Abstract
Background
Classification of chronic constipation (CC) into its three subtypes of slow transit constipation, defecation disorder and normal transit constipation, may improve its multifaceted management. We assessed the merits of the London classification in patients with CC, who were studied by both wireless motility capsule (WMC) and high-resolution anorectal manometry (HR‐ARM), examining their relative utilities in decision-making.s
Patients and Methods
Retrospective, community-based study of prospectively collected data on patients with CC by Rome IV criteria, who underwent WMC and HR-ARM, Balloon Expulsion Test, and Rectal Sensory Testing. Clinical assessment was made by standard questionnaires. On WMC, standard criteria for colonic transit time (CTT) were used (normal CTT < 59 h). The hierarchical London classification was used for HR‐ARM analyses.
Results
Of 1261 patients with CC, 166 (91 M; ages 22–86) received technically satisfactory WMC and HR-ARM, formed the analyzed study cohort, of whom 84 had normal CTT and 82 had prolonged CTT (> 59 h). Patients with slow CTT were significantly older and had longer duration and more severe disease. Using the London classification criteria for disorders of anorectal function, we noted a high prevalence of anorectal dysfunction, regardless of CTT. Except for lower rate of anal hypertonicity in patients with slow CTT, disorders of recto-anal coordination, and rectal sensation were seen at a comparable rate in patients with CC, regardless of CTT.
Conclusion
There is a significant overlap of anorectal disorders in patients with slow CTT. There is questionable specificity and utility of WMC and HR-ARM in assessing patients with CC. More work is needed to demonstrate the value of these studies as surrogate markers of the disease and its response to multifaceted therapy.
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References
Mearin F, Lacy BE, Chang L et al. Bowel disorders. Gastroenterology. 2016. https://doi.org/10.1053/j.gastro.2016.02.031.
Whitehead WE, Wald A, Diamant NE et al. Functional disorders of the anus and rectum. Gut 1999;45:ii55–ii59.
Sommers T, Petersen T, Singh P et al. Significant morbidity and mortality associated with fecal impaction in patients who present to the emergency department. Dig Dis Sci. 2019;64:1320–1327. https://doi.org/10.1007/s10620-018-5394-8.
Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14:39–46. https://doi.org/10.1080/17474124.2020.1708718.
Camilleri M, Ford AC, Mawe GM et al. Chronic constipation. Nat Rev Dis Primers. 2017;3:17095. https://doi.org/10.1038/nrdp.2017.95.
Rao S, Hatfield R, Soffer E, Rao S, Beaty J, Conklin JL. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999;94:773–783.
Carrington EV, Heinrich H, Knowles CH et al. The international anorectal physiology working group (IAPWG) recommendations: standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterol Motil. 2020;32:e13679. https://doi.org/10.1111/nmo.13679.
Camilleri M, Brandler J. Refractory constipation: how to evaluate and treat. Gastroenterol Clin North Am. 2020;49:623–642.
Triadafilopoulos G, Finlayson M, Grellet C. Bowel dysfunction in postmenopausal women. Women Health. 1998;27:55–66. https://doi.org/10.1300/J013v27n04_04.
Rosa-E-Silva L, Gerson L, Davila M, Triadafilopoulos G. Clinical, radiologic and manometric characteristics of chronic intestinal dysmotility: the Stanford experience. Clin Gastroenterol Hepatol. 2006;4:866–873. https://doi.org/10.1016/j.cgh.2006.05.001.
Huang RJ, Chun CL, Friday K, Triadafilopoulos G. Manometric abnormalities in the postural orthostatic tachycardia syndrome: a case series. Dig Dis Sci. 2013;58:3207–3211. https://doi.org/10.1007/s10620-013-2865-9.
Su A, Gandhy R, Barlow C, Triadafilopoulos G. Utility of high-resolution anorectal manometry and wireless motility capsule in the evaluation of patients with Parkinson’s disease and chronic constipation. BMJ Open Gastroenterol. 2016;3:e000118. https://doi.org/10.1136/bmjgast-2016-000118.
Saad RJ. The wireless motility capsule: a one-stop shop for the evaluation of GI motility disorders. Curr Gastroenterol Rep 2016;18:14.
Jameson JS, Chia YW, Kamm MA, Speakman C, Chye YH, Henry MM. Effect of age, sex and parity on anorectal function. Br J Surg 1994;81:1689–1692.
Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. Gastroenterology 1999;116:732–760.
Rao SS, Benninga MA, Bharucha AE et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015;27:594–609.
Chiarioni G, Whitehead WE, Pezza V et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130:657–664.
Sonu I, Triadafilopoulos G, Gardner JD. Persistent constipation and abdominal adverse events with newer treatments for constipation. BMJ Open Gastroenterol. 2016;3:e000094. https://doi.org/10.1136/bmjgast-2016-000094.
Triadafilopoulos G, Clarke JO, Kamal A, Neshatian L. Intra-subject variability in high resolution anorectal manometry using the London classification: diagnostic and therapeutic implications. Dig Dis Sci. 2022;67:5014–5018.
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Triadafilopoulos, G., Lee, M. & Neshatian, L. High Prevalence of Anorectal Dysfunction in Ambulatory Patients with Chronic Constipation, Regardless of Colon Transit Time. Dig Dis Sci 69, 180–188 (2024). https://doi.org/10.1007/s10620-023-08072-3
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DOI: https://doi.org/10.1007/s10620-023-08072-3