Digestive Diseases and Sciences

, Volume 38, Issue 6, pp 1040–1045

Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow transit type) constipation

  • Gabrio Bassotti
  • Giuseppe Chiarioni
  • Bruno Pietro Imbimbo
  • Cesare Betti
  • Fabrizio Bonfante
  • Italo Vantini
  • Antonio Morelli
  • William E. Whitehead
Original Articles

Abstract

Chronic idiopathic constipation, especially the slow transit type, is a troubling problem often afficting young women. The pathophysiological basis for this entity is unknown, although a defective cholinergic innervation has been postulated. We tested the hypothesis that cholinergic colonic innervation is deranged in this condition by studying colonic motor activity after strong cholinergic stimulation with edrophonium chloride in 14 women complaining of slow transit constipation. Unlike healthy subjects, constipated patients showed minimal or no response to edrophonium injection. It is concluded that in slow transit constipation there is an important alteration of colonic cholinergic activity and that edrophonium chloride may represent a useful test drug for colonic pathophysiological investigations.

Key Words

cholinergic colon constipation edrophonium motility 

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References

  1. 1.
    Preston DM, Lennard Jones JE: Severe chronic constipation of young women: idiopathic slow transit constipation. Gut 27:41–48, 1986Google Scholar
  2. 2.
    Read NW, Timms JM, Barfield KJ, Donnelly TC, Bannister JJ: Impairment of defecation in young women with severe constipation. Gastroenterology 90:53–56, 1986Google Scholar
  3. 3.
    Fasth S, Hedlund G, Svanninger G, Oreland T, Hultén L: Functional results after subtotal colectomy and caecorectal anastomosis. Acta Chir Scand 149:623–627, 1983Google Scholar
  4. 4.
    Klatt GR: Role of subtotal colectomy in the treatment of incapacitating constipation. Am J Surg 145:623–625, 1983Google Scholar
  5. 5.
    Poisson J, Devroede G: Severe chronic constipation as a surgical problem. Surg Clin North Am 63:193–217, 1983Google Scholar
  6. 6.
    Kamm MA, Hawley PR, Lennard-Jones JE: Outcome of colectomy for severe idiopathic constipation. Gut 29:969–973, 1988Google Scholar
  7. 7.
    Vasilevsky CA, Nemer FD, Balcos EG, Christenson CE, Goldberg SM: Is subtotal colectomy a viable option in the management of chronic constipation? Dis Colon Rectum 31:679–681, 1988Google Scholar
  8. 8.
    Yoshioka K, Keighley MRB: Clinical results of colectomy for severe constipation. Br J Surg 76:600–604, 1989Google Scholar
  9. 9.
    Christiansen J: Surgical treatment of chronic constipation. Scand J Gastroenterol 26:225–230, 1991Google Scholar
  10. 10.
    Bassotti G, Betti C, Pelli MA, Morelli A: Extensive investigation on colonic motility with pharmacological testing is useful for selecting surgical options in patients with inertia colica. Am J Gastroenterol 87:143–147, 1992Google Scholar
  11. 11.
    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, 1988Google Scholar
  12. 12.
    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, 1990Google Scholar
  13. 13.
    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, 1990Google Scholar
  14. 14.
    Bassotti G, Betti C, Morelli A: Prolonged (24 hour) manometric recording of rectal contractile activity in patients with slow transit constipation. Digestion 49:72–77, 1991Google Scholar
  15. 15.
    Preston DM, Butler MG, Smith B, Lennard-Jones JE: Neuropathology of slow transit constipation. Gut 24:A997, 1983Google Scholar
  16. 16.
    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, 1985Google Scholar
  17. 17.
    Krishnamurti S, Schuffler MD: Pathology of neuromuscular disorders of the small intestine and colon. Gastroenterology 93:610–639, 1987Google Scholar
  18. 18.
    Koch TR, Carney JA, Go VLW: Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Gastroenterology 94:300–310, 1988Google Scholar
