RESUMEN
BACKGROUND: Slow transit constipation (STC) is associated with upper gastrointestinal tract motor abnormalities in a subset of patients. This could influence the clinical approach, particularly in those rare cases where surgical management is considered. AIMS: To identify factors that predict proximal gut dysmotility in patients with STC. METHODS: Esophageal and small bowel motor function were evaluated in 77 patients with STC. Severity and pattern of colonic transit delay, prevalence of a co-existent rectal evacuatory disorder, and type (if present), and duration, and onset of constipation symptoms were compared. RESULTS: Of the 77 patients studied, 43% exhibited altered motor function in the esophagus and/or small bowel. Frequency of defecation was lower in these patients than in those without upper gastrointestinal dysmotility (0.5 +/- 0.1 vs. 1.3 +/- 0.3 bowel movements/per week, respectively; P = 0.04). Severity and patterns of colonic transit delay and the mechanism associated with the onset of constipation symptoms or with their duration were similar in subjects with or without upper gastrointestinal tract dysmotility. Small bowel but not esophageal motor dysfunction was more frequently associated with a co-existent rectal evacuatory disorder (P = 0.01). CONCLUSION: Upper gastrointestinal tract dysmotility in patients with STC is frequent, but prediction on the basis of clinical history and characteristics of colonic transit is problematic.
Asunto(s)
Estreñimiento/complicaciones , Estreñimiento/fisiopatología , Trastornos de la Motilidad Esofágica/complicaciones , Trastornos de la Motilidad Esofágica/fisiopatología , Motilidad Gastrointestinal/fisiología , Tránsito Gastrointestinal/fisiología , Adolescente , Adulto , Anciano , Estreñimiento/diagnóstico , Trastornos de la Motilidad Esofágica/diagnóstico , Femenino , Tracto Gastrointestinal/diagnóstico por imagen , Humanos , Masculino , Manometría , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Cintigrafía , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND: Severe constipation may be subclassified on the basis of speed of colonic transit and efficacy of rectal evacuation. It is hypothesized that rectal evacuatory disorder (RED) may be associated with a secondary transit delay. OBJECTIVES: To determine whether scintigraphy can discriminate between slow transit constipation (STC) with or without coexistent RED on the basis of progression of isotope throughout the colon and by analyses of specific regions of interest. METHODS: One hundred ninety-six patients with STC (radio-opaque marker study) were subclassified according to results of proctography into those with a RED (STC-RED N = 30) or normal (STC-ONLY N = 41) evacuation. Patients subsequently underwent colonic scintigraphy. Distribution of generalized or left-sided patterns of colonic transit was assessed. Severities of transit delay and regional transit at specific time points were also evaluated. RESULTS: Time-activity curves and severity of global transit delay were similar between groups as were the incidences of generalized and left-sided patterns of delay. Percentage of radioisotope retention in the right colon at 18 h was higher for the STC-ONLY group (P < 0.05), but this was poorly discriminative. No differences were observed for the percentage of radioisotope retained in the left colon at later scans. CONCLUSIONS: Global and regional assessment of colonic transit by scintigraphy failed to discriminate between patients with STC with or without coexistent RED. Thus, RED is not associated with a specific pattern of transit delay and scintigraphy alone cannot predict the presence or absence of RED, knowledge of which is important for management.