Wilkinson-Smith, Victoria;
Scott, Mark;
Menys, Alex;
Wiklendt, Lukasz;
Marciani, Luca;
Atkinson, David;
Sansone, Stefano;
... Spiller, Robin; + view all
(2024)
Combined magnetic resonance imaging, high resolution manometry and a randomised trial of bisacodyl versus hyoscine shows the significance of an enlarged colon in constipation: the RECLAIM study.
Gut
(In press).
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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(HV), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries, questionnaires and underwent oral macrogol(500-1000mL) challenge.Whole gut transit time (WGTT),segmental colonic volumes (CV), MRI-derived motility index (MMI) and chyme movement by ‘tagging’were assessed using MRI and time to defecation after macrogolrecorded. Left colonic HRCM was recorded before and after a 700kcal meal. Patients then proceeded to Part 2: a randomised cross-over study of 10-days bisacodyl 10mg daily versus hyoscine 20mg t.d.s. assessing daily pain and constipation. RESULTS: Part 1: Total CVsmedian(range) were significantly greater in IBS-C [776(595-1033)] and FC [802(633-951)] versus 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 duringHRCM versus HV. Compared to FC, IBS-C patients weremore 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 to 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.
| Type: | Article |
|---|---|
| Title: | Combined magnetic resonance imaging, high resolution manometry and a randomised trial of bisacodyl versus hyoscine shows the significance of an enlarged colon in constipation: the RECLAIM study |
| Open access status: | An open access version is available from UCL Discovery |
| Publisher version: | https://gut.bmj.com/ |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| Keywords: | constipation, MRI, colonic volume, high resolution manometry |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Department of Imaging |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10197205 |
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