Zhang Mei, Yang Shuang, Li Xiao-Cui, Zhu Hong-Ming, Peng Ding, Li Bang-Yi, Jia Tian-Xu, Tian Chen
Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
World J Gastroenterol. 2021 Mar 21;27(11):1055-1063. doi: 10.3748/wjg.v27.i11.1055.
Constipation is one of the most important nonmotor symptoms in Parkinson's disease (PD) patients, and constipation of different severities is closely related to the pathogenesis of PD. PD with constipation (PDC) is considered a unique type of constipation, but its mechanism of formation and factors affecting its severity have been less reported. Understanding the gastrointestinal motility characteristics and constipation classification of PDC patients is essential to guide the treatment of PDC. In this study, the colonic transit test and high-resolution anorectal manometry were used to identify the intestinal motility of PDC to provide a basis for the treatment of PDC.
To investigate the clinical classification of PDC, to clarify its characteristics of colonic motility and rectal anal canal pressure, and to provide a basis for further research on the pathogenesis of PDC.
Twenty PDC patients and 20 patients with functional constipation (FC) who were treated at Xuanwu Hospital of Capital Medical University from August 6, 2018 to December 2, 2019 were included. A colonic transit test and high-resolution anorectal manometry were performed to compare the differences in colonic transit time, rectal anal canal pressure, and constipation classification between the two groups.
There were no statistically significant differences in sex, age, body mass index, or duration of constipation between the two groups. It was found that more patients in the PDC group exhibited difficulty in defecating than in the FC group, and the difference was statistically significant. The rectal resting pressure, anal sphincter resting pressure, intrarectal pressure, and anal relaxation rate in the PDC group were significantly lower than those in the FC group. The proportion of paradoxical contractions in the PDC group was significantly higher than that in the FC group. There was a statistically significant difference in the type composition ratio of defecatory disorders between the two groups ( < 0.05). The left colonic transit time, rectosigmoid colonic transit time (RSCTT), and total colonic transit time were prolonged in PDC and FC patients compared to normal values. The patients with FC had a significantly longer right colonic transit time and a significantly shorter RSCTT than patients with PDC ( < 0.05). Mixed constipation predominated in PDC patients and FC patients, and no significant difference was observed.
Patients with PDC and FC have severe functional dysmotility of the colon and rectum, but there are certain differences in segmental colonic transit time and rectal anal canal pressure between the two groups.
便秘是帕金森病（PD）患者最重要的非运动症状之一，不同严重程度的便秘与PD的发病机制密切相关。帕金森病合并便秘（PDC）被认为是一种独特类型的便秘，但其形成机制及影响其严重程度的因素报道较少。了解PDC患者的胃肠动力特征及便秘分类对于指导PDC的治疗至关重要。本研究采用结肠传输试验和高分辨率肛门直肠测压来明确PDC的肠道动力情况，为PDC的治疗提供依据。
探讨PDC的临床分类，阐明其结肠动力及直肠肛管压力特征，为进一步研究PDC的发病机制提供依据。
纳入2018年8月6日至2019年12月2日在首都医科大学宣武医院就诊的20例PDC患者和20例功能性便秘（FC）患者。进行结肠传输试验和高分辨率肛门直肠测压，比较两组患者的结肠传输时间、直肠肛管压力及便秘分类的差异。
两组患者在性别、年龄、体重指数或便秘病程方面无统计学显著差异。发现PDC组排便困难的患者比FC组更多，差异有统计学意义。PDC组的直肠静息压、肛门括约肌静息压、直肠内压及肛门松弛率均显著低于FC组。PDC组反常收缩的比例显著高于FC组。两组排便障碍类型构成比有统计学显著差异（<0.05）。与正常值相比，PDC和FC患者的左半结肠传输时间及直肠乙状结肠传输时间（RSCTT）和全结肠传输时间均延长。FC患者的右半结肠传输时间显著长于PDC患者，RSCTT显著短于PDC患者（<0.05）。PDC患者和FC患者均以混合型便秘为主，未观察到显著差异。
PDC患者和FC患者均存在严重的结肠和直肠功能运动障碍，但两组在节段性结肠传输时间和直肠肛管压力方面存在一定差异。
