How to perform and assess colonic manometry and barostat study in chronic constipation

Abstract

Management of chronic constipation with refractory symptoms can be challenging. Although new drugs and behavioral treat-ments have improved outcome, when they fail, there is little guidance on what to do next. At this juncture, typically most doc-tors may refer for surgical intervention although total colectomy is associated with morbidity including complications such as recurrent bacterial overgrowth. Recently, colonic manometry with sensory/tone/compliance assessment with a barostat study has been shown to be useful. Technical challenges aside, adequate preparation, and appropriate equipment and knowledge of co-lonic physiology are keys for a successful procedure. The test itself appears to be safe with little complications. Currently, colon-ic manometry is usually performed with a 6-8 solid state or water-perfused sensor probe, although high-resolution fiber-optic colonic manometry with better spatiotemporal resolutions may become available in the near future. For a test that has evolved over 3 decades, normal physiology and abnormal findings for common phenotypes of chronic constipation, especially slow transit constipation, have been well characterized only recently largely through the advent of prolonged 24-hour ambulatory colonic manometry studies. Even though the test has been largely restricted to specialized laboratories at the moment, emerg-ing new technologies and indications may facilitate its wider use in the near future.(J Neurogastroenterol Motil 2014;20:547-552).

Keywords: Barostat; Colon; Constipation; Manometry.

Figure 1.

Colonic manometry assembly (A) and abdominal X-ray (B) showing typical location of sensors after placement.

Figure 2.

A 24-hour profile of mean area under the curve of colonic pressure waves in a healthy subject and in a constipated patient with colonic neuropathy. Note the marked impairment in meal-induced gastrocolonic response and waking response but a preserved diurnal variation in the patient.

Figure 3.

Manometric patterns of (A) normal, (B) colonic myopathy and (C) colonic neuropathy in slow transit constipation.