dc.description.abstract | Introduction
Our knowledge of normal human colonic motility remains incomplete. Historically,
this has been due to the relative inaccessibility of this organ for study, and the lack of
standardisation of methods used to investigate it. Recent device development has
provided us with advanced tools by which to assess colonic motility, namely
pancolonic manometry, and the wireless motility capsule (WMC).
Using traditional diagnostic tests, a subgroup of patients presenting with severe
intractable symptoms, but without organic disease, are found to have slow transit
constipation (STC). This is believed to be primarily due to colonic dysmotility, although
colonic motor functions remain poorly understood in this group also.
Aims
The principal aims of this thesis were to:
(1) explore the effect of pancolonic manometric recording technique on colonic
motility;
(2) describe pancolonic motility in STC, compared to healthy control subjects;
(3) using the wireless motility capsule (WMC), validate the precise location of the
pH fall around the ileo-caecal junction as a landmark for measuring colonic
motility;
(4) obtain normative data for colonic motility (transit and contractility) and
intraluminal pH in a large cohort of healthy volunteers using the WMC, and
compare this to patients with STC.
Methods
The following methods were used:
(1) prolonged pancolonic manometry in healthy volunteers and patients with STC;
(2) a dual scintigraphic technique, involving radioactive-labelling of the WMC in
healthy volunteers;
(3) wireless motility capsule studies of colonic motility in healthy volunteers and in
patients with STC.
Results
Colonic manometric recording technique (bowel preparation or not, and different
catheter types) significantly influences some characteristics of propagating sequence
(PS) activity, including frequency, amplitude, polarity, relationship between
consecutive PSs, and circadian rhythm.
Patients with STC display dysregulated colonic motor function represented by
disorganised spatiotemporal patterning and loss of ‘regional linkage’ among PSs.
The fall in pH measured by the WMC was confirmed to be either in the caecum,
ascending colon, or as the capsule moved from the caecum to the ascending colon.
Using the WMC, the upper limit of normal colonic transit time (CTT) was found to be
51 h; however, CTT is not a continuous variable and exhibits peaks every 24 h. CTT
is significantly prolonged in females and affected by the study protocol employed. In
patients with STC, colonic contractility (motility index) is increased in comparison
with healthy controls, and intraluminal pH is more acidic in the proximal colon, and
more alkaline in the distal colon.
Conclusions
The method of pancolonic manometry requires standardisation. However, novel
metrics derived from prolonged pancolonic recordings have improved our
understanding of the physiology of colonic motor function in health, and also
pathophysiology in constipation. The WMC provides an alternative, less invasive
method to investigate colonic motility; this technique also requires standardisation,
but early results in patients with STC complement those from manometry, and also
reveal alterations in intraluminal pH that may be of pathophysiological significance. | en_US |