Study of the motile activity of the small intestine in constipated subjects.
OBJECTIVE
A recent study has demonstrated that rectal balloon distension effected inhibition of jejunal and ileal motility (Shafik, Hepatogastroenterology, 2000). It was hypothesized that rectal distension occurring in rectal inertia constipation might cause enteric hypotonia. This hypothesis was investigated.


METHODS
Twenty-three patients with rectal inertia constipation (18 women, 5 men mean age 38.8 +/- 10.6 SD years) and 10 healthy volunteers (7 women, 3 men, mean age 37.2 +/- 9.8 SD years) were studied. The rectal, jejunal and ileal pressures were measured by means of saline-perfused tubes. The pressure response of rectum, jejunum and ileum to rectal balloon distension in increments of 50 mL of saline was recorded.


RESULTS
The mean basal rectal, jejunal and ileal pressures measured in the patients with rectal inertia were significantly (P < 0.05) lower than those of the volunteers. Fifty-milliliter rectal balloon distension caused no rectal, jejunal or ileal pressure response in either the volunteers or patients. One hundred-milliliter distension effected in volunteers a rectal pressure elevation (P < 0.001) and a decline of jejunal (P < 0.05) and ileal (P < 0.05) pressures which were maintained as long as rectal distension was continued. In patients, no significant (P > 0.05) pressure changes were registered from the rectum, jejunum or ileum. Rectal distension with 150 and 200 mL caused balloon expulsion in the volunteers and in patients no significant rectal, jejunal or ileal pressure changes (P > 0.05).


CONCLUSIONS
Rectal inertia was associated with reduced jejunal and ileal pressures, presumably indicating the presence of enteric hypotonia. The inertia-hypotonia relationship is proposed to be mediated through the recto-enteric reflex and transmitted by the enteric nervous plexus. The enteric hypotonia is suggested to prolong the intestinal transit, act as a contributing factor in the genesis of constipation and may explain some of its clinical manifestations.
Shafik
A
A
Department of Surgery and Experimental Research, Cairo University, Cairo, Egypt. ashafik@ahmedshafik.org
el-Sibai
O
O
D000328:Adult; D003248:Constipation / Q000503:physiopathology*; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007082:Ileum / Q000503:physiopathology; D007421:Intestine, Small / Q000503:physiopathology*; D007583:Jejunum / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000503:physiopathology; D009130:Muscle, Smooth / Q000503:physiopathology; D011312:Pressure