Colonic motor abnormalities in slow transit constipation defined by high resolution, fibre‐optic manometry

Dinning, Phil G.; Wiklendt, Lukasz; Maslen, Lyn; Patton, Vicki; Lewis, Helen; Arkwright, John W.; Wattchow, David; Lubowski, David Z.; Costa, Marcello; Bampton, Peter A.

doi:10.1111/nmo.12502

Cited by 105 publications

(162 citation statements)

References 53 publications

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“…29 A recent study employing this technique in slow transit constipation patients found that the normal increase in the postprandial propagating cyclic motor pattern was absent in patients when compared to healthy controls. 30 Similar studies in slow transit constipation patients have found a reduced daily frequency of high amplitude propagating sequences (also recognised as mass movements and responsible for a significant proportion of propulsive activity in the colon), and that all high amplitude propagating sequences originate in the proximal colon. 29,31,32 It is therefore plausible that the prolonged colonic transit times during oxycodone treatment in this study share-at least partly-pathophysiological characteristics with slow transit constipation, and that further development of the 3D-Transit software could elucidate this neglected, yet important aspect of GI motility.…”

Section: Discussionmentioning

confidence: 86%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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Background/AimsTo employ an experimental model of opioid-induced bowel dysfunction in healthy human volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility assessed by questionnaires and regional GI transit times using the 3-dimensional (3D)-Transit system. MethodsTwenty-five healthy males were randomly assigned to oxycodone or placebo for 5 days in a double blind, crossover design. Adverse GI effects were measured with the bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptom questionnaire, and Bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system, and segmental transit times in the colon were determined using a custom Matlab ® graphical user interface. ResultsGI symptom scores increased significantly across all applied GI questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 hours (P < 0.001), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 hours (P = 0.012), rectosigmoid colon transit from 2.7 to 9.0 hours (P = 0.044), and colorectal transit time from 18.6 to 38.6 hours (P = 0.001). No associations between questionnaire scores and segmental transit times were detected. ConclusionsSelf-assessed GI adverse effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of constipation.

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Section: Discussionmentioning

confidence: 86%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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“…The fi ber bundle can be inserted into a specialized catheter (tube) for protection and then placed in proximity to the specifi ed tumorous area in the body. [ 35,[53][54][55][56][57][58] However, maximum 5-FU administration dose depends on the patient's age, weight, general health, type/stage of cancer, comorbidity, and kidney function [ 59 ] and the standard duration of treatment is based on 5-FU treatment regime (5-FU as a sole treatment or in combination with other medications). [ 60 ] For instance, in intravenous infusion of 5-FU to adult patients, the maximum recommended daily dose [ 61,62 ] is 800 mg in 300-500 mL of 5% glucose solution and is administered over 4 h. This dose is equivalent to 12.3 × 10 −3 M < [5-FU] < 20.5 × 10 −3 M and in comparison with the above average release rate of 110 × 10 −6 M for one optical fi ber in a vial volume of 300 µL, we need approximately 111 to 186 separate SMF-28 optical fi bers to get the same effect in one minute as above from intravenous infusion.…”

Section: Resultsmentioning

confidence: 99%

Metal‐Organic‐Framework‐Coated Optical Fibers as Light‐Triggered Drug Delivery Vehicles

Nazari

Rubio-Martínez

Tobias

et al. 2016

Adv Funct Materials

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Physical delivery of anticancer drugs in controlled anatomic locations can complement the advances being made in chemo‐selective therapies. To this end, an optical fiber catheter is coated in a thin layer of metal organic framework UiO‐66 and the anticancer drug 5‐Fluorouracil (5‐FU) is deposited within the pores. Delivery of light of appropriate wavelength through the fiber catheter is found to trigger the release of 5‐FU on demand, offering a new route to localized drug administration. The system exhibits great potential with as much as 110 × 10−6 m of 5‐FU delivered within 1 min from one fiber.

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“…These findings on non-high amplitude propagated contractions colonic motor activity differ somewhat from those obtained with higher resolution fiberoptic manometry in adults with slow transit constipation, which showed that cyclic propagating motor patterns were not increased postprandially in contrast to observations in normal controls. 39 We acknowledge that the sample is relatively small and the data are presented to corroborate the overall results of colonic motor function appraised by scintigraphy. We have previously shown that evacuation disorders may result in reversible inhibition of colonic tone.…”

Section: Discussionmentioning

confidence: 65%

Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

Park

Burton

Busciglio

et al. 2017

J Neurogastroenterol Motil

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Background/AimsAfter exclusion of structural diseases, chronic constipation may be associated with normal or slow transit or rectal evacuation disorders. We evaluated: (1) clinical features and anorectal function, (2) difference of regional colonic transit according to the presence or absence of evacuation disorders, and (3) association of colonic transit with gender in patients with objectively slow colonic transit. MethodsWe reviewed electronic medical records of 1553 patients with constipation seen by one gastroenterologist from 1994-2015 at a tertiary medical center. We identified patients with slow colonic transit using scintigraphy. Evacuation disorders were identified on clinical examination or anorectal manometry. Colonic compliance and tone were measured in 29 patients. Statistical analysis was by the Mann-Whitney rank sum test. ResultsOf the 207 patients (155 females, mean age 41.3 ± 15.3 [SD] years), 113 had evacuation disorders (ED+ve) and 94 did not (ED-ve). There were no significant differences in colonic transit or gastric emptying between ED+ve or ED-ve; similarly, colonic compliance, tone and responses to neostigmine were not different in ED+ve and ED-ve. Conversely, there were significant differences by gender in patients with slow colonic transit: colonic transit, small bowel transit, and gastric emptying (all P < 0.005). ConclusionsDelayed colonic transit does not exclude evacuation disorders in chronic constipation. In chronic constipation and objectively slow colonic transit, females had slower gastric, small bowel, and colonic transit than males. (J Neurogastroenterol Motil 2017;23:92-100)

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Colonic motor abnormalities in slow transit constipation defined by high resolution, fibre‐optic manometry

Abstract: In patients with STC a meal fails to induce the normal increase in the distal colonic cyclic propagating motor patterns. We propose that these data may indicate that the normal extrinsic parasympathetic inputs to the colon are attenuated in these patients.

Cited by 105 publications

References 53 publications

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Metal‐Organic‐Framework‐Coated Optical Fibers as Light‐Triggered Drug Delivery Vehicles

Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

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