a minority of cases do not respond to any therapeutic measures, except surgery. The purpose of this study was to test the residual colonic motor propulsive activity with a pharmacologic stimulus in a series of patients referred for severe constipation. Patients: Twenty-five chronically constipated patients, slow transit type, age range 16–71 years, unresponsive to conventional medical treatment and referred for functional evaluation, entered the study. Methods: Colonic manometry by means of an endoscopically positioned probe was carried out in all patients. Following a basal recording period, a placebo solution followed by 10 mg bisacodyl solution was infused into the colon through the more proximal recording port. Results: After bisacodyl infusion, about 90% of patients showed a motor response characterized by the appearance (within on average 13 ± 3 min) of one or more high-amplitude propagated contractions, the manometric equivalent of mass movements, and about 75% of these were followed (mean 18.5 ± 4 min) by defecation. Conclusions: Physiological and pharmacological testing of colonic motor activity may be important in severely constipated patients, especially in those labeled as ‘intractable’, in whom more in depth investigation planning may encourage further therapeutic efforts.

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Section: Discussionsupporting

confidence: 60%

Endoluminal Instillation of Bisacodyl inPatients with Severe (Slow Transit Type)Constipation Is Useful to Test Residual ColonicPropulsive Activity

Bassotti

Chiarioni²,

Germani

et al. 1999

Digestion

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“…Concerning STC, some data suggest an impairment of colonic propulsive activity, represented by a reduced daily number of high-amplitude propagated contractions (HAPC), the manometric equivalent of mass movements [11, 12, 13, 14, 15]; more recently, similar data have been described in constipation-predominant IBS (C-IBS) patients [16]. However, impairment of HAPC is probably not sufficient to explain the overall derangement of colonic transport.…”

Section: Introductionmentioning

confidence: 75%

“…The important reduction of HAPC in STC patients is considered one of the major mechanisms responsible for constipation [11, 12, 14]. However, until now no data were available in pathological conditions concerning the other kind of propulsive activity, such as that represented by the LAPC.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Colonic Propagated Activity in Patients with Slow Transit Constipation and Constipation-Predominant Irritable Bowel Syndrome

Bassotti

Chistolini²,

Marinozzi³

et al. 2003

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Background: The pathophysiological basis of constipation is still unclear, and the role of colonic dysfunction is debated, especially in irritable bowel syndrome. Objective data are quite scarce, especially concerning colonic propulsive activity. Aims: To evaluate high- and low-amplitude colonic propulsive activity in constipated patients (slow-transit type and irritable bowel syndrome) in comparison with normal controls. Patients and Methods: Forty-five constipated patients (35 with slow-transit constipation and 10 with constipation-predominant irritable bowel syndrome) were recruited, and their data compared to those of 18 healthy subjects. Twenty-four-hour colonic manometric recordings were obtained in the three groups of subjects, and data concerning high- and low-amplitude colonic propulsive activity were then compared. Results: High-amplitude propagated contractions were significantly (p < 0.05) decreased in patients with slow-transit constipation and constipation-predominant irritable bowel syndrome with respect to controls (1.5 ± 0.4, 3.7 ± 2, and 6 ± 1 events/subject/day, respectively). In slow-transit constipation, a significant decrease of contractions’ amplitude was also observed. Concerning low-amplitude propagated contractions, patients with slow-transit constipation had significantly less events with respect to patients with constipation-predominant irritable bowel syndrome (46 ± 7 vs. 87.4 ± 19, p = 0.015); no differences were found between patients with slow-transit constipation and controls and between patients with constipation-predominant irritable bowel syndrome and controls. All three groups displayed a significant increase of low-amplitude propagated contractions after meals (6.3 ± 2 vs. 18.2 ± 5 for controls, p < 0.005; 6.4 ± 1.4 vs. 16.3 ± 2.4 for slow-transit constipation, p < 0.005; 10.5 ± 3.2 vs. 32.6 ± 7 for constipation-predominant irritable bowel syndrome, p = 0.001). Conclusions: Low-amplitude propagated contractions may represent an important physiologic motor event in constipated patients, reducing the severity of constipation in patients with irritable bowel syndrome and preserving a residual colonic propulsive activity in patients with slow-transit constipation.

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“…In this severely constipated patient the site of delay is predominantly in the transverse colon (same patient as in Fig. 7) on colonic transit (Kamm et al 1988b;Krevsky et al 1987). A stimulant could also be infused directly into the colon during a study to test colonic motor function (Kamm et al 1988b).…”

Section: Delivering Radioisotope To the Small Bowel And Colonmentioning

confidence: 99%

“…7) on colonic transit (Kamm et al 1988b;Krevsky et al 1987). A stimulant could also be infused directly into the colon during a study to test colonic motor function (Kamm et al 1988b). These early studies depended on the passage of a fine tube via the nose or mouth, through the stomach and small bowel and into the colon.…”

Section: Delivering Radioisotope To the Small Bowel And Colonmentioning

confidence: 99%

The small intestine and colon: scintigraphic quantitation of motility in health and disease

Kamm

1992

Eur J Nucl Med

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Radioisotopes allow accurate quantitation of the pattern and effectiveness of the transit of chyme through the small and large intestines. Abnormalities of small bowel transit can be demonstrated in patients with the irritable bowel syndrome, and patients with chronic idiopathic intestinal pseudo-obstruction due to either a visceral myopathy or neuropathy. In the colon, radioisotopic studies of transit have demonstrated the site of delayed transit in some severely constipated patients. In patients with these disorders of transit, functional studies may influence the choice of medical or surgical therapy although there are few prospective studies which have established their worth in this context. Radioisotope studies can also be utilised to study the effectiveness of delivery of drugs to the small and large bowel, and to study the adequacy of rectal evacuation in patients with a defaecatory disturbance. The low radiation dose and possibility of frequent observations make radioisotope studies valuable for clinical and research studies in functional gastrointestinal disorders.

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Dynamic scanning defines a colonic defect in severe idiopathic constipation.

Cited by 63 publications

References 18 publications

Endoluminal Instillation of Bisacodyl inPatients with Severe (Slow Transit Type)Constipation Is Useful to Test Residual ColonicPropulsive Activity

Endoluminal Instillation of Bisacodyl inPatients with Severe (Slow Transit Type)Constipation Is Useful to Test Residual ColonicPropulsive Activity

Abnormal Colonic Propagated Activity in Patients with Slow Transit Constipation and Constipation-Predominant Irritable Bowel Syndrome

The small intestine and colon: scintigraphic quantitation of motility in health and disease

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