International Journal of Colorectal Disease

, Volume 19, Issue 5, pp 493–497

Twenty-four-hour manometric study of colonic propulsive activity in patients with diarrhea due to inflammatory (ulcerative colitis) and non-inflammatory (irritable bowel syndrome) conditions

  • Gabrio Bassotti
  • Giuseppe de Roberto
  • Fabio Chistolini
  • Francis Sietchiping-Nzepa
  • Olivia Morelli
  • Antonio Morelli
Original Article

Abstract

Background

Little is known concerning colonic motility and almost nothing is known concerning propulsive activity in pathological conditions characterized by diarrhea of both inflammatory and non-inflammatory origin.

Aims

The purpose of the present study was to investigate colonic propulsive activity in ulcerative colitis and diarrhea-predominant irritable bowel syndrome (IBS) patients.

Patients and methods

Seven patients with active, moderate ulcerative colitis and nine diarrhea-predominant IBS patients entered the study. Sixteen healthy volunteers were recruited as a control group. In all subjects, 24-h colonic motility was recorded by a colonoscopically positioned manometric catheter. Both high- (mass movements) and low-amplitude propagated contractions were analyzed.

Results

High-amplitude propagated contractions were significantly increased in ulcerative colitis with respect to controls; no significant differences were found with respect to IBS patients, and between IBS and controls. Concerning amplitude, no significant difference was found between groups, although IBS patients approached the statistical difference with respect to controls. Low-amplitude propagated contractions were significantly increased in ulcerative colitis with respect to controls; no significant differences were found compared with IBS patients. The latter, however, displayed a trend toward an increase with respect to controls that approached but did not reach statistical significance.

Conclusions

Both inflammatory and non-inflammatory diarrheal conditions are characterized by an overall increase of colonic propulsive activity. This observation may be useful for a better understanding of the pathophysiologic mechanisms of these disorders.

