AG

AA

bst

ract

shr, p<0.05). On ARM, the squeezing pressure was decreased in myelopathy group (myelopa-thy; 126.8±69.9 mmHg, radiculopathy; 178.2±82.2 mmHg, control; 188.0±67.0 mmHg,p<0.05). The minimal volume for rectal sensation was elevated in the radiculopathy group,compared with the other two groups (radiculopathy; 14.3±11.7 ml, myelopathy; 11.9±5.4ml, control; 10.0±1.8 ml, p<0.05). The success rate of biofeedback therapy was similar inthree groups and slightly lower in the myelopathy group (60% in myelopathy, 75.4% inradiculopathy, 71.4% in control, p<0.05). Conclusion: The major characteristic finding ofconstipation was decreased rectal sensation in radiculopathy and delayed rectosigmoidcolonic transit in myelopathy. Although the success rate of biofeedback therapy in myelopathygroup was relatively low, considerable portion of patients had improvement of constipationafter biofeedback therapy suggesting that active biofeedback therapy should be recommendedto the patients with constipations and spinal cord diseases.

W1312

Heightened Motor Activity Measured By a Wireless Capsule in UnpreparedColons of Patients with Complaints of Constipation: Relation to Colon Transitand IBSWilliam L. Hasler, Richard J. Saad, Satish S. Rao, Leonard A. Katz, Henry P. Parkman,Kenneth L. Koch, Richard McCallum, Braden Kuo, Irene Sarosiek, Michael D. Sitrin,Jeffrey M. Lackner, Gregory E. Wilding, Carrie Miller, Jack Semler, William D. Chey

Background: Quantifying colon motor activity in constipation relies on catheters placed inprepared colons, which may disrupt contractions. Region-dependent patterns in unpreparedcolons in health and constipation are poorly characterized. Effects of delayed transit andthe presence of irritable bowel syndrome (IBS) on motor activities are unknown. TheSmartPill capsule measures regional transit by detecting pH changes and quantifies pressure.Hypotheses: (i) Unprepared colon activity shows proximal to distal gradients in health, (ii)in non-dyssynergic constipation, slow colon transit associates with altered motor activity,and (iii) IBS patients show greater motor activity than patients without IBS unrelated totransit. Methods: SmartPill measures of pH, pressure, and temperature were acquired in89 subjects (53 healthy subjects, 36 constipated patients with normal balloon expulsion).Cecal entry was detected by >0.7 pH drops hrs after gastric emptying. Anal passage wasdetected by temperature drops >0.045oF/sec. Contraction numbers and areas under curvesper 15 min (AUC) >25 mmHg were calculated. Colon transit was divided into quartiles bytime to assess regional motor differences. Constipated subjects were grouped into normaltransit (<60 hr), moderate slow transit constipation (STC)(60-100 hr), and severe STC (>100hr). 12/36 constipated patients had IBS on Rome II surveys. Results: Contractions rosefrom 5.9±0.6/15 min in the 1st transit quartile to 11.6±1.3 in the 4th quartile in healthysubjects (P<0.001). Mean AUC was 23.5±3.8 and rose from 9.4±1.7 to 39.8±4.6 from the1st to the 4th quartile (P<0.001). Mean contractions in constipated patients with normaltransit (9.2±1.5/15 min), moderate STC (9.5±1.2), and severe STC (6.8±0.8) were similarto healthy subjects. AUC in patients with normal transit (34.7±4.8) and moderate STC(39.5±7.6) were higher than healthy subjects (P<0.01). AUCs in severe STC (19.7±6.1) werelower than in other constipated patients (P<0.02) but were no different than healthy subjects(P=0.5). Compared to those without IBS, IBS patients had higher contractions (10.6±0.4vs. 8.0±1.2/15 min, P<0.02) and AUC (44.7±11.1 vs. 27.7±4.7, P<0.002) though transitwas similar (58.6±10.4 vs. 53.8±7.2). Conclusions: Unprepared colon motor activity inhealth increases proximally to distally. Patients with non-dyssynergic constipation withnormal to moderately (but not severely) delayed transit show increased motor activity. IBSis associated with increased colon activity irrespective of transit. These findings, quantifiedby a novel wireless capsule, offer insight into possible pathogenic factors in different typesof constipation.

