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Clinical utility of colonic manometry in slow transit constipation

Authors

  • S. Singh,

    1. Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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  • S. Heady,

    1. Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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  • E. Coss-Adame,

    1. Section of Gastroenterology, Department of Internal Medicine, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA, USA
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  • S. S. C. Rao

    Corresponding author
    1. Section of Gastroenterology, Department of Internal Medicine, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA, USA
    • Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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  • Portions of this work were presented at Digestive Disease Week and published as an abstract; Gastroenterology 2010;138:S225.

Address for Correspondence

Satish SC Rao, M.D., Ph.D., FRCP (Lon), Chief, Section of Gastroenterology/Hepatology, Georgia Health Sciences University, Augusta, Georgia 30912.

Tel: +706 721 2242; fax: +706 721 0331;

e-mail: srao@georgiahealth.edu

Abstract

Background

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.

Methods

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.

Key Results

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.

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