Pancolonic spatiotemporal mapping reveals regional deficiencies in, and disorganization of colonic propagating pressure waves in severe constipation

Background: The morphology, motor responses and spatiotemporal organization among colonic propagating sequences (PS) have never been defined throughout the entire colon of patients with slow transit constipation (STC). Utilizing the technique of spatiotemporal mapping, we aimed to demonstrate 'manometric signatures' that may serve as biomarkers of the disorder. Methods: In 14 female patients with scintigraphically confirmed STC, and eight healthy female controls, a silicone catheter with 16 recording sites spanning the colon at 7.5-cm intervals was positioned colonoscopically with the tip clipped to the cecum. Intraluminal pressures were recorded for 24-h. Key Results: Pan-colonic, 24-h, spatiotemporal mapping identified for the first time in STC patients: a marked paucity of propagating pressure waves in the mid-colon (P-=-0.01), as a consequence of a significant (P-<-0.0001) decrease in extent of propagation of PS originating in the proximal colon; an increase in frequency of retrograde PS in the proximal colon; a significant reduction in the spatiotemporal organization among PS (P-<-0.001); absence of the normal nocturnal suppression of PS.Conclusions & Inferences- Pan-colonic, 24-h, spatiotemporal pressure mapping readily identifies characteristic disorganization among consecutive PS, regions of diminished activity and absent or deficient fundamental motor patterns and responses to physiological stimuli. These features are all likely to be important in the pathophysiology of slow transit constipation.