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Constipation with colonic inertia

A manifestation of systemic disease?

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Abstract

Transit of radiopaque markers was delayed in the ascending colon of 51 females and 3 males treated for severe idiopathic constipation. Onset of symptoms was between age 10 and 20 in more than half of the patients. Eighteen percent had previously undergone unnecessary laparotomy for large bowel pseudoobstruction. Stool frequency ranged from 1 stool every three days to 1 every 2 months. Twenty-six percent suffered from fecal incontinence. In addition, 30% had orthostatic hypotension and 15% galactorrhea of idiopathic origin. Patients had a higher than normal anal pressure (P<0.001). They all had a rectoanal inhibitory reflex, but it was abnormal in 76%. In the upper esophageal sphincter, resting pressure was higher (P<0.02), and coordination poorer (P<0.05) than in normal control subjects. Incidence of spontaneous tertiary contractions in the body of the esophagus was greater than normal (P<0.03). In the lower esophageal sphincter, resting pressure was lower (P=0.001) and gastroesophageal gradient weaker (P=0.05). Closing pressure of the sphincter was lower (P<0.001) and coordination less adequate (P<0.02). After subcutaneous injection of 0.035 mg/kg bethanechol, urinary bladder intraluminal pressure increased by over 15 cm H2O in 31% of patients but never did in controls, and average maximal pressure was greater (P<0.025). Time taken to reach peak pressure was shorter (P<0.01). This study provides evidence that patients who suffer from constipation with colonic inertia also have abnormal function in other hollow viscera. The high incidence of extraintestinal symptoms provides further suggestion of the existence of one or more underlying systemic diseases.

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References

  1. Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C: Some parameters of large bowel motility in normal man. Gastroenterology 75:612–618, 1978

    Google Scholar 

  2. Martelli H, Devroede G, Arhan P, Duguay C: Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology 75:623–631, 1978

    Google Scholar 

  3. Arhan P, Devroede G, Jehannin B, Lanza M, Faverdin C, Dornic C, Persoz B, Tetreault L, Perey B, Pellerin D: Segmental colonic transit time. Dis Colon Rectum 24:625–629, 1981

    Google Scholar 

  4. Devroede G: Constipation: Mechanisms and management.In Gastrointestinal Disease Pathophysiology Diagnosis Management. 2nd ed. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, Company, 1978, pp 368–387

    Google Scholar 

  5. Lapides J, Friend CR, Ajemian EP, Reus WF. A new test for neurogenic bladder. J Urol 88:245–247, 1962

    Google Scholar 

  6. Glahn BE: Neurogenic bladder diagnosed pharmacologically on the basis of denervation sensitivity. Scand J Urol Nephrol 4:13–24, 1970

    Google Scholar 

  7. Siegel S: Nonparametric Statistics for the Behavioral Sciences. New York, McGraw-Hill, 1956, pp 64, 104–111

    Google Scholar 

  8. Siegel S: Nonparametric Statistics for the Behavioral Sciences. New York, McGraw-Hill, 1956, pp 96–104

    Google Scholar 

  9. Winer BJ: Statistical Principles in Experimental Design, 2nd ed. New York, McGraw-Hill, 1971, pp 41–44.

    Google Scholar 

  10. Nezelof C, Guy-Grand D, Thonine E: Les mégacôlons avec hyperplasie des plexus myentériques. Une entité anatomoclinique, à propos de 3 cas. Presse Med 78:1501–1506, 1970

    Google Scholar 

  11. Carney JA, Go VL, Sizemore GW, Hayles AB: Alimentary tract ganglioneuromatosis. A major component of the syndrome of multiple endocrine neoplasia, type 2b. N Engl J Med 295:1287–1291, 1976

    Google Scholar 

  12. Carney JA, Hayles AB: Alimentary tract manifestations of multiple endocrine neoplasia, type 2B. Mayo Clin Proc 52:543–548, 1977

    Google Scholar 

  13. Dyer NH, Dawson AM, Smith BF, Todd IP: Obstruction of bowel due to lesion in the myenteric plexus. Br Med J 1:686–689, 1969

