Slow-Transit Constipation May Be a Distinct Clinical Entity

Mindy Hung

February 27, 2004

Feb. 27, 2004 — Idiopathic slow-transit constipation (STC) may not be a pure colonic abnormality, but rather a component of a pangastrointestinal tract motility disorder involving several organs, according to the results of a study published in the February issue of the Southern Medical Journal.

Using scintigraphy for the gallbladder and stomach, Alp Gunay, MD, and colleagues from the Haydarpasa Training Hospital in Istanbul, Turkey, found results suggesting that STC should be considered a distinct clinical entity within the spectrum of patients who present with severe constipation.

Investigators examined more than 150 patients with chronic constipation from among 8,476 consecutive patients referred from primary care clinics. Of those 150 patients, the researchers determined that 24 had STC. They included 18 patients for study.

Subjects fulfilled two or more of the 1995 Rome criteria for constipation: (1) two or fewer bowel movements per week at least 25% of the time; (2) sensation of incomplete evacuation at least 25% of the time; (3) lumpy and/or hard stools at least 25% of the time; and (4) straining at defecation at least 25% of the time. They excluded six patients who had organic colonic disease, previous abdominal surgery, systemic metabolic disease, or gallstones.

Colon transit scintigraphy was performed in all patients with chronic idiopathic constipation. The researchers evaluated STC patients for gallbladder and gastric emptying by scintigraphy. Patients did not use oral laxatives or cleansing enemas during the test week, and the investigators did not control patients' diets during the scan period.

Gallbladder dysmotility was observed in 8 (44.4%) of 18 patients. Mean gallbladder ejection fraction was 41.6% ± 13.6% (range, 16.3% - 67.0%). In 9 (50%) of 18 patients, gastric emptying was delayed. Mean time for solid-phase gastric half-emptying was 75 minutes. The investigators observed both gallbladder dysmotility and gastric dysmotility in 5 (27.7%) of 18 patients.

"Our results point to the existence of motility defects of the bladder or stomach, although the presenting complaint was severe constipation," write Dr. Gunay and colleagues.

"Inclusion of the investigation of gallbladder and stomach function in the workup of patients with severe constipation may be beneficial and allow selection of this specific subgroup," the authors write.

South Med J. 2004;97:124-128

Reviewed by Gary D. Vogin, MD