Portions of this work were presented at Digestive Disease Week and published as an abstract; Gastroenterology 2010;138:S225.
Clinical utility of colonic manometry in slow transit constipation
Version of Record online: 6 FEB 2013
© 2013 John Wiley & Sons Ltd
Neurogastroenterology & Motility
Volume 25, Issue 6, pages 487–e367, June 2013
How to Cite
Singh, S., Heady, S., Coss-Adame, E. and Rao, S. S. C. (2013), Clinical utility of colonic manometry in slow transit constipation. Neurogastroenterology & Motility, 25: 487–e367. doi: 10.1111/nmo.12092
- Issue online: 14 MAY 2013
- Version of Record online: 6 FEB 2013
- Manuscript Accepted: 8 JAN 2013
- Manuscript Received: 24 NOV 2012
- National Institutes of Health
- NIHNCRR. Grant Numbers: 1UL1RR024979, 1KL2RR024980
- colonic manometry;
- slow transit constipation;
- treatment outcomes
The clinical significance of colorectal sensorimotor evaluation in patients with slow transit constipation (STC) is unclear. We investigated whether colonic manometric evaluation is useful for characterizing colonic sensorimotor dysfunction and for guiding therapy in STC.
24-h ambulatory colonic manometry was performed in 80 patients (70 females) with STC by placing a six sensor solid-state probe, along with assessment of colonic sensation with barostat. Anorectal manometry was also performed. Manometrically, patients were categorized as having colonic neuropathy or myopathy based on gastrocolonic response, waking response and high amplitude propagated contractions (HAPC); and based on colonic sensation, as colonic hyposensitivity or hypersensitivity. Clinical response to pharmacological, biofeedback, and surgical treatment was assessed at 1 year and correlated with manometric findings.
Forty seven (59%) patients who had abnormal colonic manometry, with features suggestive of neuropathy (26%), and myopathy (33%); 41% had normal colonic manometry. Patients who had abnormal colonic sensation were 74% and 61% had overlapping dyssynergic defecation. Patients with neuropathy were more likely to have colonic hyposensitivity. Sixty-four percent of patients with colonic myopathy or normal manometry improved with medical/biofeedback therapy when compared to 15% with colonic neuropathy (P < 0.01). Selected patients with colonic neuropathy had excellent response to surgery, but many developed bacterial overgrowth.
Conclusions & Inferences
Colonic manometry demonstrates significant colonic sensorimotor dysfunction in STC patients and reveals considerable pathophysiological heterogeneity. It can be useful for characterizing the underlying pathophysiology and for guiding clinical management in STC, especially surgery.