High Prevalence of Slow Transit Constipation in Patients With Gastroparesis

Abstract

Background/Aims Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated. Methods We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups. Results Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings. Conclusions Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

“…The explanation is likely multifactorial. Firstly, patients with suspected diabetic gastroparesis often present a diversity of unspecific symptoms, not only limited to cardinal symptoms of nausea, vomiting, early satiety, fullness, and bloating, but often also abdominal pain, reflux, diarrhea, constipation, and fecal incontinence . Adding to the confusion, delayed GE is present in 30%‐50% with longstanding diabetes regardless of symptoms, probably as a consequence of autonomic neuropathy .…”

“…Firstly, patients with suspected diabetic gastroparesis often present a diversity of unspecific symptoms, not only limited to cardinal symptoms of nausea, vomiting, early satiety, fullness, and bloating, but often also abdominal pain, reflux, diarrhea, constipation, and fecal incontinence. [27][28][29][30] Adding to the confusion, delayed GE is present in 30%-50% with longstanding diabetes regardless of symptoms, probably as a consequence of autonomic neuropathy. 5,[31][32][33] Secondly, there are multiple pathophysiological alterations associated with diabetic gastroparesis, both locally in the gut and in the autonomic and central nervous system.…”

Gastroparesis: a turning point in understanding and treatment

“…It remains unclear if higher sensitivity of detecting delayed GE which is likely driven by the emptying delay due to non-physiological nature of pill emptying is clinically meaningful. A clear advantage of WMC, however, is that it allows assessment of global transit abnormalities which can be helpful in evaluation and management of comorbidities like constipation that associate with gastroparesis 103…”

Five-fold Gastrointestinal Electrical Stimulation With Electromyography-based Activity Analysis: Towards Multilocular Theranostic Intestinal Implants

“…[4][5] Furthermore, functional disorders in one GI segment increase the risk in others. 6 GI smooth muscle electromyography (EMG) has been clinically tested for recording pacesetter slow waves or action potential spikes. Diagnosis of motility disorders according to the myoelectric activity and direct electrical stimulation (ES) appears to be reasonable.…”