Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation
- Sara Nullens1,
- Tyler Nelsen1,
- Michael Camilleri1,2,
- Duane Burton1,
- Deborah Eckert1,2,
- Johanna Iturrino1,2,
- Maria Vazquez-Roque1,2,
- Alan R Zinsmeister3
- 1Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- 2Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- 3Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence to Professor Michael Camilleri, Mayo Clinic, Charlton 8-110, 200 First St SW, Rochester, MN 55905, USA;
Contributors SN analysed the patient records and wrote the manuscript. TN analysed the patient records and critically reviewed the paper. MC was the sole clinician who managed the patients, developed the study protocol, identified aims and hypotheses, helped in interpreting the statistical analysis and wrote and finalised the manuscript. DB assisted in analysing patient records, calculated the transit times, critically reviewed the paper and participated with MC in the clinical appraisal and management of the patients. JI constructed the different databases, aided in selecting suitable patients and critically reviewed the paper. MV-R constructed the different databases, aided in correctly selecting patients and critically reviewed the paper. ARZ performed the statistical analysis and critically reviewed the paper.
- Revised 14 October 2011
- Accepted 24 October 2011
- Published Online First 16 December 2011
Objective To differentiate dys-synergic defaecation (DD) from normal function and slow transit constipation (STC).
Methods The medical records of 1411 patients evaluated by a single gastroenterologist over a 16-year period at a tertiary medical centre were reviewed. DD was characterised by anorectal manometry and balloon expulsion test. There were 390 patients with DD, and 61 with STC without DD. Transit data from 211 healthy individuals served as controls. The primary endpoints were overall colonic transit (geometric centre) at 24 h and 48 h (GC24 and GC48). Regional transit was measured as ascending colon half-emptying time (AC t1/2) and residual content in descending rectosigmoid colon and stool (DRS).
Results Age and body mass index were similar in the STC and DD groups. DD was associated with smaller perineal descent and a greater difference in rectoanal pressure than STC. Both STC and DD were associated with lower GC24 and GC48 and slower AC t1/2 than controls. GC48 differentiated DD from healthy controls (p<0.001) and DD from STC (p=0.007). AC t1/2 values differentiated healthy controls from DD (p=0.006) and STC (p<0.001) and were associated with constipation (DD vs STC, p=0.007). The regional content of DRS at 48 h discriminated DD from STC (AUC=0.82) and stool content at 48 h, increasing the odds for DD over STC (OR per 5% in stool 2.4, 95% CI 1.1 to 5.5, p=0.03).
Conclusions DD is associated with delayed overall colonic transit at 48 h and AC t1/2 compared with healthy controls. Regional scintigraphic transit profiles differentiate DD from STC and facilitate identification of a subgroup of patients with constipation.
- pelvic floor
- rectal evacuation disorder
- anal sphincter pressure
- ascending colon half-emptying time
- descending colon
- anorectal disorders
- motility disorders
- pelvic floor disorders
- inflammatory bowel disorders
- inflammatory bowel syndrome
Funding MCamilleri is funded by grant RO1-DK079866, R01-DK092179 and 1RC1-DK086182 from National Institutes of Health.
Competing interests None.
Ethics approval Ethics approval was provided by Mayo Clinic Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.