S1250 Twenty-Four Hour Pan-Colonic Manometry in Patients with Severe Slow Transit Constipation Demonstrates Diminished Propagating Pressure Wave Activity in the Transverse Colon

Pathophysiology of colonic causes of chronic constipation

“…29,40 In constipated patients a similar decrease in activity has been noted by some, 29,30,35 whilst others have demonstrated a notable absence of the normal nocturnal suppression. 37,38 Morning waking induces an increase in colonic activity in health, 29,40 and this has also been shown in some patients with constipation; 38,43 others, however, 29,35 have demonstrated that this response may be diminished or absent compared to controls. It is likely the diurnal variation in motor function is mediated by the central nervous system, and an attenuated response to sleep or morning waking may support a neuropathic cause in such patients.…”

“…Diurnal variation/morning waking In health, both propagating and nonpropagating motor activity of the colon is suppressed at night 29,40 . In constipated patients a similar decrease in activity has been noted by some, 29,30,35 whilst others have demonstrated a notable absence of the normal nocturnal suppression 37,38 . Morning waking induces an increase in colonic activity in health, 29,40 and this has also been shown in some patients with constipation; 38,43 others, however, 29,35 have demonstrated that this response may be diminished or absent compared to controls.…”

“…In patients with STC, low amplitude PS are reported as being reduced 29,35 or of similar frequency to healthy controls 36 . Some have identified regional differences in the PS frequency, with one study demonstrating a diminished frequency in the transverse colon 37 and another an increased frequency in the descending colon 38 . The implications of such findings remain unknown.…”

Surgical management of constipation

“…Thus such measures should be used with great caution in guiding surgical treatment. Of interest however is the observation that when propagated pressure data for individual patients with STC are displayed as 24‐h spatio‐temporal maps, it is evident that there is a marked paucity of activity throughout the mid‐transverse colon to splenic flexure 64 . Furthermore, in the study of patients with STC undergoing SNS described earlier in the review, 13 neuromodulation induced a significant increase in the frequency and extent of propagation of HAPSs through these mid‐colonic regions that had previously been devoid of activity.…”