Hasler William L, Saad Richard J, Rao Satish S, Wilding Gregory E, Parkman Henry P, Koch Kenneth L, McCallum Richard W, Kuo Braden, Sarosiek Irene, Sitrin Michael D, Semler John R, Chey William D
University of Michigan Health System, Ann Arbor, Michigan, USA.
Am J Physiol Gastrointest Liver Physiol. 2009 Dec;297(6):G1107-14. doi: 10.1152/ajpgi.00136.2009. Epub 2009 Oct 1.
Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to 1) characterize regional differences in colon pressure, 2) relate motor differences in constipation to colon transit, and 3) quantify the role of IBS in altered contractility with constipation. Colon pH and pressure were measured by wireless capsules in 53 healthy and 36 constipated subjects. Numbers of contractions >25 mmHg and areas under curves (AUC) were calculated for colon transit quartiles by time. Constipation was classified as normal transit (<59 h), moderate slow transit (STC) (59-100 h), and severe STC (>100 h). Twelve out of 36 constipated subjects had C-IBS; 24 had functional constipation. Numbers of contractions and AUCs increased from the first to the fourth quartile in health (P < 0.0001). Mean numbers of contractions in constipated subjects were similar to controls. Mean AUCs with normal transit (P = 0.01) and moderate STC (P = 0.004) but not severe STC (P = NS) were higher than healthy subjects. IBS was associated with greater mean numbers of contractions (P = 0.05) and AUCs (P = 0.0006) vs. controls independent of transit. Numbers of contractions increased from the first to fourth quartiles in moderate STC, C-IBS, and functional constipation; AUCs increased from the first to fourth quartiles in all groups (all P < 0.05). In conclusion, colon pressure activity is greater distally than proximally in health. Constipated patients with normal or moderately delayed transit show increased motor activity that is partly explained by IBS. These findings emphasize differential effects on transit and motility in different constipation subtypes.
在健康状态、便秘以及以便秘为主的肠易激综合征（C-IBS）中，结肠局部运动与传输之间的关系尚未得到充分描述。本研究旨在：1）描述结肠压力的区域差异；2）将便秘时的运动差异与结肠传输相关联；3）量化肠易激综合征在便秘时收缩性改变中的作用。通过无线胶囊对53名健康受试者和36名便秘受试者进行结肠pH值和压力测量。按时间计算结肠传输四分位数中收缩压>25 mmHg的次数和曲线下面积（AUC）。便秘分为正常传输（<59小时）、中度传输缓慢（STC）（59 - 100小时）和重度STC（>100小时）。36名便秘受试者中有12名患有C-IBS；24名患有功能性便秘。健康状态下，收缩次数和AUC从第一个四分位数到第四个四分位数增加（P < 0.0001）。便秘受试者的平均收缩次数与对照组相似。正常传输（P = 0.01）和中度STC（P = 0.004）时的平均AUC高于健康受试者，但重度STC时（P =无显著差异）则不然。与对照组相比，无论传输情况如何，肠易激综合征均与更高的平均收缩次数（P = 0.05）和AUC（P = 0.0006）相关。在中度STC、C-IBS和功能性便秘中，收缩次数从第一个四分位数到第四个四分位数增加；所有组的AUC从第一个四分位数到第四个四分位数均增加（所有P < 0.05）。总之，在健康状态下，结肠压力活动远端大于近端。正常或中度传输延迟的便秘患者表现出运动活动增加，部分原因可由肠易激综合征解释。这些发现强调了不同便秘亚型对传输和运动的不同影响。
