Combined magnetic resonance imaging, high resolution manometry and a randomised trial of bisacodyl versus hyoscine shows the significance of an enlarged colon in constipation: the RECLAIM study

Wilkinson-Smith, Victoria; Scott, Mark; Menys, Alex; Wiklendt, Lukasz; MARCIANI, LUCA; Atkinson, David; Sansone, Stefano; Zdanavciene, Ausra; Coupland, Carol; Knowles, Charles; Dinning, Phillip; Taylor, Stuart; Gowland, Penny; Hoad, Caroline; Corsetti, Maura; Spiller, Robin

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 (HV), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries, questionnaires and underwent oral macrogol (500-1000mL) challenge. Whole gut transit time (WGTT), segmental colonic volumes (CV), MRI-derived motility index (MMI) 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 700kcal meal. Patients then proceeded to Part 2: a randomised cross-over study of 10-days bisacodyl 10mg daily versus hyoscine 20mg t.d.s. 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)] versus 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 to 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 to 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.
 

Citation

Wilkinson-Smith, V., Scott, M., Menys, A., Wiklendt, L., MARCIANI, L., Atkinson, D., Sansone, S., Zdanavciene, A., Coupland, C., Knowles, C., Dinning, P., Taylor, S., Gowland, P., Hoad, C., Corsetti, M., & Spiller, R. (2024). Combined magnetic resonance imaging, high resolution manometry and a randomised trial of bisacodyl versus hyoscine shows the significance of an enlarged colon in constipation: the RECLAIM study. Gut, https://doi.org/10.1136/gutjnl-2024-332755

• Journal Article Type: Article
• Acceptance Date: Sep 2, 2024
• Online Publication Date: Oct 22, 2024
• Publication Date: Oct 22, 2024
• Deposit Date: Sep 9, 2024
• Publicly Available Date: Oct 22, 2024
• Journal: Gut
• Print ISSN: 0017-5749
• Electronic ISSN: 1468-3288
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1136/gutjnl-2024-332755
• Public URL: https://nottingham-repository.worktribe.com/output/39445612
• Publisher URL: https://gut.bmj.com/content/early/2024/10/22/gutjnl-2024-332755