Original Contribution
The American Journal of Gastroenterology (2004) 99, 2405–2416; doi:10.1111/j.1572-0241.2004.40453.x
Ambulatory 24-Hour Colonic Manometry in Slow-Transit Constipation
Satish SC Rao MD, PhD, FRCP1, Pooyan Sadeghi BA1, Jennifer Beaty MD1 and Renae Kavlock MD1
1Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Correspondence: Satish SC Rao, MD, PhD, FRCP (Lon), Department of Internal Medicine, Division of Gastroenterology/Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 4612 JCP, Iowa City, Iowa 52242, USA
Received 3 June 2004; Revised 0000; Accepted 8 June 2004.
Abstract
BACKGROUND:
The colonic neuromuscular dysfunction in patients with constipation and the role of colonic manometry is incompletely understood.
AIM:
To study prolonged colonic motility and assess its clinical significance.
METHODS:
Twenty-four-hour ambulatory colonic manometry was performed in 21 patients with slow-transit constipation and 20 healthy controls by placing a 6-sensor solid-state probe up to the hepatic flexure. Quantitative and qualitative manometric analysis was performed in 8-h epochs. Patients were followed up for 1 yr.
RESULTS:
Constipated patients showed fewer pressure waves and lower area under the curve (p < 0.05) than controls during daytime, but not at night. Colonic motility induced by waking or meal was decreased (p < 0.05) in patients. High-amplitude propagating contractions (HAPCs) occurred in 43% of patients compared to 100% of controls and with lower incidence (1.7 vs 10.1, p < 0.001) and propagation velocity (p < 0.04). Manometric features suggestive of colonic neuropathy were seen in 10, myopathy in 5, and normal profiles in 4 patients. Seven patients with colonic neuropathy underwent colectomy with improvement. The rest were managed conservatively with 50% improvement at 1 yr.
CONCLUSIONS:
Patients with slow-transit constipation exhibited either normal or decreased pressure activity with manometric features suggestive of colonic neuropathy or myopathy as evidenced by absent HAPC or attenuated colonic responses to meals and waking. In refractory patients, colonic manometry may be useful in characterizing the underlying pathophysiology and in guiding therapy.
