The development of colonic manometry and its clinical application in children with colonic dysmotility / 中华实用儿科临床杂志

Colonic dysmotility is a common gastrointestinal motility disease in children, with the main manifestations of abdominal distension and constipation.Colonic manometry is currently considered as a standard diagnostic method for assessing colonic motility, which real-time measures intracolonic pressure and the shape and coordination of colonic muscle pressure waves at rest and stimulating states and thus qualitatively and quantitatively assess the colonic movement.Recently, high-resolution colonic manometry has been rapidly developed into a major technique for obtaining more effective information involved in the physiology and/or pathophysiology of colonic contractile activity in colonic dysmotility patients.This review focuses on the development of colonic manometry and its clinical application in children with colonic dysmotility.

Study on the intestinal motility characteristics of 225 patients with different subtypes of constipation based on high-resolution colon manometry / 中华消化杂志

Objective:To compare the results of high-resolution colonic manometry (HRCM) in patients with four subtypes of constipation: slow transit constipation(STC), outlet obstruction constipation (OOC), mixed STC and OOC, and normal transit constipation(NTC), and to explore the intestinal motility characteristics of patients with different subtypes of constipation.Methods:From 20th January 2017 to 20th September 2020, the HRCM results of 225 patients with functional constipation who visited the Department of Anorectal Surgery of Tianjin Union Medical Center were retrospectively analyzed. According to the results of colonic transit test, 225 patients were divided into STC group (108 cases), OOC group (36 cases), mixed group (28 cases) and NTC group (53 cases). General information such as Wexner constipation scores, clinical symptoms (decreased desire to defecate, sensation of anorectal blockage, hand-assisted defecation, spontaneous bowel movements frequency<3 times per week), the incidence, frequency within one day (hereinafter referred to as frequency), average velocity, average wave amplitude, average duration of contraction, average length of contraction, and the dynamic index (DI) of average pressure of high-amplitude propagating contraction (HAPC), as well as the frequency, average wave amplitude, average duration of contraction, and the DI of average pressure of low-amplitude propagating contraction (LAPC) were compared among the four groups. One-way ANOVA and multiple comparison, Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:The Wexner constipation scores of the STC, OOC, mixed and NTC group were 13.17±4.04, 13.97±4.55, 11.36±4.03 and 11.58±4.06, respectively, and the difference was statistically significant ( F=3.879, P<0.05). The Wexner consipation scores of the STC and OOC group were both higher than the mixed and NTC group, and the difference were statistically significant (One-way ANOVA and multiple comparison, all P<0.05). The proportion of decreased desire to defecate, sensation of anorectal blockage, hand-assisted defecation, spontaneous bowel movements frequency<3 times per week of STC, OOC, mixed and NTC group were 47.2% (51/108), 36.1% (13/36), 14.3% (4/28), 20.8% (11/53); 42.6% (46/108), 75.0% (27/36), 46.4% (13/28), 64.2% (34/ 53); 31.5% (34/108), 38.9% (14/36), 3.6% (1/28), 18.9% (10/53); 90.7% (98/108), 77.8% (28/36), 82.1% (23/28) and 62.3% (33/53), and the differences were statistically significant ( χ2=17.093, 12.463, 13.437 and 18.927; all P<0.01). The proportion of decreased desire to defecate of STC group was higher than that of mixed and NTC group, and spontaneous bowel movements frequency<3 times per week was higher than that of OOC and NTC group, and the differences were statistically significant ( χ2=10.014, 10.518, 4.418 and 19.016; all P<0.05). The proportion of sensation of anorectal blockage of OOC group was higher than that of STC and mixed group, and the proportion of hand-assisted defecation was higher than that of the mixed and NTC group, and the differences were statistically significant ( χ2= 9.511, 5.486, 10.948 and 4.363, all P<0.05). The incidence of HAPC in STC, OOC, mixed and NTC groups was 39.8% (43/108), 36.1% (13/36), 57.1% (16/28), and 60.4% (32/53), respectively, and the difference was statistically significant ( χ2=8.880, P=0.031). The incidence of HAPC in STC group and OOC group were lower than that of NTC group, and the differences were statistically significant ( χ2=6.041 and 5.050, P=0.014 and 0.025). There were no statistically significant difference in the frequency, average velocity, average amplitude, average duration of contraction, average length of contraction and DI of pressure of HAPC in four groups, and there were no statistically significant difference in the frequency, average amplitude, average duration of contraction, and DI of pressure of LAPC in the four groups (all P>0.05). Conclusions:Doctors can more clearly and objectively observe the intestinal motility characteristics of patients with different subtypes of constipation through HRCM. HRCM provides a strong basis for the diagnosis and further treatment of functional constipation, and has a high clinical application value.