Keywords

Colon Manometry Motility Ulcerative colitis 

References

  1. 1.
    Jewell DP (1998) Ulcerative colitis. In: Feldman M, Scharschmidt BF, Sleisenger MH (eds) Gastrointestinal and liver disease, 6th edn. Saunders, pp 1735–1761Google Scholar
  2. 2.
    Greig E, Sandle GI (2000) Diarrhea in ulcerative colitis. The role of altered colonic sodium transport. Ann N Y Acad Sci 915:327–332PubMedGoogle Scholar
  3. 3.
    Snape WJ (1991) The role of a colonic motility disturbance in ulcerative colitis. Keio J Med 40:6–8PubMedGoogle Scholar
  4. 4.
    Spriggs EA, Code CF, Bargen JA, Curtis RK, Hightower NC (1951) Motility of the pelvic colon and rectum of normal persons and patients with ulcerative colitis. Gastroenterology 19:480–491PubMedGoogle Scholar
  5. 5.
    Kern F, Almy TP, Abbott FK, Bogdanoff MD (1951) The motility of the distal colon in non-specific ulcerative colitis. Gastroenterology 19:492–503PubMedGoogle Scholar
  6. 6.
    Snape WJ, Matarazzo SA, Cohn S (1980) Abnormal gastrocolonic response in patients with ulcerative colitis. Gut 21:392–396PubMedGoogle Scholar
  7. 7.
    Denis P, Colin R, Galmiche JP, et al (1979) Elastic properties of the rectal wall in normal adults and in patients with ulcerative colitis. Gastroenterology 77:45–48Google Scholar
  8. 8.
    Rao SSC, Read NW, Stobart JAH, Haynes WG, Benjamin S, Holdsworth CD (1987) Anorectal sensitivity and responses to rectal distension in patients with ulcerative colitis. Gastroenterology 93:1270–1275PubMedGoogle Scholar
  9. 9.
    Reddy SN, Bazzocchi G, Chan S, et al (1991) Colonic motility and transit in health and ulcerative colitis. Gastroenterology 101:1289–1297PubMedGoogle Scholar
  10. 10.
    Coulie B, Camilleri M, Bharucha AE, Sandborn WJ, Burton D (2001) Colonic motility in chronic ulcerative proctosigmoiditis and the effects of nicotine on colonic motility in patients and healthy subjects. Aliment Pharmacol Ther 15:653–663CrossRefPubMedGoogle Scholar
  11. 11.
    Bassotti G, Germani U, Morelli A (1995) Human colonic motility: physiological aspects. Int J Colorectal Dis 10:173–180PubMedGoogle Scholar
  12. 12.
    Sethi AK, Sarna SK (1991) Colonic motor activity in acute colitis in conscious dogs. Gastroenterology 100:954–963PubMedGoogle Scholar
  13. 13.
    Sethi AK, Sarna SK (1991) Colonic motor response to a meal in acute colitis. Gastroenterology 101:1537–1546PubMedGoogle Scholar
  14. 14.
    Baron JH, Connell AM, Lennard-Jones JE (1964) Variations between observers in describing mucosal appearances in proctocolitis. BMJ 1:89–95Google Scholar
  15. 15.
    Pera A, Bellando B, Caldera D, et al (1987) Colonoscopy in inflammatory bowel disease. Gastroenterology 92:181–185PubMedGoogle Scholar
  16. 16.
    Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA (1999) Functional bowel disorders and functional abdominal pain. Gut 45[Suppl II]: II43–II47Google Scholar
  17. 17.
    Bassotti G, Gaburri M, Imbimbo BP, et al (1988) Colonic mass movements in idiopathic chronic constipation. Gut 29:1173–1179Google Scholar
  18. 18.
    Bassotti G, Betti C, Fusaro C, Morelli A (1992) Colonic high-amplitude propagated contractions (mass movements): repeated 24-h manometric studies in healthy volunteers. J Gastrointest Motility 84:118–122Google Scholar
  19. 19.
    Bassotti G, Battaglia E, Spinozzi F, Pelli MA, Tonini M (2001) Twenty-four hour recordings of colonic motility in patients with diverticular disease. Evidence for abnormal motility and propulsive activity. Dis Colon Rectum 44:1814–1820PubMedGoogle Scholar
  20. 20.
    Bassotti G, Betti C, Imbimbo BP, Pelli MA, Morelli A (1989) Colonic motor response to eating: a manometric investigation in proximal and distal portions of the viscus in man. Am J Gastroenterol 84:118–122Google Scholar
  21. 21.
    Bassotti G, Iantorno G, Fiorella S, Bustos-Fernandez L, Bilder CR (1999) Colonic motility in man: features in normal subjects and in patients with chronic idiopathic constipation. Am J Gastroenterol 94:1760–1770CrossRefPubMedGoogle Scholar
  22. 22.
    Bassotti G, Crowell MD (2002) Colon and rectum: normal function and clinical disorder. Manometry. In: Schuster MM, Crowell MD, Koch KL (eds) Schuster atlas of gastrointestinal motility in health and disease, 2nd edn. Decker, Hamilton, pp 241–252Google Scholar
  23. 23.
    Bassotti G, Gaburri M (1988) Manometric investigation of high-amplitude propagated contractile activity of the human colon. Am J Physiol 255: G660–G664Google Scholar
  24. 24.
    Bassotti G, Chistolini F, Marinozzi G, Morelli A (2003) Abnormal colonic propagated activity in patients with slow transit constipation and constipation-predominant irritable bowel syndrome. Digestion 178–183Google Scholar
  25. 25.
    Bassotti G, Clementi M, Antonelli E, Pelli MA, Tonini M (2001) Low-amplitude propagated contractile waves: a relevant propulsive mechanism of the human colon. Dig Liver Dis 33:36–40CrossRefPubMedGoogle Scholar
  26. 26.
    Bassotti G, Gaburri M, Imbimbo BP, Morelli A, Whitehead WE (1994) Distension-stimulated propagated contractions in human colon. Dig Dis Sci 39:1955–1960PubMedGoogle Scholar
  27. 27.
    Chauve A, Devroede G, Bastin E (1976) Intraluminal pressures during perfusion of the human colon in situ. Gastroenterology 70:336–340PubMedGoogle Scholar
  28. 28.
    Bassotti G, Germani U, Morelli A (1996) Flatus-related colorectal and anal motor events. Dig Dis Sci 41:335–338PubMedGoogle Scholar
  29. 29.
    Snape WJ, Williams R, Hyman PE (1991) Defect in colonic smooth muscle contraction in patients with ulcerative colitis. Am J Physiol 261:G987–G991PubMedGoogle Scholar
  30. 30.
    Cook TA, Brading AF, Mortensen NJ (2000) Abnormal contractile properties of rectal smooth muscle in chronic ulcerative colitis. Aliment Pharmacol Ther 14:1287–1294CrossRefPubMedGoogle Scholar
  31. 31.
    Vrees ND, Pricolo VE, Potenti FM, Cao W (2002) Abnormal motility in patients with ulcerative colitis: the role of inflammatory cytokines. Arch Surg 137:439–445CrossRefPubMedGoogle Scholar
  32. 32.
    Connell AM (1962) The motility of the pelvic colon. II. Paradoxical motility in diarrhea and constipation. Gut 3:342–348PubMedGoogle Scholar
  33. 33.
    Loenig-Baucke V, Metcalf AM, Shirazi S (1989) Rectosigmoid motility in patients with uiescent and active ulcerative colitis. Am J Gastroenterol 84:34–39PubMedGoogle Scholar
  34. 34.
    Farthing MJG, Lennard-Jones JE (1978) Sensibility of the rectum to distension and anorectal distension reflex in ulcerative colitis. Gut 19:64–69PubMedGoogle Scholar
  35. 35.
    Rodriguez LA, Ruigomez A (1999) Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ 318:565–566PubMedGoogle Scholar
  36. 36.
    Neal KR, Barker L, Spiller RC (2002) Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut 51:410–413CrossRefPubMedGoogle Scholar
  37. 37.
    Read NW (1986) Diarrhée motrice. Gastroenterol Clin North Am 15:657–686Google Scholar
  38. 38.
    Vassallo M, Camilleri M, Phillips SF, Brown ML, Chapman NJ, Thomforde GM (1992) Transit through the proximal colon influences stool weight in the irritable bowel syndrome. Gastroenterology 102:102–108PubMedGoogle Scholar
  39. 39.
    Steadman CJ, Talley NJ, Phillips SF, Zinsmeister AR (1992) Selective 5-hydroxytryptamine type 3 receptor antagonism with ondansetron as treatment for diarrhea-predominant irritable bowel syndrome: a pilot study. Mayo Clin Proc 67:732–738PubMedGoogle Scholar
  40. 40.
    Camilleri M, Ford MJ (1998) Review article: colonic sensorimotor physiology in health, and its alteration in constipation and diarrhoeal disorders. Aliment Pharmacol Ther 12:287–302CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Gabrio Bassotti
    • 1
  • Giuseppe de Roberto
    • 1
  • Fabio Chistolini
    • 1
  • Francis Sietchiping-Nzepa
    • 1
  • Olivia Morelli
    • 1
  • Antonio Morelli
    • 1
  1. 1.Clinica di Gastroenterologia ed EpatologiaDipartimento di Medicina Clinica e Sperimentale, Università di PerugiaPerugiaItaly

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