Diagnosis of colonic dysmotility associated with autonomic dysfunction in patients with chronic refractory constipation

Abstract

We report the first study assessing human colon manometric features and their correlations with changes in autonomic functioning in patients with refractory chronic constipation prior to consideration of surgical intervention. High-resolution colonic manometry (HRCM) with simultaneous heart rate variability (HRV) was performed in 14 patients, and the resulting features were compared to healthy subjects. Patients were categorized into three groups that had normal, weak, or no high amplitude propagating pressure waves (HAPWs) to any intervention. We found mild vagal pathway impairment presented as lower HAPW amplitude in the proximal colon in response to proximal colon balloon distention. Left colon dysmotility was observed in 71% of patients, with features of (1) less left colon HAPWs, (2) lower left colon HAPW amplitudes (69.8 vs 102.3 mmHg), (3) impaired coloanal coordination, (4) left colon hypertonicity in patients with coccyx injury. Patients showed the following autonomic dysfunction: (1) high sympathetic tone at baseline, (2) high sympathetic reactivity to active standing and meal, (3) correlation of low parasympathetic reactivity to the meal with absence of the coloanal reflex, (4) lower parasympathetic and higher sympathetic activity during occurrence of HAPWs. In conclusion, left colon dysmotility and high sympathetic tone and reactivity, more so than vagal pathway impairment, play important roles in refractory chronic constipation and suggests sacral neuromodulation as a possible treatment.

Modulation of the autonomic nervous system by one session of spinal low-level laser therapy in patients with chronic colonic motility dysfunction

“…Our overall objective is to develop new treatments for patients with severe chronic colonic motility disorders, refractory to established treatments ( Rao et al, 2016 ; Camilleri et al, 2017 ; Chen and Huizinga, 2019 ). Our specific objective related to neuromodulation is to evaluate if sacral neuromodulation can relieve symptoms and restore autonomic dysfunction in these patients ( Liu et al, 2022 ). Patients with chronic constipation may not be able to generate spontaneous bowel movements.…”

“…HRV analysis is explored to evaluate autonomic functioning and dysfunction ( Shields, 2009 ; Huizinga et al, 2018 ; Barbier et al, 2022 ; Liu et al, 2022 ). We used HRV successfully to show that propulsive motor patterns generated by the human colon are associated with an increase in parasympathetic activity and a decrease in sympathetic activity ( Yuan et al, 2020 ; Ali et al, 2021 ).…”

“…Our overall objective is to develop new treatments for patients with severe chronic colonic motility disorders, refractory to established treatments (Rao et al, 2016;Camilleri et al, 2017;Chen and Huizinga, 2019). Our specific objective related to neuromodulation is to evaluate if sacral neuromodulation can relieve symptoms and restore autonomic dysfunction in these patients (Liu et al, 2022) et al, 1993;Rao et al, 2016;Camilleri et al, 2017;Callaghan et al, 2018;Milkova et al, 2020;Ali et al, 2021). A propulsive colonic motor pattern may start with triggering of afferent neurons whose cell bodies lie within the DRG of the lumbar and sacral portions of the spinal cord (Brookes et al, 2009).…”

“…Through the neural activity in the brain stem, particularly the NTS, the neural traffic originating in the sacrum can influence autonomic innervation to the heart and hence affect HRV (Yuan et al, 2020;Ali et al, 2021). HRV analysis is explored to evaluate autonomic functioning and dysfunction (Shields, 2009;Huizinga et al, 2018;Barbier et al, 2022;Liu et al, 2022). We used HRV successfully to show that propulsive motor patterns generated by the human colon are associated with an increase in parasympathetic activity and a decrease in sympathetic activity (Yuan et al, 2020;Ali et al, 2021).…”

Slow, deep breathing intervention improved symptoms and altered rectal sensitivity in patients with constipation-predominant irritable bowel syndrome

“…As high sympathetic tone and impaired vagal pathway are implicated in the pathophysiology of IBS and constipation (Tanaka et al, 2008;Liu et al, 2022), it is reasonable to hypothesize that SDB is a potentially effective, complementary lifestyle management in patients with IBS. A previous study found that microvascular endothelial function of IBS patients improved following the SDB intervention (Katherine Jurek et al, 2022).…”