The "institutional colon": a frequent colonic dysmotility in psychiatric and neurologic disease

Abstract

Objectives: The true existence of a disease entity termed "institutional colon" has remained controversial. The present study serves to test whether this entity actually exists and how frequently psychiatric and neurologic diseases are associated with colonic dysmotility.

Methods: Using the hospital discharge records of four million US military veterans, we investigated the comorbid occurrence of volvulus, impaction of intestine, constipation, and megacolon with any neurologic or psychiatric disease.

Results: Comorbidity of colonic and neurologic/psychiatric diseases in identical subjects occurred two to three times more often than one would expect from the overall distribution of each group of diseases alone. Presenile dementia and Alzheimer's disease, Parkinson's disease, multiple sclerosis, and quadriplegia were associated significantly with all four colonic diseases. The various forms of schizophrenia coincided mostly with megacolon and constipation. Major depressive disorder was associated only with constipation, but with none of the other colonic diseases.

Conclusion: Psychiatric and neurologic diseases are frequently associated with colonic dysmotility. The association raises the possibility of a pathophysiologic link involving the neuronal control of colonic motility.