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Use of high‐resolution colonic manometry to establish etiology and direct treatment in patients with constipation: Case series with correlation to histology
Author(s) -
Li Yuwei,
Cong Jiying,
Fei Fei,
Zhang Zhao,
Yu Yongjun,
Xu Chen,
Zhang Xipeng,
Zhang Shiwu
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14287
Subject(s) - medicine , constipation , anorectal manometry , gastroenterology , etiology , functional constipation , colectomy , rectum , peristalsis , colorectal cancer , cancer
Abstract Background and Aim Different clinical treatments are available to treat patients with constipation. We aimed to study the etiology and direct treatment in a case series of patients with constipation by the use of high‐resolution colonic manometry (HRCM). Methods High‐resolution colonic manometry was used to record the colorectal peristaltic contractions of the entire colon in patients. Based on the results of HRCM, 151 patients with constipation were classified into groups and received different clinical treatment such as a total or subtotal colectomy, local excision, or conservative treatment. Paraffin‐embedded samples obtained after resection were studied using hematoxylin and eosin, as well as immunohistochemical staining. Results All patients underwent HRCM over 24 h. Based on the amplitude, intensity, and trends in peristaltic contractions recorded by HRCM, we observed 117 patients with slow‐transit constipation and 34 with functional outlet obstruction constipation. After an overall evaluation of the results of HRCM and anorectal function, 26, 23, 27, and 75 patients were treated with total colectomy, subtotal colectomy, local excision, and conservative treatment, respectively. Furthermore, histological examination of surgical samples showed vacuolar degeneration of nerve plexuses as well as of the muscularis propria, which also showed fibrosis in its outer layers in patients with constipation. Conclusion Different types of constipation showed different colonic motility patterns and morphological changes in the colonic wall. HRCM plays an important role in the diagnosis and classification of patients with constipation. Furthermore, HRCM can accurately identify the diseased colonic segments and help to choose the appropriate treatment.