Small Bowel Dysmotility

Traditional thinking has been that patients with significant small-bowel dysmotility should be excluded from colectomy because recurrent constipation and abdominal pain are likely to occur. Much of this has been speculative, because accurate means of measuring small-bowel transit have been lacking. Radiopaque marker studies measure whole-gut transit (of which colonic transit time forms a large part) and are not useful to assess the small bowel. Barium studies are helpful only when motility is severely affected, causing megaduodenum and grossly delayed small-bowel transit. Gastric emptying studies are probably similarly helpful only to exclude patients from surgery if emptying is markedly abnormal. Small-bowel transit, assessed in the initial phase of an isotope colon transit study,provides a rough measure of small-bowel motility. All of the ingested isotope should reach the cecum after 6 hours, and failure to do so is an indication of delayed small-bowel transit.11 Small-bowel transit time can be calculated using the median position of the column of isotope, but this has not been shown to correlate with outcome after colectomy.

Small-bowel manometry is a relatively simple technique and should be more thoroughly investigated in order to determine which parameters of small-bowel manometry can accurately predict significant extracolonic dysmotility that will lead to failure of surgery. Bassotti et al62 demonstrated that in 21 patients with chronic slow-transit constipation, 71% displayed motor abnormalities of the upper gut. Redmond et al28 examined the outcome of colectomy in patients with colonic inertia (CI) compared with generalized intestinal dysmotility (GID). Twenty-one patients with CI and 16 patients with GID were studied. Upper gastrointestinal studies included esophageal, gastric, and small-bowel manometry and electrogastrogram, upper endoscopy, and small-bowel follow-through series. Ninety percent of CI patients improved at a mean follow-up of 7.5 years, with one patient having recurrent constipation and one patient requiring an ileostomy for diarrhea. At 1 year, 12% of GID patients had recurrent constipation but this increased to 80% at 5 years, and ultimately only 13% had a long-term successful outcome. No CI patients complained of abdominal pain or distention by the fifth year, compared with 70% of the GID patients who had abdominal pain and 20% who had distention.

Another study examined patients with slow-transit constipation and small-bowel involvement, and found a high incidence of postoperative small-bowel obstruction (71%).39 Eighty-six percent of the 21 patients had at least one abnormality of gastrointestinal motility, bladder function, or autonomic function. Symptoms of abdominal pain, bloating, urgency, and straining at defecation continued in the postoperative period. There was also other evidence of smooth-muscle dysfunction in the patients who subsequently developed small-bowel obstruction, with abnormal esophageal motility, delayed gastric emptying, urinary dysfunction, and auto-nomic dysfunction. The authors concluded that only selected patients with no evidence of smooth muscle dysfunction might be expected to benefit from colectomy.

One small study found that defecation frequency after subtotal colectomy in eight patients was closely related to small-bowel transit time, but another study of 21 patients failed to identify a relationship between small-bowel transit measured by lactulose breath hydrogen test and functional results after colectomy.41,59 It is clear that additional work is required in this area.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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