Abnormalities of upper gut motility in patients with slow-transit constipation

Objective To further delineate motor activity of the upper gastrointestinal tract in patients with slow-transit constipation. Design A prospective study comparing healthy volunteers with patients with a clinical diagnosis of slow-transit constipation, Methods Eighteen patients with clinical diagnosis of slow-transit constipat ion and 10 healthy controls were included in the study. Fasting antroduoden al motility was measured by perfusion manometry for at least one complete c ycle of the migrating motor complex or a maximum of 300 min. Oesophageal ma nometry, gastric emptying and orocaecal transit time measurements were also performed. Results At least one complete cycle of the migrating motor complex was obse rved in all controls, but in only nine patients (P < 0.01 versus control), The migrating motor complex cycle was incomplete (n = 5) or phase 3 activit y was absent (n = 4) in the other patients, The incidence of clustered cont ractions was significantly increased in slow-transit constipation (P = 0.05 versus controls). The area under the contraction curve during late phase 2 (1509 +/- 296 mmHg.s) in patients with a complete cycle was significantly smaller than that in controls (2997 +/- 614 mmHg s; P = 0.05), Orocaecal tr ansit time was not significantly different among patients and controls, but oesophageal motility was abnormal in five of 18 patients and gastric empty ing was abnormal in eight of 15 patients. Conclusion Abnormalities of upper gut motility occur frequently in patients with slow-transit constipation, Interdigestive antroduodenal motility is c haracterized by (i) absence or prolonged duration of the migrating motor co mplex, (ii) an increased number of clustered contractions, or (iii) a decre ased motility during late phase 2 of the migrating motor complex. Eur J Gas troenterol Hepatol 11:701-708. (C) 1999 Lippincott Williams & Wilkins.