Does the Oral-Anal Transit Test Correlate with Colonic Manometry Findings in Children with Refractory Constipation? / 대한소아소화기영양학회지

PURPOSE: The Oral-anal Transit Test (OTT) is a simple method of obtaining information about colonic transit. We aim to assess the correlation of OTT with the neuromuscular integrity of the colon determined by colonic manometry (CM).METHODS: All patients who had OTT followed by CM were evaluated. Less than 6 of 24 markers remaining on OTT was considered normal. CM was performed per previously published guidelines. A normal CM was defined as at least one High Amplitude Propagating Contraction progressing from the most proximal sensor through the sigmoid colon.RESULTS: A total of 34 patients underwent both OTT and CM (44% male, age 4–18 years, mean 11.5 years, 97% functional constipation +/− soiling, Hirschsprung's Disease). Of normal and abnormal OTT patients, 85.7% (6/7) and 18.5% (5/27) respectively had normal CM. When all markers progressed to at least the sigmoid colon, this was 100% predictive against colonic inertia. Greater than 50% of patients with manometric isolated sigmoid dysfunction had markers proximal to the recto-sigmoid.CONCLUSION: OTT and CM are both valuable studies that assess different aspects of colonic function. OTT can be used as a screening test to rule out colonic inertia. However, the most proximal extent of remaining markers does not predict the anatomical extent of the manometric abnormality, particularly in isolated sigmoid dysfunction.

Postprandial Colonic Motor Activity in Patients with Irritable Bowel Syndrome / 대한소화관운동학회지

BACKGROUND/AIMS: The purpose of this study was to discover the physiologic difference of a postprandial motor response in different segments of the colon between patients with irritable bowel syndrome and healthy subjects. METHODS: Irritable bowel syndrome patients are categorized into three groups according to their main symptoms; loose stool-dominant (A, n=5), abdominal pain-dominant (B, n=5), constipation-dominant (C, n=6) and the normal control group (n=5). The intraluminal pressure activity was measured with a colonoscopically positioned multilumen manometric catheter. The change of the colonic motility index (MI) is presented as a percent change (mean+/-SE%) over the basal period in response to a meal. RESULTS: 1) In the transverse, descending and sigmoid colon of healthy subjects, the percentage changes in the basal MI during the first 30 min after the meal are significantly increased (p < 0.05-0.01). 2) In the sigmoid colon, the percentage changes in the basal MI during the first 30 min after the meal were 62+/-18 in A, 29+/-18 in B, 12+/-8 in C and 306+/-102% in heathy subjects respectively, which shows a significant difference between the MI of control and healthy subjects (p < 0.05). 3) In B and C, the percentage changes in the basal MI during the first 30 min after the meal in the descending colon were 105+/-38, 11+/-7, respectively, which shows a significant difference between the two groups (p < 0.05). In A and C, the percentage changes in the basal MI during the first 30 min after the meal in the sigmoid colon was 62+/-18, 12+/-8, respectively, which shows a significant change between the two groups (p < 0.05). CONCLUSION: This study suggests that postprandial intraluminal pressure differences play a role in the pathophysiology of irritable bowel syndrome.