Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS

Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to 1) characterize regional differences in colon pressure, 2) relate motor differences in constipation to colon tran...

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Published in:American journal of physiology: Gastrointestinal and liver physiology Vol. 297; no. 6; p. G1107
Main Authors: Hasler, William L, Saad, Richard J, Rao, Satish S, Wilding, Gregory E, Parkman, Henry P, Koch, Kenneth L, McCallum, Richard W, Kuo, Braden, Sarosiek, Irene, Sitrin, Michael D, Semler, John R, Chey, William D
Format: Journal Article
Language:English
Published: United States 01.12.2009
Subjects:
Area Under Curve
Capsule Endoscopy
Case-Control Studies
Colon - physiopathology
Colonoscopy
Constipation - diagnosis
Constipation - etiology
Constipation - physiopathology
Female
Gastrointestinal Transit
Humans
Hydrogen-Ion Concentration
Irritable Bowel Syndrome - complications
Irritable Bowel Syndrome - diagnosis
Irritable Bowel Syndrome - physiopathology
Linear Models
Male
Middle Aged
Muscle Contraction
Muscle, Smooth - physiopathology
Pressure
Severity of Illness Index
Surveys and Questionnaires
ISSN:1522-1547, 1522-1547
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Summary:Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to 1) characterize regional differences in colon pressure, 2) relate motor differences in constipation to colon transit, and 3) quantify the role of IBS in altered contractility with constipation. Colon pH and pressure were measured by wireless capsules in 53 healthy and 36 constipated subjects. Numbers of contractions >25 mmHg and areas under curves (AUC) were calculated for colon transit quartiles by time. Constipation was classified as normal transit (<59 h), moderate slow transit (STC) (59-100 h), and severe STC (>100 h). Twelve out of 36 constipated subjects had C-IBS; 24 had functional constipation. Numbers of contractions and AUCs increased from the first to the fourth quartile in health (P < 0.0001). Mean numbers of contractions in constipated subjects were similar to controls. Mean AUCs with normal transit (P = 0.01) and moderate STC (P = 0.004) but not severe STC (P = NS) were higher than healthy subjects. IBS was associated with greater mean numbers of contractions (P = 0.05) and AUCs (P = 0.0006) vs. controls independent of transit. Numbers of contractions increased from the first to fourth quartiles in moderate STC, C-IBS, and functional constipation; AUCs increased from the first to fourth quartiles in all groups (all P < 0.05). In conclusion, colon pressure activity is greater distally than proximally in health. Constipated patients with normal or moderately delayed transit show increased motor activity that is partly explained by IBS. These findings emphasize differential effects on transit and motility in different constipation subtypes.
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ISSN:1522-1547
1522-1547
DOI:10.1152/ajpgi.00136.2009