W1313

Wireless Capsule Quantification of Region-Specific Gastrocolonic Responseand Sleep Inhibition of Colon Motor Activity in Unprepared Colons ofHumans with Normal Colon TransitWilliam L. Hasler, Satish S. Rao, Kenneth L. Koch, Irene Sarosiek, Richard McCallum,Jeffrey M. Lackner, Henry P. Parkman, William D. Chey, Richard J. Saad, Braden Kuo,Carrie Miller, Michael D. Sitrin, Leonard A. Katz, Gregory E. Wilding, John R. Semler

Background: Colon motor activity in humans is modulated by meals (gastrocolonic response,GCR) and sleep. These responses may be abnormal with constipation or nocturnal symptomssuch as incontinence. Most studies rely on catheters placed after colon lavage, which mayaffect findings. Effects of different meals on unprepared colons are poorly characterized.Region-dependent GCR and sleep inhibition of unprepared colon activity are not welldescribed. The SmartPill capsule continuously measures luminal pressure and pH, whichserves to localize the device in the gut. Hypotheses: (i) Meals increase while sleep decreasescolon motor activity in humans with normal transit, (ii) different meals have distinct effectson GCRs, (iii) GCR and sleep effects are present throughout the colon, and (iv) GCR andsleep effects do not relate to colon transit. Methods: SmartPill measurement of pH, pressure,and temperature was performed in 22 subjects. Times of eating (54 meals) and sleeping(26 nocturnal recordings) were recorded. Cecal entry was detected by pH drops >0.7unit hours after gastric emptying. Anal passage was reflected by abrupt temperature drops>0.045oF/sec. Contraction numbers/15 min and areas under curves/15 min (AUC) >25mmHg were calculated. Colon transit was divided into quartiles by time to facilitate estimatingregional motor differences. SmartPill colon transit was <60 hr in all subjects. Results: Mealsincreased contractions from 10.1±1.0 to 12.8±1.2/15 min (P=0.05) 30-60 min after eating.There was a trend to increased AUC from 27.5±3.7 to 35.9±5.6 (P=0.1). Contractionsincreased by 5.1±2.1 (P<0.03) and 2.9±1.6/15 min (P=0.07) after breakfast and dinner.Lunch had no effect (P=0.77). AUC increased after dinner from 17.4±4.4 to 32.9±10.2(P<0.03) but not after other meals (P>0.4). Similar increases in contractions and AUC werenoted in each transit quartile. Correlations of colon transit with meal effects on contractions(R=-0.04) and AUC (R=-0.24) were poor. Sleep reduced contractions by 6.9±2.5/15 minand AUC by 16.1±4.9 (P<0.01). Similar >40% decreases in contractions and AUC werenoted in each quartile. Colon transit did not correlate with sleep effects on contractions(R=-0.02) or AUC (R=-0.05). Conclusions: Stimulatory motor effects of meals and inhibitory

T : 11501$$CH204-02-08 16:47:14 Page 678Layout: 11501B : e

A-678AGA Abstracts

effects of sleep are demonstrable in unprepared colons from humans with normal transitusing a wireless capsule. Both effects are prominent in all regions and do not relate to transit.Differential responses to distinct meals are present and may relate to timing or composition.This method shows promise in characterizing colon response defects in constipation ornocturnal incontinence.

W1314

Antegrade Enemas for Defecation Disorders: Does It Improve the ColonicMotility?Ann Aspirot, Sergio Fernandez, Carlo Di Lorenzo, Beth Skaggs, Hayat Mousa

Background: Chronic constipation is a common problem in the pediatric population. Whensevere, constipation has important adverse psychosocial consequences and significantlyimpacts quality of life. Use of antegrade enemas through as cecostomy is an effective treatmentof children with idiopathic constipation, spinal abnormalities, and imperforate anus. Becausecolonic manometry has been found to be a good predictor of antegrade enemas success, weroutinely study all patients prior to cecostomy insertion. The effects of antegrade enemason colonic motility were never reported. Objective: To compare colonic manometry resultsbefore and after antegrade enema. Methods: We reviewed colonic manometry tracings ofpatients who had used antegrade enemas for at least 6 months and were being evaluatedfor possible discontinuation of this treatment. Results: Seven patients (median age of 12years, range 3-15 years) met our inclusion criteria. Four patients had idiopathic constipation,2 had tethered cord, and 1 had Hirschsprung disease surgically addressed at six weeks old.Colonic manometry prior to the use of antegrade enemas showed dysmotility in 6 of them(86%), mostly in the distal colon. None of the patients underwent colonic resection betweenthe 2 studies. All the patients had colonic manometry repeated between 14 and 46 monthsafter the insertion of the cecostomy. All patients with abnormal colonic manometry improvedwith the use of antegrade enema with a complete normalization of colonic motility in 5patients (83%). Conclusion: Use of antegrade enema alone, without diversion or resection,may improve colonic motility.