    Google Scholar 

  14. Phat VN, Chousterman M, Block F, Petite JP, Camilleri JP: Lésions des plexus myentériques dans la pseudo-obstruction intestinale chronique idiopathique et certaines maladies générales. Ann Anat Path (Paris) 23:131–142, 1978

    Google Scholar 

  15. Hickler RB, Thompson GR, Fox LM, Hamlin JT III: Successful treatment of orthostatic hypotension with 9-alphafluoro-hydrocortisone. N Engl J Med 261:788–791, 1959

    Google Scholar 

  16. Ziegler MG, Lake CR, Kopin IJ: The sympathetic-nervous system defect in primary orthostatic hypotension. N Engl J Med 296:293–297, 1977

    Google Scholar 

  17. Shy GM, Drager GA: A neurological syndrome associated with orthostatic hypotension: A clinical-pathologic study. Arch Neurol 2:511–527, 1960

    Google Scholar 

  18. Caronna JJ, Plum F: Cerebrovascular regulation in preganglionic and postganglionic autonomic insufficiency. Stroke 4:12–19, 1973

    Google Scholar 

  19. Faulk DL, Anuras S, Christensen J: Chronic intestinal pseudo-obstruction. Gastroenterology 74:922–931, 1978

    Google Scholar 

  20. Ogilvie H: Large-intestine colic due to sympathetic deprivation: A new clinical syndrome. Br Med J 2:671–673, 1948

    Google Scholar 

  21. Caves PK, Crockard HA: Pseudo-obstruction of the large bowel. Br Med J 2:583–586, 1970

    Google Scholar 

  22. Wanebo H, Mathewson C, Conolly B: Pseudo-obstruction of the colon. Surg Gyneco Obstet 133:44–48, 1971

    Google Scholar 

  23. Spira IA, Wolff WI: Colonic pseudo-obstruction following termination of pregnancy and uterine operation. Am J Obstet Gynecol 126:7–12, 1976

    Google Scholar 

  24. Bachulis BL, Smith PE: Pseudo-obstruction of the colon. Am J Surg 136:66–72, 1978

    Google Scholar 

  25. Maldonado JE, Gregg JA, Green PA, Brown AL: Chronic idiopathic intestinal pseudo-obstruction. Am J Med 49:203–212, 1970

    Google Scholar 

  26. Moss AA, Goldberg HI, Brotman M: Idiopathic intestinal pseudo-obstruction. Am J Roentgenol 115:312–317, 1972

    Google Scholar 

  27. Philippon MMF, Goujon G: Pseudo-obstruction intestinale chronique idiopathique. Arch Fr Mal Appar Dig 61:145–160, 1972

    Google Scholar 

  28. Lukie BE, Sanders MG: Chronic idiopathic intestinal pseudo-obstruction with malabsorption, a scleroderma-like disorder. Can Med Assoc J 109:1222–1227, 1973

    Google Scholar 

  29. Schuffler MD, Pope CE: Esophageal motor dysfunction in idiopathic intestinal pseudo-obstruction. Gastroenterology 70:677–682, 1976

    Google Scholar 

  30. Schuffler MD, Lowe MD, Bill AH: Studies of idiopathic intestinal psuedo-obstruction. I. Hereditary, hollow visceral myopathy: Clinical and pathological studies. Gastroenterology 73:327–338, 1977

    Google Scholar 

  31. Schuffler MD, Pope CE: Studies of idiopathic intestinal pseudo-obstruction. II. Hereditary hollow visceral myopathy: Family studies. Gastroenterology 73:339–344, 1977

    Google Scholar 

  32. Sullivan MA, Snape WJ, Matarazzo SA, Petrobuki RJ, Jeffries G, Cohen S: Gastrointestinal myoelectrical activity in idiopathic intestinal pseudo-obstruction. N Engl J Med 297:233–238, 1977

    Google Scholar 

  33. Byrne WJ, Cipel L, Euler AR, Halpin TC, Ament ME: Chronic idiopathic intestinal pseudo-obstruction syndrome in children-clinical characteristics and prognosis. Pediatr 90:585–589, 1977

