Slow-transit constipation - Solitary symptom of a systemic gastrointestinal disease

被引:52
作者
Altomare, DF [1 ]
Portincasa, P
Rinaldi, M
Di Ciaula, A
Martinelli, E
Amoruso, A
Palasciano, G
Memeo, V
机构
[1] Univ Bari, Sch Med, Policlin, Ist Clin Chirurg, I-70124 Bari, Italy
[2] Univ Bari, Sch Med, Dipartimento Med Interna Lavoro, Cattedra Semeiot Med, I-70124 Bari, Italy
[3] Univ Bari, Sch Med, Cattedra Gastroenterol, I-70124 Bari, Italy
关键词
constipation; colonic inertia; autonomic neuropathy; gastrointestinal motility; stomach; gallbladder motility;
D O I
10.1007/BF02237134
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
INTRODUCTION: Autonomic neuropathy is thought to play a role in the pathogenesis of slow-transit constipation, but other gastrointestinal organs may also be involved, even if they are symptom-free. We investigated whether motility in gastrointestinal organs other than the colon was impaired in patients with slow-transit constipation and a whether the autonomic nervous system was involved. METHODS: Twenty-one consecutive patients (18 females; median age, 46 years) with severe chronic constipation (less than or equal to 2 defecations/ week and delayed colonic transit time) were studied. Autonomic neuropathy function was tested with esophageal manometry, gastric and gallbladder emptying (fasting and postprandial motility) by ultrasonography, orocecal transit time (H-2-breath test), colonic transit time (radiopaque markers), and anorectal volumetric manometry. The integrity of the autonomic nervous system was assessed by a quantitative sweat-spot test for preganglionic and postganglionic fibers, tilt-table test, and Valsalva electrocardiogram R-R ratio. RESULTS: Esophageal manometry showed gastroesophageal reflux or absence of peristalsis in five of the seven patients examined. Gallbladder dysmotility (i.e., increased fasting, postprandial residual volume, or both) was observed in 6 of 14 (43 percent) patients. Gastric emptying was decreased in 13 of 17 (76 percent) patients. Orocecal transit time was delayed in 18 of 20 (90 percent) patients; median transit time was 160 (range, 90-200) minutes. Median colonic transit time was 97 (range, 64-140) hours. Anorectal function showed abnormal rectoanal inhibitory reflex and decreased rectal sensitivity in 11 of 19 (58 percent) patients. Signs of autonomic neuropathy of the sympathetic cholinergic system were found in 14 of 18 (78 percent) patients. Only one of nine patients had vagal abnormalities detected with the Valsalva test and four of five patients with a history of orthostatic hypotension had a positive tilt-table test. CONCLUSIONS: Slow-transit constipation may be associated with impaired function of other gastrointestinal organs. More than 70 percent of patients with slow-transit constipation present some degree of autonomic neuropathy. Severe constipation may be the main complaint in patients with a systemic disease involving several organs and possibly involving the autonomic nervous system. This should be considered in the management of such cases.
引用
收藏
页码:231 / 240
页数:10
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