Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation

Nullens, Sara; Nelsen, Tyler; Camilleri, Michael; Burton, Duane D.; Eckert, Deborah J.; Iturrino, Johanna; Vázquez-Roque, María I.; Zinsmeister, Alan R.

doi:10.1136/gutjnl-2011-301181

Cited by 97 publications

(104 citation statements)

References 46 publications

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“…Our previous study showed that overall colonic transit was delayed in patients with dyssynergic def- ecation and in those with slow transit constipation in the absence of evacuation disorders, relative to healthy volunteers. 6 We previously showed the higher proportion of isotope in the left colon at 48 hours in patients with dyssynergic defecation compared to those with only slow transit constipation. However, in that study, patients with either normal or slow colonic transit were included in the group of dyssynergic defecation.…”

Section: Discussionmentioning

confidence: 99%

“…We performed anorectal manometry and balloon expulsion tests as previously described; theses included traditional and high resolution manometry, 6 and the maximum resting and squeeze anal pressures were expressed as mmHg. After the manometry study, a latex balloon was inserted into the rectum and filled with 50 mL water.…”

Section: Anorectal Manometry and Balloon Expulsion Studiesmentioning

confidence: 99%

“…5 Evacuation disorders were associated with delayed overall colonic transit and ascending colon half-emptying times (AC t 1/2 ) compared to healthy controls. [6][7][8] In addition, our prior study had suggested that the regional colonic transit profile may differentiate evacuation disorders or slow transit constipation, chiefly by the predominant location of the isotope in the colon at 48 hours. Thus, isotope presence was predominantly in the left colon in patients with evacuation disorders who had either normal or delayed overall colonic transit, and the isotope was predominantly in the ascending and transverse colonic regions in slow transit constipation patients with evacuation disorders.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, isotope presence was predominantly in the left colon in patients with evacuation disorders who had either normal or delayed overall colonic transit, and the isotope was predominantly in the ascending and transverse colonic regions in slow transit constipation patients with evacuation disorders. 6 In the current analysis, we focused exclusively on patients with slow colonic transit in order to clarify whether the regional colonic transit pattern is useful in identifying evacuation disorders in constipated patients, since there is limited information about regional colonic transit between those patients with slow colonic transit compared to those without evacuation disorders. In this study, we aimed to evaluate: (1) clinical features and anorectal function, (2) differences in regional colonic transit according to the presence or absence of evacuation disorders, and (3) association of colonic transit with gender in patients with objectively slow colonic transit.…”

Section: Introductionmentioning

confidence: 99%

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Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

Park

Burton

Busciglio

et al. 2017

J Neurogastroenterol Motil

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Background/AimsAfter exclusion of structural diseases, chronic constipation may be associated with normal or slow transit or rectal evacuation disorders. We evaluated: (1) clinical features and anorectal function, (2) difference of regional colonic transit according to the presence or absence of evacuation disorders, and (3) association of colonic transit with gender in patients with objectively slow colonic transit. MethodsWe reviewed electronic medical records of 1553 patients with constipation seen by one gastroenterologist from 1994-2015 at a tertiary medical center. We identified patients with slow colonic transit using scintigraphy. Evacuation disorders were identified on clinical examination or anorectal manometry. Colonic compliance and tone were measured in 29 patients. Statistical analysis was by the Mann-Whitney rank sum test. ResultsOf the 207 patients (155 females, mean age 41.3 ± 15.3 [SD] years), 113 had evacuation disorders (ED+ve) and 94 did not (ED-ve). There were no significant differences in colonic transit or gastric emptying between ED+ve or ED-ve; similarly, colonic compliance, tone and responses to neostigmine were not different in ED+ve and ED-ve. Conversely, there were significant differences by gender in patients with slow colonic transit: colonic transit, small bowel transit, and gastric emptying (all P < 0.005). ConclusionsDelayed colonic transit does not exclude evacuation disorders in chronic constipation. In chronic constipation and objectively slow colonic transit, females had slower gastric, small bowel, and colonic transit than males. (J Neurogastroenterol Motil 2017;23:92-100)

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Section: Discussionmentioning

confidence: 99%

Section: Anorectal Manometry and Balloon Expulsion Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

Park

Burton

Busciglio

et al. 2017

J Neurogastroenterol Motil

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“…CIC is associated with reduced colonic motility; however, in one tertiary referral study, almost 30% of patients with chronic constipation had evidence of rectal evacuation disorders (67). Patients with evacuation disorders are less likely to respond to colonic prokinetic agents, as demonstrated in a comparison of prucalopride and PEG3350 in patients with chronic constipation, many of whom endorsed symptoms suggestive of rectal evacuation disorders (68).…”

Section: Cic and Oicmentioning

confidence: 99%

Pharmacological agents currently in clinical trials for disorders in neurogastroenterology

Camilleri¹

2013

J. Clin. Invest.

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Esophageal, gastrointestinal, and colonic diseases resulting from disorders of the motor and sensory functions represent almost half the patients presenting to gastroenterologists. There have been significant advances in understanding the mechanisms of these disorders, through basic and translational research, and in targeting the receptors or mediators involved, through clinical trials involving biomarkers and patient responses. These advances have led to relief of patients' symptoms and improved quality of life, although there are still significant unmet needs. This article reviews the pipeline of medications in development for esophageal sensorimotor disorders, gastroparesis, chronic diarrhea, chronic constipation (including opioid-induced constipation), and visceral pain. IntroductionGastrointestinal motility and functional disorders result in either abnormal propulsion of content or excessive sensation of normal or abnormal functions in different regions of the gut. These conditions constitute about 40% of referrals to gastroenterologists, and they result in significant disease burden. Advances in clinical management of these disorders are based on understanding the basic mechanisms involved in sensorimotor and secretory functions, coupled with clinical investigation and trial methodology.The most frequent gastrointestinal motility and functional disorders are esophagitis, gastroparesis, chronic diarrhea, chronic idiopathic constipation (CIC), opioid-induced constipation (OIC), and visceral pain. This review summarizes the pathophysiology, lists commonly used current medications, and focuses on pharmacological agents in development for each disorder. At present, several approved medications relieve constipation and diarrhea; the major unmet needs are in gastroparesis, OIC, and visceral pain.

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Diagnosis and Treatment of Irritable Bowel Syndrome

Camilleri

2021

JAMA

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207

135

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ImportanceThe prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments.ObservationsValidation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective.Conclusions and RelevanceAdvances in the identification of specific dysfunctions as causes of individual symptoms in the “IBS spectrum” leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.

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Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation

Cited by 97 publications

References 46 publications

Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

Pharmacological agents currently in clinical trials for disorders in neurogastroenterology

Diagnosis and Treatment of Irritable Bowel Syndrome

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