Submitted on July 2, 2008
Revised on March 30, 2009
Accepted on April 1, 2009
Colorectal Responses to Distension and Feeding in Patients with Spinal Cord Injury
Vid P Suttor1, Clinton Ng1, Susan Rutkowski1, Ross D Hansen1, John E Kellow, and Allison Malcolm1*
1 Royal North Shore Hospital
* To whom correspondence should be addressed. E-mail: amalcolm{at}med.usyd.edu.au.
Objective: The role of the central nervous system in entero-enteric motor reflexes remains controversial. Our aims were: (1) to evaluate colorectal, rectocolic, gastrocolonic and gastrorectal reflex responses in patients with cervical spinal cord injury (SCI); and (2) to compare with healthy subjects. Setting: Tertiary Referral Centre. Patients: Six patients with SCI (5 M, 42±4 years), and 6 healthy control subjects (5 M, 36±5 years). Design: Two-minute phasic distensions performed randomly via dual barostat balloons in the colon and rectum. Continuous colonic and rectal balloon volumes recorded during distensions and after a 1000 kcal liquid meal. Main Outcome Measures: Mean balloon volumes before, during and after phasic distensions; and over 60 minutes postprandially. Results: The colorectal response was present in all subjects, similarly in health and SCI (rectal volume reduction 28±11% SCI vs 15±5% health); the rectocolic response was variable. The gastrocolonic response was present in all subjects (colonic volume reduction 49±4% SCI vs 44±3% health), with a time effect in the first 30 minutes (p<0.0001), and a group effect in the second 30 minutes (p<0.004). The gastrorectal response was present in 4 SCI and 5 health (rectal volume reduction 38±4% SCI vs 41±3% health), with a time effect in the first 30 minutes (p<0.0001), but no group effect in the second 30 minutes. Conclusion: Intact neural transmission between the spinal cord and higher centres is not essential for normal colorectal motor responses to feeding and to distension; however a degree of CNS and neurohormonal modulation of these responses is likely.
