Review
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2005; 11(18): 2691-2696
Published online May 14, 2005. doi: 10.3748/wjg.v11.i18.2691
Normal aspects of colorectal motility and abnormalities in slow transit constipation
Gabrio Bassotti, Giuseppe de Roberto, Danilo Castellani, Luca Sediari, Antonio Morelli
Gabrio Bassotti, Giuseppe de Roberto, Danilo Castellani, Luca Sediari, Antonio Morelli, Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Perugia, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Gabrio Bassotti, Strada del Cimitero, 2/a, 06131 San Marco Perugia, Italy. gabassot@tin.it
Fax: +39-75-5847570
Received: April 28, 2004
Revised: April 29, 2004
Accepted: July 22, 2004
Published online: May 14, 2005
Abstract

Human colonic motility is a relatively difficult topic to investigate. However, the refinement of manometric techniques in recent years enabled us to study both the proximal and distal segments of the viscus. The present paper reviews our knowledge about normal aspects of colorectal motility in man and the abnormalities found in slow transit constipation (STC), one of the most frequent and difficult to treat subtypes of constipation. An internet-based search strategy of the Medline and Science Citation Index was performed using the keywords colon, colonic, colorectal, constipation, slow transit, motility, rectal, rectum in various combinations with the Boolean operators AND, OR and NOT. Only articles related to human studies were used, and manual cross-referencing was also performed. Most of colonic motor activity is represented by single nonpropagated contractions, rarely organized in bursts; this activity is maximal during the day, especially after waking and following meals. In addition, a specialized propagated activity with propulsive features is detectable, represented by high- and low-amplitude propagated contractions. In the severe form of constipation represented by the slow transit type, the above motor activity is completely deranged. In fact, both basal segmental activity (especially in response to meals) and propagated activity (especially that of high amplitude) are usually decreased, and this may represent a physiologic marker of this disorder. Human colonic motor activity is quite a complex issue, still only partly understood and investigated, due to anatomic and physiological difficulties. In recent years, however, some more data have been obtained, even in proximal segments. These data have helped in elucidating, although only in part, some pathophysiological mechanisms of chronic constipation, and especially of the STC subtype.

Keywords: Colonic motility; Constipation; Slow transit