Skip to main content
SpringerLink
Log in

Upper gastrointestinal motor activity in patients with slow-transit constipation

Further evidence for an enteric neuropathy

  • Motility, Nerve-Gut Interactions, Hormones, And Receptors
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may have motor abnormalities not limited to the colon. We studied by manometric means gastric and small bowel motility in a homogeneous group of patients with chronic idiopathic constipation ie, the slow transit type. Twenty-one patients were recruited for the study and compared to 33 healthy subjects. Manometric examination was carried out for about 5 hr fasting and 1 hr after a standard meal. Analysis of the manometric tracings revealed during fasting no abnormalities in number and configuration of migrating motor complex with respect to controls. However, in 70% of patients motor abnormalities were detected, represented by bursts of nonpropagated contractions and discrete clustered contractions. After feeding, the patient group displayed a significantly shorter antral motor response to the meal with respect to controls; moreover, intestinal bursts of nonpropagated contractions were found in 19% of patients, and 14% of them had an early return of the activity fronts. We conclude that patients with slow transit constipation frequently display motor abnormalities of the upper gut. These findings further strengthen the concept that this condition may represent a panenteric disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sandler RS, Drossman DA: Bowel habits in young adults not seeking health care. Dig Dis Sci 32:841–845, 1987

    PubMed  Google Scholar 

  2. Sonnenberg A, Koch TR: Epidemiology of constipation in the United States. Dis Colon Rectum 32:1–8, 1989

    PubMed  Google Scholar 

  3. Whitehead WE, Drinkwater D, Cheskin LJ, Heller BR, Schuster MM: Constipation in the elderly living at home: Definition, prevalence, and relationship to lifestyle and health status. J Am Geriatr Soc 37:423–429, 1989

    PubMed  Google Scholar 

  4. Whitehead WE, Chaussade S, Corazziari E, Kumar D: Report of an international workshop on management of constipation. Gastroenterol Int 4:99–113, 1991

    Google Scholar 

  5. Preston DM, Bulter MG, Smith B, Lennard-Jones JE: Neuropathology of slow transit constipation. Gut 24:A997, 1983

    Google Scholar 

  6. Krishnamurti S, Schuffler MD, Rohrmann CA, Pope CE: Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myoenteric plexus. Gastroenterology 88:26–34, 1985

    PubMed  Google Scholar 

  7. Krishnamurti S, Schuffler MD: Pathology of neuromuscular disorders of the small intestine and colon. Gastroenterology 93:610–639, 1987

    PubMed  Google Scholar 

  8. Koch TR, Carney JA, Go VLW: Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Gastroenterology 94:300–310, 1988

    PubMed  Google Scholar 

  9. Lincoln J, Crowe R, Kamm MA, Burnstock G, Lennard-Jones JE: Serotonin and 5-hydroxyindolacetic acid are increased in the sigmoid colon in severe idiopathic constipation. Gastroenterology 98:1219–1225, 1990

    PubMed  Google Scholar 

  10. Milner P, Crowe R, Kamm MA, Lennard-Jones JE, Burnstock G: Vasoactive intestinal polypeptide levels in sigmoid colon in idiopathic constipation and diverticular disease. Gastroenterology 99:666–675, 1990

    PubMed  Google Scholar 

  11. Dolk A, Brodén G, Holmström B, Johansson C, Schultzberg M: Slow transit constipation (Arbuthnot Lane's disease): An immunohistochemical study of neuropeptide-containing nerves in resected specimens from the large bowel. Int J Colorect Dis 5:181–187, 1990

    Google Scholar 

  12. Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farroni F, Pelli MA, Morelli A: Colonic mass movements in idiopathic chronic constipation. Gut 29:1173–1179, 1988

    PubMed  Google Scholar 

  13. Bazzocchi G, Ellis J, Villanueva-Meyer J, Jing J, Reddy SN, Mena I, Snape WJ: Postprandial colonic transit and motor activity in chronic constipation. Gastroenterology 98:686–693, 1990

    PubMed  Google Scholar 

  14. Bassotti G, Chiarioni G, Vantini I, Betti C, Fusaro C, Pelli MA, Morelli A: Anorectal manometric abnormalities and colonic propulsive impairment in patients with severe chronic idiopathic constipation. Dig Dis Sci 39:1558–1564, 1994

