Wilkinson-Smith, Victoria (V);Scott, Mark (M);Menys, Alex (A);Wiklendt, Lukasz (L);Marciani, Luca (L);Atkinson, David (D);Sansone, Stefano (S);Zdanaviciene, Ausra (A);Coupland, Carol (C);Knowles, Charles H (CH);Dinning, Philip (P);Taylor, Stuart A (SA);Gowland, Penny (P);Hoad, Caroline Louise (CL);Corsetti, Maura (M);Spiller, Robin C (RC);

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Gut.2024 Dec 10;74(1):35-44.doi:10.1136/gutjnl-2024-332755

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.