  19. 19.
    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, 1990Google Scholar
  20. 20.
    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, 1990Google Scholar
  21. 21.
    Ek B: Studies on mechanisms for beta-adrenoceptor mediated inhibition of colon motility. Acta Physiol Scand 125 (suppl 546):1–39, 1985Google Scholar
  22. 22.
    Narducci F, Bassotti G, Daniotti S, Del Soldato P, Pelli MA, Morelli A: Identification of muscarinic receptor subtype mediating colonic response to eating. Dig Dis Sci 30:124–128, 1985Google Scholar
  23. 23.
    Roman C: Commande nerveuse de la motricité digestive. Gastroenterol Clin Biol 11:27B-34B, 1987Google Scholar
  24. 24.
    Burks TF: Actions of pharmacological agents on gastrointestinal functions.In An Illustrated Guide to Gastrointestinal Motility D Kumar, S Gustavsson (eds). Chichester, John Wiley & Sons Ltd, 1988, pp 272–289Google Scholar
  25. 25.
    Burleigh DB: Evidence for a functional cholinergic deficit in human colonic tissue resected for constipation. J Pharm Pharmacol 40:55–57, 1988Google Scholar
  26. 26.
    Reynolds JC, Ouyang A, Lee CA, Baler L, Sunshine AG, Cohen S: Chronic severe constipation. Prospective motility studies in 25 consecutive patients. Gastroenterology 92:414–420, 1987Google Scholar
  27. 27.
    Bassotti G, Imbimbo BP, Betti C, Erbella GS, Pelli MA, Morelli A: Edrophonium chloride for testing colonic contractile activity in man. Acta Physiol Scand 141:289–293, 1991Google Scholar
  28. 28.
    Bassotti G, Gaburri M, Clausi GG, Pelli MA, Morelli A: Can idiopathic megacolon cause functional motor abnormalities in the upper gastrointestinal tract? Hepato-Gastroenterol 4:186–189, 1987Google Scholar
  29. 29.
    Preston DM, Lennard-Jones JE: Anismus in chronic constipation. Dig Dis Sci 30:413–418, 1985Google Scholar
  30. 30.
    Whitehead WE, Chaussade S, Corazziari E, Kumar D: Report of an international workshop on management of constipation. Gastroenterol Int 4:99–113, 1991Google Scholar
  31. 31.
    Narducci F, Bassotti G, Gaburri M, Morelli A: Twenty four hour manometric recording of colonic motor activity in healthy man. Gut 28:17–25, 1987Google Scholar
  32. 32.
    Bassotti G, Imbimbo BP, Gaburri M, Daniotti S, Morelli A: Transverse and sigmoid colon motility in healthy humans: Effects of eating and of cimetropium bromide. Digestion 37:59–64, 1987Google Scholar
  33. 33.
    Bassotti G, Gaburri M: Manometric investigation of highamplitude propagated contractile activity of the human colon. Am J Physiol 255:G660-G664, 1988Google Scholar
  34. 34.
    Bartlett MS: The use of transformations. Biometrics 3:39–52, 1947Google Scholar
  35. 35.
    Wilkinson, L: SYSTAT: The System for Statistics. Evanston, Illinois, Systat, Inc, 1986Google Scholar
  36. 36.
    Chowdhury AR, Dinoso VP, Lorber SH: Characterization of a hyperactive segment in the rectosigmoid junction. Gastroenterology 71:584–588, 1976Google Scholar
  37. 37.
    Kosterlitz HW, Lees GM: Pharmacological analysis of intrinsic intestinal reflexes. Pharmacol Rev 16:301–339, 1964Google Scholar
  38. 38.
    Furness JB, Costa M: Identification of gastrointestinal neurotransmitters.In Mediators and Drugs in Gastrointestinal Motility, Vol I. G Bertaccini (ed). Berlin, Springer-Verlag, 1982, pp 383–462Google Scholar
  39. 39.
    North RA: Electrophysiology of the enteric nervous system. Neuroscience 7:315–327, 1982Google Scholar
  40. 40.
    Sarna SK: Physiology and pathophysiology of colonic motor activity (part one). Dig Dis Sci 36:827–862, 1991Google Scholar
  41. 41.
    Misiewicz JJ, Connell AM, Pontes FA: Comparison of the effect of meals and prostigmine on the proximal and distal colon in patients with and without diarrhoea. Gut 7:468–473, 1966Google Scholar
  42. 42.
