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Research Article

Heightened Colon Motor Activity Measured by a Wireless Capsule in Patients With Constipation: Relation to Colon Transit and IBS

¹University of Michigan Health System ²University of Michigan ³University of Iowa ⁴State University of NY at Buffalo ⁵Temple University Hospital ⁶Wake Forest University Baptist ⁷University of Kansas Medical Center ⁸Massachusetts General Hospital ⁹University of Kansas ¹⁰Univ. ¹¹

Submitted 9 April 2009 ; revision received 10 September 2009 ; accepted in final form 30 September 2009

ABSTRACT

Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to (i) characterize regional differences in colon pressure, (ii) relate motor differences in constipation to colon transit, and (iii) quantify the role of IBS in altered contractility with constipation. Colon pH and pressure were measured by wireless capsules in 53 healthy and 36 constipated subjects. Numbers of contractions >25 mmHg and areas under curves (AUC) were calculated for colon transit quartiles by time. Constipation was classified as normal transit (<59 hr), moderate slow transit (STC)(59-100 hr), and severe STC (>100 hr). 12/36 constipated subjects had C-IBS; 24 had functional constipation. Numbers of contractions and AUCs increased from the 1st to 4th quartile in health (P<0.0001). Mean numbers of contractions in constipated subjects were similar to controls. Mean AUCs with normal transit (P=0.01) and moderate STC (P=0.004) but not severe STC (P=NS) were higher than healthy subjects. IBS was associated with greater mean numbers of contractions (P=0.05) and AUCs (P=0.0006) versus controls independent of transit. Numbers of contractions increased from the 1st to 4th quartiles in moderate STC, C-IBS, and functional constipation; AUCs increased from the 1st to 4th quartiles in all groups (all P<0.05). In conclusion, colon pressure activity is greater distally than proximally in health. Constipated patients with normal or moderately delayed transit show increased motor activity that is partly explained by IBS. These findings emphasize differential effects on transit and motility in different constipation subtypes.

Gastrointestinal motility; Colon transit; Constipation; Irritable bowel syndrome