Automated Quantitative Analysis of Nocturnal Jejunal Motor Activity Identifies Abnormalities in Individuals and Subgroups of Patients With Slow Transit Constipation

Abstract

Thirty-seven patients with STC underwent 24-h ambulatory jejunal manometry; data were compared with those obtained in 38 healthy controls. Automated quantitative analysis of seven variables of the nocturnal migrating motor complex was performed, to assess whether differences existed between groups, and whether individual patients had evidence of small intestinal dysmotility, defined as two or more measures of migrating motor complex variables outside the normal range. Four variables differed significantly between STC patients and controls: in phase III, propagation was slower, duration was longer, and contraction amplitude was higher; in phase II, contraction frequency was increased. Seven of 24 patients with a generalized pattern of colonic transit delay had abnormal small bowel motility compared with none of 13 with a left-sided delay (p < 0.04). These included four patients with chronic idiopathic symptoms and three with acquired symptoms. Approximately one third of patients with a generalized delay in colonic transit had evidence of jejunal enteric neuromuscular dysfunction. Individual patients with a left-sided colonic delay did not satisfy the criteria for nocturnal small bowel dysmotility, but as a group, some differences were noted from controls. In contrast to previous reports, evidence of generalized enteric dysmotility may be present irrespective of the mode of onset.

Clinical Presentation and Patterns of Slow Transit Constipation Do Not Predict Coexistent Upper Gut Dysmotility

“…Recording System and Study Protocol Study methodology has been described in detail elsewhere [10,23]. In brief, duodeno-jejunal motility was monitored via three miniature strain gauge transducers mounted on a soft, nasojejunal catheter (Gaeltec, Dunvegan, Isle of Skye, Scotland/Unisensor AG, Attikon, Switzerland; outer diameter 2.5 mm, length 2.5 m).…”

“…Initially, patients with constipation can be classified simply on the basis of colonic transit and rectal evacuatory function [3,4]. In a subset of patients with a proven delay in colonic transit (slow transit constipation, STC), however, gut dysfunction may extend beyond the colorectum, and several reports have described co-existent upper gastrointestinal (GI) tract motor abnormalities involving the esophagus, stomach, gallbladder, and small intestine [5][6][7][8][9][10][11].…”

“…Stationary manometry is the gold standard technique for the esophagus as it allows the simultaneous evaluation of esophageal body peristalsis and lower esophageal sphincter (LES) activity [19]. Small bowel manometry provides information on this region's contractile activity in the fasting and postprandial state, and ambulatory studies allow for prolonged recordings, including the nocturnal period, which may prove important in characterizing an individual as having normal or abnormal small bowel motility [10]. There is currently no standardized technique in routine clinical use that provides an integrated understanding of complex gastric motor function, as this involves both fundic accommodation upon ingestion and coordinated antro-pyloric motor activity to deliver chyme into the duodenum.…”

Accurate localization of a fall in pH within the ileocecal region: validation using a dual-scintigraphic technique

“…Nevertheless, such studies have shown that approximately half of constipated patients will have delayed colonic transit (range 13-80%) (17,38). Furthermore, a proportion of these patients have upper gastrointestinal (GI) symptoms, and evidence of a panenteric motor disorder may be found in 18 -72% (42,47). This is of clinical significance, as such patients may have poorer outcome to intervention compared with those patients with an isolated colonic disorder (40).…”

Chronic idiopathic intestinal pseudo-obstruction: the need for a multidisciplinary approach to management

“…Small intestinal manometry has now been undertaken in over fifty patients with severe midgut dysmotility, and the abnormalities seen in the patients all conform to this description. What is striking about the findings is that they are the characteristic manometric abnormalities described in patients with chronic idiopathic intestinal pseudo-obstruction (CIIP; Stanghellini et al 1987); findings, in turn, that are generally considered predictive of enteric neuropathy as the dominant lesion (Stanghellini et al 1987;Quigley et al 1997;Camilleri et al 1998;Wingate et al 2002;Scott et al 2003).…”