    PubMed  Google Scholar 

  15. Waldron DJ, Kumar D, Hallan RI, Wingate DL, Williams NS: Evidence for motor neuropathy and reduced filling of the rectum in chronic intractable constipation. Gut 31:1284–1288, 1990

    PubMed  Google Scholar 

  16. Bassotti G, Betti C, Pelli MA, Morelli A: Prolonged (24 hour) manometric recording of rectal contractile activity in patients with slow transit constipation. Digestion 49:72–77, 1991

    PubMed  Google Scholar 

  17. Kamm MA, Hawley PR, Lennand-Jones JE: Outcome of colectomy for severe idiopathic constipation. Gut 29:969–973, 1988

    PubMed  Google Scholar 

  18. Watier A, Devroede G, Duranceau A, Abdel-Raman M, Duguay C, Forand M, Tetreault L, Arhan P, Lamarche J, Elhilali M: Constipation with colonic inertia. A manifestation of systemic disease? Dig Dis Sci 28:1025–1033, 1983

    PubMed  Google Scholar 

  19. Reynolds JC, Ouyang A, Lee CA, Baker C, Sunshine AG, Cohen S: Chronic severe constipation. Prospective motility studies in 25 consecutive patients. Gastroenterology 92:414–420, 1987

    PubMed  Google Scholar 

  20. Bannister JJ, Timms JM, Barfield LJ, Donelly TC, Read NW: Physiological studies in young women with chronic constipation. Int J Colorect Dis 1:175–183, 1986

    Google Scholar 

  21. Van der Sijp JRM, Kamm MA, Nightingale JMD, Britton KE, Granowska M, Mather SJ, Akkermans LMA, Lennard-Jones JE: Disturbed gastric and small bowel transit in severe idiopathic constipation. Dig Dis Sci 38:837–844, 1993

    PubMed  Google Scholar 

  22. Kumar D, Waldron D, Williams NS, Wingate DL: Slow-transit constipation: A pan-enteric motor disorder? Gastroenterology 96:A277, 1989

  23. Neri M, Schiavone C, Grossi E, Laterza F, Cuccurullo F: Gallbladder motility in slow-transit constipation: Evidences toward a generalized motility disorder. Gastroenterology 104:A558. 1994

    Google Scholar 

  24. Bassotti G, Castellucci G, Betti C, Fusaro C, Cavalletti ML, Bertotto A, Spinozzi F, Morelli A, Pelli MA: Abnormal gastrintestinal motility in patients with celiac sprue. Dig Dis Sci 39:1947–1954, 1994

    PubMed  Google Scholar 

  25. Vantrappen G, Janssens J, Hellemans J, Ghoos Y: The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest 59:1158–1166, 1977

    PubMed  Google Scholar 

  26. Malagelada JR, Camilleri M, Stanghellini V: Manometric Diagnosis of Gastrointestinal Motility Disorders. New York, Thieme Inc., 1986

    Google Scholar 

  27. Summers RW, Anuras S, Green J: Jejunal manometry patterns in health, partial intestinal obstruction and pseudo-obstruction. Gastroenterology 85:1290–1300, 1983

    PubMed  Google Scholar 

  28. Stanghellini V, Camilleri M, Malagelada JR: Chronic idiopathic intestinal pseudo-obstruction: Clinical and intestinal manometric findings. Gut 28:5–12, 1987

    PubMed  Google Scholar 

  29. Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987

    PubMed  Google Scholar 

  30. Kerlin P, Phillips S: Variability of motility of the ileum and jejunum in healthy humans. Gastroenterology 82:694–700, 1982

    PubMed  Google Scholar 

  31. Kelly KA: Motility of the stomach and gastroduodenal junction.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1981, pp 393–410

    Google Scholar 

  32. Stanghellini V, Ghidini C, Ricci Maccarini M, Paparo GF, Corinaldesi R, Barbara L: Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia. Gut 33:184–190, 1992

    PubMed  Google Scholar 

  33. Diamant NE, Hall K, Mui H, El-Sharkawy TY: Vagal control of the feeding motor pattern in the lower esophageal sphincter, stomach, and small intestine of the dog.In Gastrointestinal Motility. J. Christensen (ed). New York, Raven Press, 1980, pp 365–370

    Google Scholar 

  34. Malagelada JR, Rees WD, Mazzotta LJ, Go VLW: Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanecol. Gastroenterology 78:286–293, 1980

