Impaired colonic motor response to eating in patients with slow-transit constipation

Because little is known about the pathophysiological mechanisms responsible for chronic idiopathic constipation, we studied colon motor response to eating, one of the most physiological and reproducible stimuli, in a clinically homogeneous group of severely constipated subjects. Fifteen patients (14 women, one man) with slow transit constipation (average duration of symptoms 18 +/- 2 yr) entered the study. After colonoscopic positioning of a manometric probe, 2-h basal and 3-h postprandial (1000 kcal standard mixed meal) recordings were obtained. Comparison of tracings with those of 29 healthy volunteers showed that motor response to eating was decreased in constipated subjects. Patients' response was characterized by a shorter duration of contractile activity in all three colon segments studied, after ingestion of the meal, and significantly less high-amplitude propagated contractions (7% vs. 45%). We conclude that several mechanisms are involved in the pathophysiology of colon contractile motor function of patients with chronic idiopathic constipation.