    Snape WJ, Carlson GM, Cohen S: Human colonic myoelectric activity in response to prostigmine and the gastrointestinal hormones. Am J Dig Dis 22:881–887, 1977Google Scholar
  43. 43.
    Sarna S, Latimer P, Campbell D, Waterfall WE: Effect of stress, meal and neostigmine on rectosigmoid electrical control activity (ECA) in normals and in irritable bowel syndrome patients. Dig Dis Sci 27:582–591, 1982Google Scholar
  44. 44.
    American Hospital Formulary Service: Drug Information 87. American Society of Hospital Pharmacists, Inc., Bethesda, 1987Google Scholar
  45. 45.
    Taylor P: Anticholinesterase agents.In The Pharmacological Basis of Therapeutics, 7th ed. AG Gilman, LS Goodman, TW Rall, F Murad (eds). New York, Macmillan, 1985, pp 110–129Google Scholar
  46. 46.
    Hollis JB, Castell DO: Effects of cholinergic stimulation on human esophageal peristalsis. J Appl Physiol 40:40–43, 1976Google Scholar
  47. 47.
    London RL, Ouyang A, Snape WJ, Goldberg S, Hirschfeld JW, Cohen S: Provocation of esophageal pain by ergonovine or edrophonium. Gastroenterology 81:10–14, 1981Google Scholar
  48. 48.
    Richter JE, Hackshaw BT, Wu WC, Castell DO: Edrophonium: A useful provocative test for esophageal chest pain. Ann Intern Med 103:14–21, 1985Google Scholar
  49. 49.
    Van Dyk HJL, Florence L: The Tensylon test. A safe office procedure. Ophthalmology 87:210–212, 1980Google Scholar
  50. 50.
    Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing in patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients. Ann Intern Med 106:593–597, 1987Google Scholar
  51. 51.
    Atienza P, Chaussade S, Hiltgen M, Couturier D, Guerre J: Danger du test a l'edrophonium au cors du syndrome d'hypertonie vagale. Gastroenterol Clin Biol 12:180–181, 1988Google Scholar
  52. 52.
    Read NW, Timms JM: Defecation and the pathophysiology of the constipation. Pathophysiology of non-neoplastic colonic disorders. Clin Gastroenterol 15:937–965, 1986Google Scholar
  53. 53.
    Kamm MA, Lennard-Jones JE, Thompson DG, Sobnack R, Garvie NW, Granowska M: Dynamic scanning defines a colonic defect in severe idiopathic constipation. Gut 29:1085–1092, 1988Google Scholar
  54. 54.
    Devroede G: Constipation.In Gastrointestinal Disease, 4th ed. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, 1989, pp 331–368Google Scholar
  55. 55.
    Sarna SK: Physiology and pathophysiology of colonic motor activity (part two). Dig Dis Sci 36:998–1018, 1991Google Scholar
  56. 56.
    Kamm MA: Pathophysiology of constipation.In The Large Intestine: Physiology, Pathophysiology, and Disease. SF Phillips, JH Pemberton, RG Shorter (eds). New York, Raven Press, 1991, pp 709–726Google Scholar
  57. 57.
    Williams NS, Womack NR: Surgical therapy of constipation and incontinence.In The Large Intestine: Physiology, Pathophysiology, and Disease. SF Phillips, JH Pemberton, RG Shorter (eds). New York, Raven Press, 1991, pp 757–774Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Gabrio Bassotti
    • 1
    • 4
  • Giuseppe Chiarioni
    • 2
  • Bruno Pietro Imbimbo
    • 3
  • Cesare Betti
    • 1
  • Fabrizio Bonfante
    • 2
  • Italo Vantini
    • 2
  • Antonio Morelli
    • 1
  • William E. Whitehead
    • 4
  1. 1.Laboratorio di Motilità Intestinale, Istituto di Gastroenterologia ed Endoscopia DigestivaUniversità di PerugiaItaly
  2. 2.Divisione di Riabilitazione GastroenterologicaOspedale Clinicizzato di Valeggio sul Mincio, Università di VeronaItaly
  3. 3.Direzione MedicaMediolanum FarmaceuticiMilanoItaly
  4. 4.Center for Study of Functional and Motility Disorders of the Gut, Departments of Psychiatry and MedicineThe Johns Hopkins University School of Medicine and Francis Scott Key Medical CenterBaltimoreMaryland
  5. 5.Laboratorio di Motilità IntestinaleIstituto di Gastroenterologia ed Endoscopia Digestiva, Policlinico MontelucePerugiaItaly

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