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

Wilkinson-Smith, Victoria; Scott, Mark; Menys, Alex; Wiklendt, Lukasz; Marciani, Luca; Atkinson, David; Sansone, Stefano; Zdanaviciene, Ausra; Coupland, Carol; Knowles, Charles H.; Dinning, Philip; Taylor, Stuart A.; Gowland, Penny; Hoad, Caroline Louise; Corsetti, Maura; Spiller, Robin C.

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.

Citation

Wilkinson-Smith, V., Scott, M., Menys, A., Wiklendt, L., Marciani, L., Atkinson, D., Sansone, S., Zdanaviciene, A., Coupland, C., Knowles, C. H., Dinning, P., Taylor, S. A., Gowland, P., Hoad, C. L., Corsetti, M., & Spiller, R. C. (2024). 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, 74(1), 35-44. 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: Dec 10, 2024
• Deposit Date: Oct 25, 2024
• Publicly Available Date: Oct 29, 2024
• Journal: Gut
• Print ISSN: 0017-5749
• Electronic ISSN: 1468-3288
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 1
• Pages: 35-44
• DOI: https://doi.org/10.1136/gutjnl-2024-332755
• Public URL: https://nottingham-repository.worktribe.com/output/40870566
• Publisher URL: https://gut.bmj.com/content/74/1/35