Combined MRI, high-resolution manometry and a randomised trial of bisacodyl versus hyoscine show the significance of an enlarged colon in constipation: the RECLAIM study Gut. 2024 Oct 22:gutjnl-2024-332755. doi: 10.1136/gutjnl-2024-332755. Online ahead of print. Victoria Wilkinson-Smith 1 2, Mark Scott 3, Alex Menys 4, Lukasz Wiklendt 5, Luca Marciani 6 7, David Atkinson 8, Stefano Sansone 9, Ausra Zdanaviciene 10, Carol Coupland 11, Charles H Knowles 12, Philip Dinning 13, Stuart A Taylor 14, Penny Gowland 2 15, Caroline Louise Hoad 2 15, Maura Corsetti 2 16, Robin C Spiller 17 18 |
Author information 1School of Medicine, University of Nottingham, Nottingham, UK. 2NIHR Nottingham Biomedical Research Centre, Nottingham, UK. 3Academic Surgical Unit, Barts and The London School of Medicine and Dentistry, London, UK. 4Motilent Ltd, London, UK. 5College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia. 6Translational Medical Sciences, Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK. 7Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham, UK. 8Centre for Medical Imaging, UCL, London, UK. 9Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. 10Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK. 11Centre for Academic Primary Care, University of Nottingham, Nottingham, UK. 12Blizzard Institute, Queen Mary University, London, UK. 13Gastroenterology and Surgery, Flinders Medical Center, Adelaide, South Australia, Australia. 14Imaging Department, University College London Hospitals NHS Foundation Trust, London, UK. 15Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, UK. 16Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK. 17Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham, UK robin.spiller@nottingham.ac.uk. 18Translational Medical Science, University of Nottingham, Nottingham, UK. Abstract Background: Colonic motility in constipation can be assessed non-invasively using MRI. Objective: To compare MRI with high-resolution colonic manometry (HRCM) for predicting treatment response. Design: Part 1: 44 healthy volunteers (HVs), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries and questionnaires and underwent oral macrogol (500-1000 mL) challenge. Whole gut transit time (WGTT), segmental colonic volumes (CV), MRI-derived Motility Index and chyme movement by 'tagging' were assessed using MRI and time to defecation after macrogol recorded. Left colonic HRCM was recorded before and after a 700 kcal meal. Patients then proceeded to Part 2: a randomised cross-over study of 10-days bisacodyl 10 mg daily versus hyoscine 20 mg three times per day, assessing daily pain and constipation. Results: Part 1: Total CVs median (range) were significantly greater in IBS-C (776 (595-1033)) and FC (802 (633-951)) vs HV (645 (467-780)), p<0.001. Patients also had longer WGTT and delayed evacuation after macrogol. IBS-C patients showed significantly reduced tagging index and less propagated pressure wave (PPW) activity during HRCM versus HV. Compared with FC, IBS-C patients were more anxious and reported more pain. Abnormally large colons predicted significantly delayed evacuation after macrogol challenge (p<0.02), impaired manometric meal response and reduced pain with bisacodyl (p<0.05).Part 2: Bisacodyl compared with hyoscine increased bowel movements but caused more pain in both groups (p<0.03). Conclusion: An abnormally large colon is an important feature in constipation which predicts impaired manometric response to feeding and treatment responses. HRCM shows that IBS-C patients have reduced PPW activity. Trial registration number: The study was preregistered on ClinicalTrials.gov, Reference: NCT03226145. |
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