Title: ACP-ASIM: Difficulty with Bowel Evacuation in Patients with Spinal Cord Injury Related to Decreased Colonic Motility

"ACP-ASIM: Difficulty with Bowel Evacuation in Patients with Spinal Cord Injury Related to Decreased Colonic Motility"

By Peggy Peck

Special to DG News

PHILADELPHIA, PA -- April 16, 2002 -- Study results suggest that phasic post-prandial colonic response and a more exaggerated sleep-induced depression of colonic motility are the likely mechanisms for neurogenic bowel dysfunction and difficulty with evacuation of the bowels associated with spinal cord injury.

The findings were reported here Saturday at the 2002 Annual Session of the American College of Physicians-American Society of Internal Medicine.

Noel R. Fajardo, MD, and Mark A.Korsten, MD, of Mount Sinai School of Medicine, Bronx, New York enrolled eight patients with spinal cord injury (SCI), five were paraplegics and three were quadriplegics. The mean age of SCI patients was 59, and mean duration of injury was 17 years. The control group was made up of six spinally intact volunteers with a mean age of 57 years.

Following colonoscopy, the proximal end of a solid-state pressure transducer catheter was tethered to the splenic flexure using endoclips. Data from the catheter were recorded on a Gaeltec (Medical Measurements Inc.) portable tape recorder during a period of more than 24 hours, and were uploaded into a computer for analysis after the study was completed. Subjects could carry out their usual daily activities while the catheter was in place.

The authors analysed the Motility Index one hour before, during, and after breakfast, as well as one hour prior to and after sleep. These figures were compared to the index obtained after an average of one hour of sleep, and the significance of the difference was evaluated by Student's t test.

The SCI group had significantly less motility than the control group. One hour before breakfast, motility in the SCI group was 3.6, 4.6 during breakfast and 3.9 after breakfast. In the control group, pre-breakfast motility was 9.3 (p<0.01), it was 14.3 at breakfast (p<0.02) and 10.2 after breakfast (p<0.01). In both groups post-prandial response was significant, but in the SCI group it was only evident in the proximal but not the distal leads.

The findings were similar for the sleep studies. An hour before sleep colonic motility in the SCI group was 3.5, 1.4 during sleep and 4.5 an hour after waking. In the control group the pre-sleep, sleep and waking colonic motility index was 8.7, 8.8 and 17.8 respectively.

The authors report that the study is the first to assess colonic motility of individuals with SCI under physiologic conditions over a prolonged period of time. The study is significant, they say, because it demonstrated that DWE is related to decreased colonic motility.

"Efforts to better understand the causes of [difficulty with evacuation] may lead to effective treatments that will improve the quality of life in patients with SCI," Dr. Korsten said.