Ambulatory 24-hour colonic manometry in slow-transit constipation.
BACKGROUND
The colonic neuromuscular dysfunction in patients with constipation and the role of colonic manometry is incompletely understood.


OBJECTIVE
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.
Rao
Satish S C
SS
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Sadeghi
Pooyan
P
Beaty
Jennifer
J
Kavlock
Renae
R
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D016022:Case-Control Studies; D003106:Colon / Q000503:physiopathology*; D003248:Constipation / Q000503:physiopathology*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011312:Pressure; D018709:Statistics, Nonparametric