Combined MRI, high-resolution manometry and a randomised trial of bisacodyl versus hyoscine show the significance of an enlarged colon in constipation: the RECLAIM study

Gut. 2024 Dec 10;74(1):35-44. doi: 10.1136/gutjnl-2024-332755.

Abstract

Background: Colonic motility in constipation can be assessed non-invasively using MRI.

Objective: To compare MRI with high-resolution colonic manometry (HRCM) for predicting treatment response.

Design: Part 1: 44 healthy volunteers (HVs), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries and questionnaires and underwent oral macrogol (500-1000 mL) challenge. Whole gut transit time (WGTT), segmental colonic volumes (CV), MRI-derived Motility Index and chyme movement by 'tagging' were assessed using MRI and time to defecation after macrogol recorded. Left colonic HRCM was recorded before and after a 700 kcal meal. Patients then proceeded to Part 2: a randomised cross-over study of 10-days bisacodyl 10 mg daily versus hyoscine 20 mg three times per day, assessing daily pain and constipation.

Results: Part 1: Total CVs median (range) were significantly greater in IBS-C (776 (595-1033)) and FC (802 (633-951)) vs HV (645 (467-780)), p<0.001. Patients also had longer WGTT and delayed evacuation after macrogol. IBS-C patients showed significantly reduced tagging index and less propagated pressure wave (PPW) activity during HRCM versus HV. Compared with FC, IBS-C patients were more anxious and reported more pain. Abnormally large colons predicted significantly delayed evacuation after macrogol challenge (p<0.02), impaired manometric meal response and reduced pain with bisacodyl (p<0.05).Part 2: Bisacodyl compared with hyoscine increased bowel movements but caused more pain in both groups (p<0.03).

Conclusion: An abnormally large colon is an important feature in constipation which predicts impaired manometric response to feeding and treatment responses. HRCM shows that IBS-C patients have reduced PPW activity.

Trial registration number: The study was preregistered on ClinicalTrials.gov, Reference: NCT03226145.

Keywords: COLORECTAL MOTILITY; COLORECTAL PHYSIOLOGY; CONSTIPATION; LAXATIVES.

Publication types

  • Randomized Controlled Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Bisacodyl* / administration & dosage
  • Bisacodyl* / therapeutic use
  • Colon* / diagnostic imaging
  • Colon* / physiopathology
  • Constipation* / diagnostic imaging
  • Constipation* / drug therapy
  • Constipation* / physiopathology
  • Cross-Over Studies*
  • Female
  • Gastrointestinal Motility / drug effects
  • Gastrointestinal Transit / drug effects
  • Humans
  • Irritable Bowel Syndrome* / complications
  • Irritable Bowel Syndrome* / diagnostic imaging
  • Irritable Bowel Syndrome* / drug therapy
  • Irritable Bowel Syndrome* / physiopathology
  • Magnetic Resonance Imaging* / methods
  • Male
  • Manometry* / methods
  • Middle Aged
  • Treatment Outcome
  • Young Adult

Substances

  • Bisacodyl

Associated data

  • ClinicalTrials.gov/NCT03226145