title: Colonic propulsive impairment in intractable slow-transit constipation.
abstract: 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.
authors.affiliation: Gastroenterolgy and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Perugia, Italy. gabassot@tin.it
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Fabio
authors.initials: F
authors.lastname: Chistolini
authors.forename: Francis Sietchiping
authors.initials: FS
authors.lastname: Nzepa
authors.forename: Antonio
authors.initials: A
authors.lastname: Morelli
mesh_terms: 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