Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2016 Jun;28(6):861-70.
doi: 10.1111/nmo.12784. Epub 2016 Feb 12.

Colonic response to laxative ingestion as assessed by MRI differs in constipated irritable bowel syndrome compared to functional constipation

C Lam  1 , G Chaddock  2 , L Marciani  1 , C Costigan  1 , J Paul  2 , E Cox  2 , C Hoad  1   2 , A Menys  3 , S Pritchard  2 , K Garsed  4 , S Taylor  3 , D Atkinson  3 , P Gowland  2 , R Spiller  1
Affiliations
Clinical Trial

Colonic response to laxative ingestion as assessed by MRI differs in constipated irritable bowel syndrome compared to functional constipation

C Lam et al. Neurogastroenterol Motil. 2016 Jun.

Abstract

Background: Functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) share many symptoms but underlying mechanisms may be different. We have developed a magnetic resonance imaging (MRI) technique to measure intestinal volumes, transit, and motility in response to a laxative, Moviprep(®) . We aim to use these biomarkers to study the pathophysiology in IBS-C and FC.

Methods: Twenty-four FC and 24 IBS-C were studied. Transit was assessed using the weighted average position score (WAPS) of five MRI marker pills, taken 24 h before MRI scanning. Following baseline scan, participants ingested 1 L of Moviprep(®) followed by hourly scans. Magnetic resonance imaging parameters and bowel symptoms were scored from 0 to 4 h.

Key results: Weighted average position score for FC was 3.6 (2.5-4.2), significantly greater than IBS-C at 2.0 (1.5-3.2), p = 0.01, indicating slower transit for FC. Functional constipation showed greater fasting small bowel water content, 83 (63-142) mL vs 39 (15-70) mL in IBS-C, p < 0.01 and greater ascending colon volume (AC), 314 (101) mL vs 226 (71) mL in IBS-C, p < 0.01. FC motility index was lower at 0.055 (0.044) compared to IBS-C, 0.107 (0.070), p < 0.01. Time to first bowel movement following ingestion of Moviprep(®) was greater for FC, being 295 (116-526) min, compared to IBS-C at 84 (49-111) min, p < 0.01, and correlated with AC volume 2 h after Moviprep(®) , r = 0.44, p < 0.01. Using a cut-off >230 min distinguishes FC from IBS-C with low sensitivity of 55% but high specificity of 95%.

Conclusion & inferences: Our objective MRI biomarkers allow a distinction between FC and IBS-C.

Keywords: colon; functional constipation; irritable bowel syndrome with constipation; laxative; motility.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Three‐dimensional segmented colon from (A) a healthy control giving a total colonic volume of 383 mL and (B) a functional constipation patient giving a total colonic volume of 1244 mL.
Figure 2
Figure 2
Small bowel water content (SBWC) in the functional constipation (FC) and irritable bowel syndrome with constipation (IBS‐C) patient groups during the initial 2 h of the study. The baseline scan is at time −60 min and the arrow shows the start of Moviprep® ingestion. Time 0 is time of completion of Moviprep® ingestion. Small bowel water content rose significantly over time for FC. FC patients had significant elevated fasting SBWC at baseline (time −60 min); p < 0.01, Time 0 after completion of Moviprep®; p < 0.01 and 1 h after completion of Moviprep®; p = 0.03, compared to IBS‐C.
Figure 3
Figure 3
Ascending colon volumes in functional constipation (FC) and irritable bowel syndrome with constipation (IBS‐C) patients were 314 (101) and 597 (170) mL for FC, and 226 (71) mL and 389 (169) mL for IBS‐C at baseline and 120 min after the start of Moviprep® ingestion, respectively. Both fasting and 120‐min values for FC were significantly greater than IBS‐C, both p < 0.01.
Figure 4
Figure 4
Total colonic volumes over time for functional constipation (FC) and irritable bowel syndrome with constipation (IBS‐C) patients. The time is from completion of Moviprep® ingestion. As can be seen, total colon volumes peaked at 60 min. Two‐way anova showed a significant difference both over time (p < 0.01) and between groups (p < 0.01), with significantly higher values for FC. The interaction effect was significant at p < 0.01.
Figure 5
Figure 5
Motility of the ascending colon for functional constipation (FC) and irritable bowel syndrome with constipation (IBS‐C) patients during the study day. Motility for IBS‐C rapidly rose from baseline and peaked at 120 min from the start of Moviprep® ingestion when the motility for IBS‐C was significantly elevated at 0.107 (0.070) compared to FC 0.055 (0.044), p < 0.01.
See this image and copyright information in PMC

References

    1. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 2004; 99: 750–9. - PubMed
    1. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther 2007; 25: 599–608. - PubMed
    1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006; 130: 1480–91. - PubMed
    1. Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, von Korff M, Whitehead WE. Inability of the Rome III criteria to distinguish functional constipation from constipation‐subtype irritable bowel syndrome. Am J Gastroenterol 2010; 105: 2228–34. - PMC - PubMed
    1. Rao SS, Sadeghi P, Beaty J, Kavlock R. Ambulatory 24‐hour colonic manometry in slow‐transit constipation. Am J Gastroenterol 2004; 99: 2405–16. - PubMed

MeSH terms