High-resolution colonic motility recordings in vivo compared with ex vivo recordings after colectomy, in patients with slow transit constipation.
BACKGROUND
The pathogenesis of slow transit constipation (STC) remains poorly understood, with intrinsic and extrinsic abnormalities implicated. Here, we present high-resolution colonic manometry recordings from four STC patients recorded before total colectomy, and subsequently, ex vivo, after excision.


METHODS
In four female, treatment-resistant STC patients (median age 35.5 years), a fiber-optic manometry catheter (72 sensors spaced at 1 cm intervals) was placed with the aid of a colonoscope, to the mid-transverse colon. Colonic manometry was recorded 2 h before and after a meal. After the colectomy, ex vivo colonic manometry was recorded in an organ bath. Ex vivo recordings were also made from colons from 4 patients (2 male; median age 67.5 years) undergoing anterior resection for nonobstructive carcinoma ('control' tissue).


RESULTS
A large increase in 'short single propagating contractions' was recorded in STC colon ex vivo compared to in vivo (ex vivo 61.3 ± 32.7 vs in vivo 2.5 ± 5/h). In STC patients, in vivo, the dominant frequency of contractile activity was 2-3 cycle per minute (cpm), whereas 1-cpm short-single propagating contractions dominated ex vivo. This same 1-cpm frequency was also dominant in control colons ex vivo.


CONCLUSIONS
In comparison to control adults, the colon of STC patients demonstrates significantly less propagating motor activity. However, once the STC colon is excised from the body it demonstrates a regular and similar frequency of propagating activity to control tissue. This paper provides interesting insights into the control of colonic motor patterns.
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.|Departments of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
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Dinning
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.|Departments of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
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Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.|Departments of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
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Kumar
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.|Departments of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
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Mohd Rosli
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.
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Kyloh
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.|Departments of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.
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Wattchow
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.
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Wiklendt
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.
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Brookes
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.
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Costa
Disciplines of Human Physiology, Flinders University, Bedford Park, SA, Australia.
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Spencer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000639:trends; D003248:Constipation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods* / Q000639:trends; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology; D009924:Organ Culture Techniques
colectomy; constipation; ex vivo motility; high-resolution manometry