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Colonic propulsive impairment in intractable slow-transit constipation
Gabrio Bassotti1, Fabio Chistolini, Francis Sietchiping Nzepa
1Gastroenterolgy and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Perugia, Italy. gabassot@tin.it
Archives of Surgery (Chicago, Ill. : 1960)
|December 10, 2003
Summary
Patients with severe slow-transit constipation have significantly reduced colonic propulsive activity. This finding supports surgical intervention for refractory cases after thorough physiological assessment.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Physiology
Background:
- Intractable constipation, particularly slow-transit constipation, can stem from various causes.
- Impaired colonic propulsive activity is a potential key mechanism in severe constipation.
Purpose of the Study:
- To investigate colonic propulsive activity in patients with severe, medically refractory slow-transit constipation.
- To compare propulsive activity between these patients and healthy volunteers.
Main Methods:
- A case series design was employed at a tertiary university hospital.
- Twenty-nine patients with severe slow-transit constipation and 16 healthy controls underwent 24-hour manometric recordings.
- Colonic high- and low-amplitude propulsive activity was assessed.
Main Results:
- Patients exhibited significantly reduced high-amplitude propagated activity compared to controls (<1 event/subject/day).
- No significant differences in low-amplitude propagated activity were observed between groups.
Conclusions:
- Severe, refractory slow-transit constipation is associated with a marked decrease in forceful colonic propulsion.
- Surgical intervention may be beneficial but requires thorough physiological evaluation.
- Residual low-amplitude activity might be a compensatory mechanism.