RSS-Feed abonnieren
DOI: 10.1055/s-2008-1075864
Slow Transit Constipation: A Review of a Colonic Functional Disorder
Publikationsverlauf
Publikationsdatum:
29. April 2008 (online)
![](https://www.thieme-connect.de/media/ccrs/200802/lookinside/thumbnails/10.1055-s-2008-1075864-1.jpg)
ABSTRACT
Constipation is a common gastrointestinal complaint that can cause significant physical and psychosocial problems. It has been categorized as slow transit constipation, normal transit constipation, and obstructed defecation. Both the definition and pathophysiology of constipation are unclear, but attempts to describe each of the three types have been made. Slow transit constipation, a functional colonic disorder represents ~15 to 30% of constipated patients. The theorized etiologies are disorders of the autonomic and enteric nervous system and/or a dysfunctional neuroendocrine system. Slow transit constipation can be diagnosed with a complete history, physical exam, and a battery of specific diagnostic studies. Once the diagnosis is affirmed and medical management has failed, there are several treatment options. Biofeedback, sacral nerve stimulation, segmental colectomy, and subtotal colectomy with various anastomoses have all been used. Of those treatment options, a subtotal colectomy with ileorectal anastomosis is the most efficacious with the data to support its use.
KEYWORDS
Constipation - slow transit constipation - colonic inertia - subtotal colectomy
REFERENCES
- 1 Arbuthnot L W. The results of operative treatment of chronic constipation. BMJ. 1908; i 126-130
- 2 Drossman D A, Sandler R S, McKee D C, Lovitz A J. Bowel patterns among patients not seeking health care. Gastroenterology. 1982; 82 529-534
- 3 Drossman D A, Corazziari E, Talley N J, Thompson W G, Whitehead W E. Rome II: The Functional Gastrointestinal Disorders. McLean, VA; Degnon Associates 2000
- 4 Preston D M, Lennard-Jones J E. Severe chronic constipation of young women: ‘idiopathic slow transit constipation’. Gut. 1986; 27 41-48
- 5 Bassotti G, de Roberto G, Sediari L, Morelli A. Toward a definition of colonic inertia. World J Gastroenterol. 2004; 10(17) 2465-2467
- 6 Johanson J. Constipation. Washington, DC; US Department of Health and Human Services, Public Health Service, National Institutes of Health, NIDDK 1994
- 7 Sonnenberg A, Koch T R. Physician visits in the United States for constipation. Dig Dis Sci. 1989; 34 606-611
- 8 Surrenti E, Rath D M, Pemberton J H, Camilleri M. Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol. 1995; 90 1471-1475
- 9 Probert C S, Emmett P M, Cripps H A, Heaton K W. Evidence for the ambiguity of the term constipation: the role of irritable bowel syndrome. Gut. 1994; 35(10) 1455-1458
- 10 Preston D M, Lennard-Jones J E. Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation. Dig Dis Sci. 1985; 30 289-294
- 11 Bassotti G, Chiarioni G, Imbimbo B et al.. Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow transit type) constipation. Dig Dis Sci. 1993; 38(6) 1040-1045
- 12 He C-L, Burgart L, Wang L et al.. Decreased interstitial cells of Cajal volume in patients with slow-transit constipation. Gastroenterology. 2000; 118 14-21
- 13 Bassotti G, Stanghellini V, Chiarioni G et al.. Upper gastrointestinal motor activity in patients with slow-transit constipation. Further evidence for an enteric neuropathy. Dig Dis Sci. 1996; 41(10) 1999-2005
- 14 Camilleri M, Fealey R D. Idiopathic autonomic denervation in 8 patients presenting with functional gastrointestinal disease. A causal association?. Dig Dis Sci. 1990; 35 609-616
- 15 Kerrigan D D, Lucas M G, Sun W M, Donelly T C, Read N W. Idiopathic constipation associated with impaired urethrovesical and sacral reflex function. Br J Surg. 1989; 76 748-751
- 16 Watier A, Devroede G, Duranceau A et al.. Constipation with colonic inertia. A manifestation of systemic disease?. Dig Dis Sci. 1983; 28 1025-1033
- 17 Knowles C H, Scott S M, Lunniss P J. Slow transit constipation: a disorder of pelvic autonomic nerves?. Dig Dis Sci. 2001; 46 389-401
- 18 Roe A M, Bartolo D C, Mortensen N J. Slow transit constipation. Comparison between patients with or without previous hysterectomy. Dig Dis Sci. 1988; 33 1159-1163
