Upper gut dysmotility in slow-transit constipation: is it evidence for a pan-enteric neurological deficit in severe slow transit constipation?

Although constipation is common only a small fraction meet the criteria of slow transit constipation. Those that do are resistant to treatment and present a significant clinical problem to the physician and surgeon. Evidence has been accumulating over many years that the impaired colonic motility is part of a generalized motility defect. There are several reports of oesophageal dysmotility, delayed gastric emptying and slow small bowel transit. These abnormalities are not secondary to a distended colon since they are still seen after colonic cleansing and even after colectomy. The manometric abnormalities of small bowel motility are hard to assess unless done over a prolonged period (24 h) because of the great variability observed. The clinical picture of slow transit constipation is quite different from chronic intestinal pseudo-obstruction and the manometric abnormalities are much less obvious. The possibility of an underlying autonomic disturbance warrants further study.