Abstract
Background: The clinical significance of colorectal sensorimotor evaluation in patients with slow transit constipation (STC) is unclear. We investigated whether colonic manometric evaluation is useful for characterizing colonic sensorimotor dysfunction and for guiding therapy in STC. Methods: 24-h ambulatory colonic manometry was performed in 80 patients (70 females) with STC by placing a six sensor solid-state probe, along with assessment of colonic sensation with barostat. Anorectal manometry was also performed. Manometrically, patients were categorized as having colonic neuropathy or myopathy based on gastrocolonic response, waking response and high amplitude propagated contractions (HAPC); and based on colonic sensation, as colonic hyposensitivity or hypersensitivity. Clinical response to pharmacological, biofeedback, and surgical treatment was assessed at 1 year and correlated with manometric findings. Key Results: Forty seven (59%) patients who had abnormal colonic manometry, with features suggestive of neuropathy (26%), and myopathy (33%); 41% had normal colonic manometry. Patients who had abnormal colonic sensation were 74% and 61% had overlapping dyssynergic defecation. Patients with neuropathy were more likely to have colonic hyposensitivity. Sixty-four percent of patients with colonic myopathy or normal manometry improved with medical/biofeedback therapy when compared to 15% with colonic neuropathy (P < 0.01). Selected patients with colonic neuropathy had excellent response to surgery, but many developed bacterial overgrowth. Conclusions & Inferences: Colonic manometry demonstrates significant colonic sensorimotor dysfunction in STC patients and reveals considerable pathophysiological heterogeneity. It can be useful for characterizing the underlying pathophysiology and for guiding clinical management in STC, especially surgery.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 487-495 |
| Number of pages | 9 |
| Journal | Neurogastroenterology and Motility |
| Volume | 25 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2013 |
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Keywords
- Colectomy
- Colonic manometry
- Neuropathy
- Slow transit constipation
- Treatment outcomes
ASJC Scopus subject areas
- Physiology
- Endocrine and Autonomic Systems
- Gastroenterology
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Clinical utility of colonic manometry in slow transit constipation. / Singh, S.; Heady, S.; Coss-Adame, E.; Rao, Satish Sanku Chander.
In: Neurogastroenterology and Motility, Vol. 25, No. 6, 01.06.2013, p. 487-495.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinical utility of colonic manometry in slow transit constipation
AU - Singh, S.
AU - Heady, S.
AU - Coss-Adame, E.
AU - Rao, Satish Sanku Chander
PY - 2013/6/1
Y1 - 2013/6/1
N2 - Background: The clinical significance of colorectal sensorimotor evaluation in patients with slow transit constipation (STC) is unclear. We investigated whether colonic manometric evaluation is useful for characterizing colonic sensorimotor dysfunction and for guiding therapy in STC. Methods: 24-h ambulatory colonic manometry was performed in 80 patients (70 females) with STC by placing a six sensor solid-state probe, along with assessment of colonic sensation with barostat. Anorectal manometry was also performed. Manometrically, patients were categorized as having colonic neuropathy or myopathy based on gastrocolonic response, waking response and high amplitude propagated contractions (HAPC); and based on colonic sensation, as colonic hyposensitivity or hypersensitivity. Clinical response to pharmacological, biofeedback, and surgical treatment was assessed at 1 year and correlated with manometric findings. Key Results: Forty seven (59%) patients who had abnormal colonic manometry, with features suggestive of neuropathy (26%), and myopathy (33%); 41% had normal colonic manometry. Patients who had abnormal colonic sensation were 74% and 61% had overlapping dyssynergic defecation. Patients with neuropathy were more likely to have colonic hyposensitivity. Sixty-four percent of patients with colonic myopathy or normal manometry improved with medical/biofeedback therapy when compared to 15% with colonic neuropathy (P < 0.01). Selected patients with colonic neuropathy had excellent response to surgery, but many developed bacterial overgrowth. Conclusions & Inferences: Colonic manometry demonstrates significant colonic sensorimotor dysfunction in STC patients and reveals considerable pathophysiological heterogeneity. It can be useful for characterizing the underlying pathophysiology and for guiding clinical management in STC, especially surgery.
AB - Background: The clinical significance of colorectal sensorimotor evaluation in patients with slow transit constipation (STC) is unclear. We investigated whether colonic manometric evaluation is useful for characterizing colonic sensorimotor dysfunction and for guiding therapy in STC. Methods: 24-h ambulatory colonic manometry was performed in 80 patients (70 females) with STC by placing a six sensor solid-state probe, along with assessment of colonic sensation with barostat. Anorectal manometry was also performed. Manometrically, patients were categorized as having colonic neuropathy or myopathy based on gastrocolonic response, waking response and high amplitude propagated contractions (HAPC); and based on colonic sensation, as colonic hyposensitivity or hypersensitivity. Clinical response to pharmacological, biofeedback, and surgical treatment was assessed at 1 year and correlated with manometric findings. Key Results: Forty seven (59%) patients who had abnormal colonic manometry, with features suggestive of neuropathy (26%), and myopathy (33%); 41% had normal colonic manometry. Patients who had abnormal colonic sensation were 74% and 61% had overlapping dyssynergic defecation. Patients with neuropathy were more likely to have colonic hyposensitivity. Sixty-four percent of patients with colonic myopathy or normal manometry improved with medical/biofeedback therapy when compared to 15% with colonic neuropathy (P < 0.01). Selected patients with colonic neuropathy had excellent response to surgery, but many developed bacterial overgrowth. Conclusions & Inferences: Colonic manometry demonstrates significant colonic sensorimotor dysfunction in STC patients and reveals considerable pathophysiological heterogeneity. It can be useful for characterizing the underlying pathophysiology and for guiding clinical management in STC, especially surgery.
KW - Colectomy
KW - Colonic manometry
KW - Neuropathy
KW - Slow transit constipation
KW - Treatment outcomes
UR - http://www.scopus.com/inward/record.url?scp=84878015903&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84878015903&partnerID=8YFLogxK
U2 - 10.1111/nmo.12092
DO - 10.1111/nmo.12092
M3 - Article
C2 - 23384415
AN - SCOPUS:84878015903
VL - 25
SP - 487
EP - 495
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
SN - 1350-1925
IS - 6
ER -