W1315

Evaluation of the Bristol Stool Form Scale As a Marker for GI Transit inPatients with Chronic ConstipationSajneet Khangura, Zeeshan Ramzan, Alan H. Maurer, John Gaughan, Robert S. Fisher,Henry P. Parkman

The Bristol stool form scale, which grades stool form from 1 (hard lumps) to 7 (watery),has been suggested as a surrogate marker for colonic transit. Stool form has been suggestedto correlate with colonic transit time, but not frequency of bowel movements, in healthysubjects and patients with IBS. Aim: The aim of this study was to determine if the Bristolstool form correlates with colonic transit, anal sphincter function, and/or frequency of bowelmovements in patients with chronic constipation. Methods: Results of 50 patients undergoingwhole gut transit scintigraphy (WGTS; combined gastric emptying, small bowel and colonictransit) and anorectal testing for evaluation of constipation from Jan 2005 to June 2007were reviewed. On the fourth day of WGTS and prior to anal manometry, patients completeda questionnaire listing symptoms and documenting stool form on the Bristol stool formscale. The geometric center of colonic radioactivity (1=cecum to 7=excreted stool) duringWGTS was used to quantify colonic transit. Normal values: >1.6 at 24 hours, >4.0 at 48hours, >6.2 at 72 hours. Results: Of the 50 patients (mean age 41 yrs; 41 females), 34 haddelayed colonic transit; the geometric center of colonic activity was diminished at 24 hr in2 patients, at 48 hours in 20 and at 72 hours in 32 patients. One “constipated” patient hadrapid colonic transit. The Bristol stool form averaged 2.2 with a range from 1 to 7. TheBristol stool form was moderately correlated with geometric center of colonic transit at 24hr (r=0.381; p=0.009), 48 hr (r=0.341; p=0.02) and 72 hr (r=0.251; p=0.09), but nosignificant correlation with gastric emptying or small bowel transit. The Bristol stool formdid not correlate with frequency of bowel movements (r=0.220; p=0.16) or with mostparameters measured by anorectal testing including basal anal sphincter pressure (r=0.217;p=0.12), sensory threshold to rectal balloon distension (r= -0.190; p=0.19), internal analsphincter relaxation (r= -0.081; p=0.57), volitional contraction of external anal sphincter(r= -0.107; p=0.47), and balloon expulsion time (r=0.172; p=0.23). There was a negativecorrelation between threshold volume for anal sphincter relaxation on anorectal manometryand geometric center at 48 hr (r= -0.297; p=0.048) and 72 hr (r= -0.318; p=0.036).Conclusions: In constipated patients, the Bristol stool form correlates moderately withcolonic transit as measured by WGTS. The Bristol stool form was not related to the frequencyof bowel movements, anal manometry, anal EMG findings, or balloon expulsion time. Therewas a negative correlation between rectal threshold volume for anorectal relaxation andcolon transit.

W1316

Non-Invasive Evaluation of Colonic Motility By Electrocolonography (ECoG)Masako Kaji, Toshiya Okahisa, Tetsuo Kimura, Tatsuzo Itagaki, Hisashi Takeuchi, NaokiMuguruma, Seisuke Okamura, Tetsuji Takayama, Akitsugu Murakami

[Purpose] Recently, the number of patients with colonic dysmotility due to irritable bowelsyndrome have been increasing. Much attention should be paid to develop a convenientmethod to evaluate colonic motility in order to adjust medication for patients. Previousreports have showed that colonic electrical activity is generated at about several cycle/min(cpm). We examined the possibility of evaluating colonic motility by measuring its electricalpotential using electrocolonography (ECoG). [Method] Twenty well-informed healthy volun-teers were enrolled in this study. ECoG was performed using a portable electrogastrograph(NIPRO EGG, A&D, Tokyo, Japan). After detecting a sigmoid colon at the left lower quadrantof abdomen in a volunteer using external ultrasonography, 4 electrodes of ECoG wereattached to the abdomen as follows: at upper end of ultrasonic probe placed along the longaxis of the sigmoid colon (Central Electrode); lower end (Ch-1); inside the axis (Ch-2);