Colonic propulsive impairment in intractable slow-transit constipation.
OBJECTIVE
Intractable constipation, especially of the slow-transit subtype, may represent several pathophysiologic entities with a common final symptomatic appearance. An overall impairment of colonic propulsive activity may represent a major disease mechanism.


METHODS
Case series.


METHODS
Tertiary university hospital.


METHODS
Twenty-nine severely constipated patients with clinical and homogeneous features of slow-transit constipation that were unresponsive to conventional medical measures and 16 age-matched healthy volunteers.


METHODS
Twenty-four-hour manometric recordings obtained in patients and controls to assess high- and low-amplitude colonic propulsive activity.


RESULTS
Compared with controls, patients showed heavily reduced high-amplitude propagated activity (average, <1 event per subject per day). No differences were found in low-amplitude propagated activity.


CONCLUSIONS
Patients with severe constipation that is refractory to medical treatment may display an important reduction of colonic forceful propulsive activity. This may justify a surgical approach, which may offer the best results in such patients. It is, however, important to obtain thorough physiologic documentation before such a drastic approach is considered. The residual low-amplitude propulsive activity might represent a partially compensatory mechanism in these patients. Studies in more homogeneous groups of such patients are needed.
Bassotti
Gabrio
G
Gastroenterolgy and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Perugia, Italy. gabassot@tin.it
Chistolini
Fabio
F
Nzepa
Francis Sietchiping
FS
Morelli
Antonio
A
D000328:Adult; D016022:Case-Control Studies; D003248:Constipation / Q000503:physiopathology*; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged