Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Division of Gastroenterology-Hepatology, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands.
Int J Colorectal Dis. 2019 Oct;34(10):1819-1822. doi: 10.1007/s00384-019-03376-1. Epub 2019 Aug 31.
Colonic manometry (CM) can be of additive value in the diagnostic workup of colonic motility in chronic constipated patients. However, it is claimed that colonic motor disturbances occur in normal-transit constipation (NTC) and slow-transit (STC) constipation, as measured using a radio-opaque marker study, and therefore, the relationship between colonic motor disturbances on CM and colonic transit time (CTT) remains unclear. Our aim was to compare results from colonic marker study with the outcome of CM in patients with treatment-refractory chronic constipation (CC).
Eighty-seven CC patients and 12 healthy volunteers, undergoing both a CTT study and a 24-h CM in a Dutch tertiary referral center, were included. CTT was measured using radio-opaque markers (X-ray at day 4 after ingestion of 20 markers at day 0). CM was performed using a catheter with 6 solid-state pressure sensors, endoscopically clipped to the mucosa in the right colon. CM was defined as normal when at least three high-amplitude propagating contractions (HAPCs), i.e., propagating waves with amplitude ≥ 80 mmHg over at least three sensors, were identified.
In total, 70 patients showed STC on CTT, of which 21 (30%) showed normal CM. All 17 NTC patients and healthy volunteers showed normal CM. The negative predictive value of CTT for normal CM was 100%.
Colonic manometry should be considered in therapy-refractory STC patients in order to further delineate colonic motility. However, in this exploratory study, for patients presenting with NTC on a radio-opaque marker study, colonic manometry does not appear to have added value.
结肠测压（CM）在慢性便秘患者的结肠运动功能诊断中具有附加价值。然而，据报道，在正常传输型便秘（NTC）和慢传输型便秘（STC）中，使用不透射线标志物研究可以测量到结肠运动障碍，因此 CM 上结肠运动障碍与结肠通过时间（CTT）之间的关系尚不清楚。我们的目的是比较难治性慢性便秘（CC）患者的结肠标志物研究结果与 CM 的结果。
87 例 CC 患者和 12 例健康志愿者在荷兰一家三级转诊中心同时进行 CTT 研究和 24 小时 CM 检查。CTT 是通过放射性不透射线标志物（第 0 天摄入 20 个标志物后第 4 天 X 射线）测量的。CM 使用带有 6 个固态压力传感器的导管进行，在内镜下夹在右结肠的黏膜上。CM 定义为至少识别出三个高振幅传播收缩（HAPC），即至少三个传感器上的振幅≥80mmHg 的传播波。
总共 70 例患者的 CTT 显示为 STC，其中 21 例（30%）的 CM 正常。所有 17 例 NTC 患者和健康志愿者的 CM 均正常。CTT 对正常 CM 的阴性预测值为 100%。
对于难治性 STC 患者，应考虑结肠测压以进一步描绘结肠运动。然而，在这项探索性研究中，对于在不透射线标志物研究中出现 NTC 的患者，结肠测压似乎没有额外的价值。