    Google Scholar 

  34. Lipton AB, Knauer CM: Pseudo-obstruction of the bowel. Therapeutic trial of metoclopramide. Am J Dig Dis 22(3):263–265, 1977

    Google Scholar 

  35. Euler AR, Ament ME: Esophageal motor dysfunction in idiopathic pseudo-obstruction. Gastroenterology 71:712, 1977

    Google Scholar 

  36. Bradley WE: Autonomic neuropathy and the genitourinary system. J Urol 119:299–302, 1978

    Google Scholar 

  37. Ellenberg M: Diabetic neurogenic vesical dysfunction. Arch Intern Med 117:348–354, 1966

    Google Scholar 

  38. Goyal RK, Spiro HM: Gastrointestinal manifestations of diabetes mellitus. Med Clin North Am 55:1031–1044, 1971

    Google Scholar 

  39. Dorfman LE, Bailey J, Smith JP: Sub-clinical neurogenic bladder in children. J Urol 101:48–54, 1969

    Google Scholar 

  40. Shopfner CE: Urinary tract pathology associated with constipation. Radiology 90:865–877, 1968

    Google Scholar 

  41. Williams DI, Hirst G, Doyle D: The occult neuropathic bladder. J Pediatr Surg 9(1):35–41, 1974

    Google Scholar 

  42. Mix LW: Occult neuropathic bladder. Urology 10:1–9, 1977

    Google Scholar 

  43. Glahn BE: The neurogenic factor in vesical dysfunction following radical hysterectomy for carcinoma of the cervix. Scand J Urol Nephrol 4:107–116, 1970

    Google Scholar 

  44. Cannon WB, Rosenblueth A: The Supersensitivity of Denervated Structures; A Law of Denervation. New York, Macmillan, 1949

    Google Scholar 

  45. Thompson WS, Heaton KW: Functional bowel disorders in apparently healthy people. Gastroenterology 79:283–288, 1980

    Google Scholar 

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Authors and Affiliations

  1. Centre de recherche en pathophysiologie digestive, départements de Chirurgie générale et d'Urologie, Faculté de Médecine, Université de Sherbrooke, J1H 5N4, Sherbrooke, Québec, Canada

    Alain Watier,  Ghislain Devroede, André Duranceau, Mohamed Abdelrahman, Colette Duguay, Marcelle D. Forand, Léon Tétreault, Pierre Arhan, Jacques Lamarche & Mostafa Elhilali

  2. Department de Chirurgie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada

    Alain Watier,  Ghislain Devroede, André Duranceau, Mohamed Abdelrahman, Colette Duguay, Marcelle D. Forand, Léon Tétreault, Pierre Arhan, Jacques Lamarche & Mostafa Elhilali

  3. Départements de Physiologie et de Chirurgie pédiatrique, Centre Hospitalier Necker-Enfants-Malades, Paris, France

    Alain Watier,  Ghislain Devroede, André Duranceau, Mohamed Abdelrahman, Colette Duguay, Marcelle D. Forand, Léon Tétreault, Pierre Arhan, Jacques Lamarche & Mostafa Elhilali

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  1. Alain Watier
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  2. Ghislain Devroede
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  3. André Duranceau
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  4. Mohamed Abdelrahman
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  5. Colette Duguay
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  6. Marcelle D. Forand
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  7. Léon Tétreault
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  8. Pierre Arhan
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  9. Jacques Lamarche
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  10. Mostafa Elhilali
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Additional information

Partly supported by the following granting agencies: CRM (Canada) (MT-3511); CRL INSERM (77-2-1857); la sous-commission franco-québécoise pour les accords de la santé; le Centre de Recherche Médicale de l'Université de Sherbrooke (CRMUS).

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Watier, A., Devroede, G., Duranceau, A. et al. Constipation with colonic inertia. Digest Dis Sci 28, 1025–1033 (1983). https://doi.org/10.1007/BF01311732

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  • DOI: https://doi.org/10.1007/BF01311732

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