Slow transit constipation: a model of human gut dysmotility. Review of possible aetiologies

Abstract

Slow transit constipation is a severe condition of gut dysmotility that predominantly affects young women and may result in surgical intervention. Current medical treatments for STC are often ineffective, and the outcome of surgery is unpredictable. STC was first described almost a century ago. Since this time, progress in improving therapy for this condition has been complicated by a lack of understanding of the aetiology, and great variation in the methods and criteria used for the study of patients with this debilitating disorder. It is difficult to find unequivocal data, and harder still to give a definitive picture of the cause or causes of STC. Here we consider the evidence for various aetiologies of STC, in the light of the physiological and pathological findings.

Interstitial cells of Cajal (ICC) in equine colic: an immunohistochemical study of horses with obstructive disorders of the small and large intestines

“…A reduction in ICC density has been implicated in human dysmotility syndromes including slow transit constipation (He et al 2000;Knowles and Martin 2000), chronic idiopathic intestinal pseudo-obstruction (Isozaki et al 1997), megacolon (Faussone-Pellegrini et al 1999), Chagasic megacolon (Hagger et al 2000) and ulcerative colitis (Rumessen 1996). A significant reduction in ICC density has been found in horses with grass sickness (Hudson et al 2001).…”

Characterization of motor patterns in isolated human colon: are there differences in patients with slow-transit constipation?

“…Slowtransit constipation (STC), for example, is one of many different types of constipation that is known to occur when the normal transit of colonic contents is impaired, leading to a buildup or blockage of fecal content in the large bowel (3,5,12,13,33). A number of studies have made attempts to identify mechanisms underlying the onset of STC, but no clear underlying mechanism has yet been determined.…”

Overexpression of progesterone receptor B increases sensitivity of human colon muscle cells to progesterone

“…Female sex hormones have been suggested as possible etiologic factors in the pathogenesis of slow-transit constipation (STC) because of the higher incidence of constipation in young women than in men (29,35) as well as during the last two trimesters of pregnancy, when the levels of progesterone (P 4 ) are highest (2,5,11,13,26,28,42). This type of constipation correlates with prolonged gastrointestinal transit time (14,22). Some studies have also shown that colonic transit time is longer during the luteal phase than during the follicular phase of the menstrual cycle (1,39,40).…”