- 19 Scott S M, Knowels C H, Newell M, Garvie N, Williams N S, Lunniss P J. Scintigraphic assessment of colonic transit in women with slow-transit constipation arising de novo and following pelvic surgery or childbirth. Br J Surg. 2001; 88 405-411
- 20 Giaroni C, De Ponti F, Cosentino M, Lecchini S, Frigo G. Plasticity in the enteric nervous system. Gastroenterology. 1999; 117 1438-1458
- 21 Lyford G L, He C-L, Soffer E et al.. Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation. Gut. 2002; 51 496-501
- 22 Wong S W, Lubowski D. Slow transit constipation: evaluation and treatment. ANZ J Surg. 2007; 77 320-328
- 23 Hulzinga J D, Thuneberg L, Kluppel M, Malysz J, Mikkelsen B, Bernstein A. W/Kit gene required for interstitial cells of Cajal and intestinal pacemaker activity. Nature. 1995; 373 347-349
- 24 Ward S M, Burns A J, Torihashi S, Sanders K M. Mutation of the proto-oncogene c-kit blocks development of interstitial cells and electrical rhythmicity in murine intestine. J Physiol. 1994; 480 91-97
- 25 Shafik A, Shafik A A, El-Sibai O, Ahmed I. Colonic pacing. A therapeutic option for the treatment of constipation due to total colonic inertia. Arch Surg. 2003; 138 1007-1011
- 26 Bassotti G, Gaburri M, Imbimbo B P et al.. Colonic mass movements in idiopathic chronic constipation. Gut. 1988; 29(9) 1173-1179
- 27 Bassotti G, Chistolini F, Nzepa F S, Morelli A. Colonic propulsive impairment in intractable slow transit constipation. Arch Surg. 2003; 138 1302-1304
- 28 Altomare D F, Portincasa P, Rinaldi M et al.. Slow-transit constipation. Solitary symptom of a systemic gastrointestinal disease. Dis Colon Rectum. 1999; 42 231-240
- 29 El-Salhy M. Chronic idiopathic slow transit constipation: pathophysiology and management. Colorectal Dis. 2003; 5 288-296
- 30 Zhao R, Baig M K, Wexner S D et al.. Enterochromaffin and serotonin cells are abnormal for patients with colonic inertia. Dis Colon Rectum. 2000; 43 858-863
- 31 Zhao R H, Baig M K, Thaler K J et al.. Reduced expression of serotonin receptor(s) in the left colon of patients with colonic inertia. Dis Colon Rectum. 2003; 46 81-86
- 32 Agachan F, Chen T, Pfeifer J, Reissman P, Wexner S D. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996; 39 681-685
- 33 Spiller R. Serotonergic modulating drugs for functional gastrointestinal diseases. Br J Clin Pharmacol. 2002; 54 11-20
- 34 Emmanuel A V, Roy A J, Nicholls T J, Kamm M A. Prucalopride, a systemic enterokinetic, for the treatment of constipation. Aliment Pharmacol Ther. 2002; 16 1347-1356
- 35 Koustsomanis D, Lennard-Jones J E, Kamm M A. Prospective study of biofeedback treatment for patients with slow and normal transit constipation. Eur J Gastroenterol Hepatol. 1994; 6 131-137
- 36 Battaglia E, Serra A M, Buonafede G et al.. Long-term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow-transit constipation. Dis Colon Rectum. 2004; 47 90-95
- 37 Emmanuel A V, Kamm M A. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation. Gut. 2001; 49 214-219
- 38 Wang J, Luo M-H, Qi Q-H, Dong Z-L. Prospective study of biofeedback retraining in patients with chronic idiopathic functional constipation. World J Gastroenterol. 2003; 9 2109-2113
- 39 Chiotakakou-Faliakou E, Kamm M A, Roy A J, Storrie J B, Turner I C. Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut. 1998; 42 517-521
- 40 Brown S R, Donati D, Seow-Choen F, Ho Y-H. Biofeedback avoids surgery in patients with slow-transit constipation: report of four cases. Dis Colon Rectum. 2001; 44 737-740
- 41 Brazzelli M, Murray A, Fraser C. Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol. 2006; 175 835-841
- 42 Kenefick N J, Christiansen J. A review of sacral stimulation for the treatment of faecal incontinence. Colorectal Dis. 2004; 6 75-80
- 43 Kenefick N J, Nicholls R J, Cohen R G, Kamm M A. Permanent sacral nerve stimulation for treatment of idiopathic constipation. Br J Surg. 2002; 89 882-888
- 44 Kenefick N J, Vaizey C J, Cohen R G, Nicholls R J, Kamm M A. Double-blind placebo-controlled crossover study of sacral nerve stimulation for idiopathic constipation. Br J Surg. 2002; 89 1570-1571
