Colonic Transit Time and Gut Peptides in Adult Patients with Slow and Normal Colonic Transit Constipation

Abstract

Purpose: To investigate whether pathophysiological differences exist among healthy controls (HC) and patients with slow and normal transit constipation (STC and NTC), we evaluated (1) gastrointestinal (GI) symptoms using validated questionnaires; (2) circulating concentrations of neurotensin, motilin, corticotrophin-releasing factor (CRF), and somatostatin; and (3) possible differences in frequency distribution of the neurotensin rs1800832 A/G and Neurotensin Receptor 1 rs6090453 C/G SNPs.

Methods: Fifty-one patients with severe functional constipation and 20 HC completed the study. Symptoms were evaluated by GSRS and Constipaq scoring system. Plasma concentrations of GI peptides were evaluated by ELISA on fasting and six sequential blood samples after a standard meal. Genotyping was performed by PCR and endonuclease digestion.

Results: Symptom profiles largely overlapped between NTC and STC patients. As for peptide profiles, neurotensin showed lower concentrations at 60 and 90 min in STC versus HC, and motilin showed throughout the curve 85% and 82% lower levels in STC than HC and NTC, respectively. Finally, neurotensin polymorphism resulted in being associated with the peptide levels.

Conclusions: Symptom profile is not a reliable tool to discriminate STC, whilst the GI peptide profiles might help in identifying it.

Figure 1

The flow of participants through the study.

Figure 2

The figure plots the serial changes in the GI peptide concentrations in healthy controls (HC) and constipated patients with normal transit constipation (NTC) and slow transit constipation (STC) recorded at baseline and every 30 minutes up to 180 minutes following meal administration. Data reported as median and the 25th–75th percentile. Each sample time was analysed by Kruskal-Wallis and Dunn's multiple comparison test (^∗STC versus HC, ^§STC versus NTC, p < 0.05).