Noel R. Fajardo

Decreased Colonic Motility in Persons With Chronic Spinal Cord Injury

OBJECTIVES:In persons with spinal cord injury (SCI), several studies have shown that large bowel transit is decreased at the level of the left colon and rectum, and that postprandial colonic response to food is absent. To define these parameters further, the effects of food on colonic motility in persons with SCI were studied and compared to those of spinally intact (SI) individuals.METHODS:The study was conducted in eight subjects with SCI (four paraplegic and four quadriplegic) and six age-matched SI subjects. After routine bowel preparation, colonoscopy was performed with the proximal end of a solid state pressure transducer catheter (four sensors each separated by 10 cm) tethered to the splenic flexure using endoclips (Olympus). The subjects were then allowed to carry out their usual daily activities. Two phases were compared: 1 h before breakfast, designated as the “resting phase,” and 1 h during breakfast, designated as the “food-ingestion phase.”RESULTS:Baseline colonic activity of the SCI group was significantly less than in SI subjects. During meals, the motility index, mean amplitude of the waves, percent activity, and number of waves was significantly less in the SCI group. In both the SI and SCI groups, a postprandial colonic response was observed. However, in the SCI group, the response was seen only in the descending colon and not in the rectosigmoid region.CONCLUSIONS:SCI decreases colonic motility, and this alteration may relate to difficulty with evacuation. The postprandial colonic response in SCI is present but is suboptimal and confined to the descending colon.

Prolonged ambulatory colonic manometric studies using endoclips

BACKGROUND It is difficult to study human colonic motility under physiologic conditions. An important limitation associated with prolonged colonic recording is the failure of the sensors to resist normal expulsive forces. METHOD In this article we describe a method of endoscopically positioning a manometric catheter by using clips in conjunction with a solid-state catheter. With the use of a rotatable clip-fixing device loaded on to a colonoscope, the manometric catheter was clipped to the colonic mucosa. RESULTS Recordings for up to 120 hours were obtained from 6 subjects without apparent migration of the catheter assembly. No complications were noted, the catheter does not interfere with defecation, and defecation does not result in its expulsion. CONCLUSION The current technique will allow reliable ambulatory measurements over prolonged periods of time in relatively comfortable and unrestrained subjects. This technique should increase our understanding of normal and abnormal colonic motility.

Difficulty with evacuation after spinal cord injury: colonic motility during sleep and effects of abdominal wall stimulation.

Difficulty with evacuation (DWE) is common in individuals with spinal cord injury (SCI). Numerous studies have concluded that constipation, impaction, and incontinence cause significant morbidity and, collectively, constitute an important quality-of-life issue in individuals with SCI. Colonic motor activity was assessed using a solid-state manometry probe. We report here that colonic pressure activity is depressed during sleep compared to that observed in able-bodied controls. In addition, pressure activity was decreased during sleep compared to pre-sleep and post-sleep. We suspect that this may contribute to delayed colon transit time after SCI. In addition, since contraction of the abdominal wall musculature plays a role in normal defecation, we assessed whether an abdominal belt with implanted electrodes would improve DWE. In this respect, we demonstrated that neuromuscular stimulation of the abdominal wall improves a number of indices of defecatory function, including time to first stool and total bowel care time.

Colonic motility during sleep: Effect of spinal cord injury (SCI)

Background:. Motor activity of the colon during sleep is relatively quiescent but bursts of activity are observed during periods of arousal and when sleep is completed. However, it is not known how sleep alters the colonic motility of parsons with SCI. We thus studied the effect of sleep on the colonic motility of subjects with SCI and compared it with that in persons who were spinally intact (SI). Method£ The study was conducted on 8 subjects with SCI (mean age of 59 years, mean duration of injury of 17 years, 4 paraplegics, 4 quadriplegies), and 6 SI subjects (mean age 57 years). SCI subjects all complained of difficulty with evacuation (DWE) at least once in 6 months preceding the study; all received bowel care at least three/ week. After routine bowel preparation with lavage solution or Phosphosoda, colonoscopy was performed (all subjects had normal examinations). After colonoacopy, the proximal end of a solid-state pressure transducer catheter (4 sensors each separated by 10 cme.) was tethered to the splenic flexure using endoclips (Olympus Corp.) The subjects ware then allowed to carry out their usual daily activities, including sleep. Data from the catheter was recorded on a Gaeltec portable recorder. After compl~on of the study (which lasted 24 hours), the data was uploaded to a desktop computer for analysis. Significance of the difference between groups was evaluated by Students T-test. Result. During sleep, the motility index was significantly lower in subjects with SCI than the SI (1.5 vs. 5.8, p<O.O08). In subjects with SCI, there was a significant decrease in the motility index during sleep as compared to presleep (1.5 vs. 2.8, p<O.02) and post-sieap (1.5 ve 4.3, p<O.03). This decrease was also seen in the SI, but was not statistically significant. Conclusion~. Colonic moBity decreases during sleep in both persons with SCI and the SI. However, this decrease was found to be of greater degree in subjects with SCI as compared to SI. To the extent that sleep-induced depression of colonic motility slows colonic transit, our results may, in part, explain DWE seen after SCi.