- 45 Malouf A J, Wiesel P H, Nicholls T, Nicholls R J, Kamm M A. Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. World J Surg. 2002; 26 166-170
- 46 Dinning P G, Fuentealba S E, Kennedy M L, Lubowski D Z, Cook I J. Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow-transit constipation. Colorectal Dis. 2007; 9 123-132
- 47 Malone P S, Ransley P G, Kiely E M. Preliminary report: the antegrade continence enema. Lancet. 1990; 336 1217-1218
- 48 Rongen M JGM, van der Hoop A G, Baeten C GMI. Cecal access for antegrade colon enemas in medically refractory slow-transit constipation: a prospective study. Dis Colon Rectum. 2001; 44 1644-1649
- 49 Lees N P, Hodson P, Hill J, Pearson R C, MacLennan I. Long-term results of the antegrade continent enema procedure for constipation in adults. Colorectal Dis. 2004; 6 362-368
- 50 Knowles C H, Scott M, Lunniss P J. Outcome of colectomy for slow transit constipation. Ann Surg. 1999; 230 627-638
- 51 Pikarsky A J, Singh J J, Weiss E G, Nogueras J J, Wexner S D. Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum. 2001; 44 179-183
- 52 Glia A, Akerlund J E, Lindberg G. Outcome of colectomy for slow-transit constipation in relation to presence of small-bowel dysmotility. Dis Colon Rectum. 2004; 47 96-102
- 53 Verne G N, Hocking M P, Davis R H et al.. Long-term response to subtotal colectomy in colonic inertia. J Gastrointest Surg. 2002; 6 738-744
- 54 FitzHarris G P, Garcia-Aguilar J, Parker S C et al.. Quality of life after subtotal colectomy for slow-transit constipation: both quality and quantity count. Dis Colon Rectum. 2003; 46 433-440
- 55 Athanasakis H, Tsiaoussis J, Vassilakis J S, Xynos E. Laparoscopically assisted subtotal colectomy for slow-transit constipation. Surg Endosc. 2001; 15 1090-1092
- 56 Ho Y H, Tan M, Eu K W, Leong A, Seow-Choen F. Laparoscopic-assisted compared with open total colectomy in treating slow transit constipation. Aust N Z J Surg. 1997; 67 562-565
- 57 Sarli L, Costi R, Sarli D, Roncoroni L. Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation. Dis Colon Rectum. 2001; 44 1514-1520
- 58 Sarli L, Iusco D, Donadei E et al.. The rationale for cecorectal anastomosis for slow transit constipation. Acta Biol Med (Gdansk). 2003; 74(suppl 2) 74-79
- 59 Marchesi F, Sarli L, Percalli L et al.. Subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of slow-transit constipation: Long-term impact on quality of life. World J Surg. 2007; 31 1658-1664
- 60 Iannelli A, Fabiani P, Mouiel J, Gugenheim J. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation. Surg Endosc. 2006; 20 171-173
- 61 Lundin E, Karlbom U, Pahlman L, Graf W. Outcome of segmental colonic resection for slow-transit constipation. Br J Surg. 2002; 89 1270-1274
- 62 You Y T, Wang J Y, Changchien C R et al.. Segmental colectomy in the management of colonic inertia. Am Surg. 1998; 64 775-777
- 63 Akervall S, Fasth S, Nordgren S, Oresland T, Hulten L. The functional results after colectomy and ileorectal anastomosis for severe constipation (Arbuthnot Lane's disease) as related to rectal sensory function. Int J Colorectal Dis. 1988; 3 96-101
- 64 Pluta H, Bowes K L, Jewell L D. Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum. 1996; 39 160-166
- 65 Mollen R M, Kuijpers H C, Claassen A T. Colectomy for slow-transit constipation: preoperative functional evaluation is important but not a guarantee for a successful outcome. Dis Colon Rectum. 2001; 44 577-580
- 66 Ripetti V, Caputo D, Greco S, Alloni R, Coppola R. Is total colectomy the right choice in intractable slow-transit constipation?. Surgery. 2006; 140 435-440
- 67 Kalbassi M R, Winter D C, Deasy J M. Quality-of-life assessment of patients after ileal pouch-anal anastomosis for slow-transit constipation with rectal inertia. Dis Colon Rectum. 2003; 46 1508-1512
- 68 Keighley M RB, Grobler S, Bain I. An audit of restorative proctocolecotmy. Gut. 1993; 34 680-684
Juan J NoguerasM.D.
Department of Colorectal Surgery, Cleveland Clinic Florida
2950 Cleveland Clinic Blvd., Weston, FL 33331
eMail: noguerj@ccf.org