    PubMed  Google Scholar 

  35. Bockus HL, Bank J, Wilkinson SA: Neurogenic mucous colitis. Am J Med Sci 176:813–829, 1928

    Google Scholar 

  36. Smart HL, Atkinson M: Abnormal vagal function in irritable bowel syndrome. Lancet 2:475–478, 1987

    PubMed  Google Scholar 

  37. Chakraborty TK, Ogilvie AL, Heading RC, Ewing DJ: Abnormal cardiovascular reflexes in patients with gastroesophageal reflux. Gut 30:46–49, 1989

    PubMed  Google Scholar 

  38. Eckardt VF, Stenner F, Liewen H, Roder R, Koop H, Bernhard G: Autonomic dysfunction in patients with achalasia. Neurogastroenterol Mot 7:55–61, 1995

    Google Scholar 

  39. Bassotti G, Chiarioni G, Imbimbo BP, Betti C, Bonfante F, Vantini I, Morelli A, Whitehead WE: Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow transit type) constipation. Dig Dis Sci 38:1040–1045, 1993

    PubMed  Google Scholar 

  40. Pilot MA, Raethjen J, Warner G, Anand P, Williams NS: Slow transit constipation. A result of selective autonomic deficits? Neurogastroenterol Mot 6:175, 1994

    Google Scholar 

  41. Wood JD: Electrical activity of the intestine of mice with hereditary megacolon and absence of enteric ganglion cells. Am J Dig Dis 18:477–488, 1973

    PubMed  Google Scholar 

  42. Booth JW, Fenton TR, Milla PJ, Harries JT: A pathophysiological study of the intestinal manifestations of a vasoactive intestinal peptide, calcitonin, and catecholamine-secreting tumor. Gut 24:954–959, 1983

    PubMed  Google Scholar 

  43. Camilleri M, Malagelada JR, Stanghellini V, Fealey RD, Sheps SG: Gastrointestinal motility disturbances in patients with orthostatic hypotension. Gastroenterology 88:1223–1231, 1985

    PubMed  Google Scholar 

  44. Summers RW, Anuras S, Green J: Jejunal manometry patterns in health, partial intestinal obstruction, and pseudoobstruction. Gastroenterology 85:1290–1300, 1983

    PubMed  Google Scholar 

  45. Summers RW, Yanda R, Prihoda M, Flatt A: Acute intestinal obstruction: an electromyographic study in dogs. Gastroenterology 1301–1306, 1983

  46. Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–1218, 1990

    PubMed  Google Scholar 

  47. Manning AP, Thompson WG, Heaton KW, Morris AF: Toward positive diagnosis of the irritable bowel. Br Med J 2:653–654, 1978

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Laboratorio di Motilità Intestinale, Clinica di Gastroenterologia ed Endoscopia Digestiva, Dipartimento di Medicina Clinica, Patologia e Farmacologia, Università di Perugia, Italy

    Gabrio Bassotti MD, PhD, Vincenzo Stanghellini MD, Giuseppe Chiarioni MD, Ugo Germani MD, Roberto de Giorgio MD, Italo Vantini MD, Antonio Morelli MD & Roberto Corinaldesi MD

  2. Cattedra di Patologia Medica II, Università degli Studi di Bologna, Italy

    Gabrio Bassotti MD, PhD, Vincenzo Stanghellini MD, Giuseppe Chiarioni MD, Ugo Germani MD, Roberto de Giorgio MD, Italo Vantini MD, Antonio Morelli MD & Roberto Corinaldesi MD

  3. Divisione di Riabilitazione Gastroenterologica, Ospedale Clinicizzato di Valeggio sul Mincio, Università di Verona, Italy

    Gabrio Bassotti MD, PhD, Vincenzo Stanghellini MD, Giuseppe Chiarioni MD, Ugo Germani MD, Roberto de Giorgio MD, Italo Vantini MD, Antonio Morelli MD & Roberto Corinaldesi MD

Authors
  1. Gabrio Bassotti MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vincenzo Stanghellini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Chiarioni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ugo Germani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto de Giorgio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Italo Vantini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Morelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roberto Corinaldesi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bassotti, G., Stanghellini, V., Chiarioni, G. et al. Upper gastrointestinal motor activity in patients with slow-transit constipation. Digest Dis Sci 41, 1999–2005 (1996). https://doi.org/10.1007/BF02093603

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02093603

Key words

Search

Navigation