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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Colorectal motility patterns and psychiatric traits in functional constipation and constipation-predominant irritable bowel syndrome: A study from China
Chao-Lan Lv, Geng-Qing Song, Jie Liu, Wei Wang, Yi-Zhou Huang, Bo Wang, Jia-Shuang Tian, Meng-Qing Yin, Yue Yu
Chao-Lan Lv, Jie Liu, Yue Yu, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Chao-Lan Lv, Jie Liu, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Geng-Qing Song, Department of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, United States
Wei Wang, Jia-Shuang Tian, Meng-Qing Yin, Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, Anhui Province, China
Yi-Zhou Huang, Bo Wang, Department of Gastroenterology, Graduate School of Bengbu Medical College, Bengbu 233000, Anhui Province, China
Author contributions: Yu Y designed the study and critically revised the article for important intellectual content; Lv CL participated in the analysis and interpretation of the data, and drafted the initial manuscript; Song GQ participated in project supervision and editing the manuscript; Liu J, Wang W, Huang YZ, Wang B, Tian JS, and Yin MQ participated in acquisition of the data.
Supported by the External Science and Technology Cooperation Planning Projects of Anhui Province of China, No. 1604b060202.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Anhui Provincial Hospital.
Informed consent statement: As approved by the Ethics Board, informed consent was not required for this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yue Yu, MD, PhD, Professor, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, No. 9 Lujiang Road, Hefei 230001, Anhui Province, China. yuyuemd@ustc.edu.cn
Received: July 10, 2023
Peer-review started: July 10, 2023
First decision: September 1, 2023
Revised: September 14, 2023
Accepted: October 11, 2023
Article in press: October 11, 2023
Published online: November 7, 2023
BACKGROUND
Functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) represent a spectrum of constipation disorders. However, the majority of previous clinical investigations have focused on Western populations, with limited data originating from China.
AIM
To determine and compare the colorectal motility and psychiatric features of FC and IBS-C in an Eastern Chinese population.
METHODS
Consecutive chronic constipation patients referred to our motility clinic from December 2019 to February 2023 were enrolled. FC and IBS-C diagnoses were established using ROME IV criteria, and patients underwent high-resolution anorectal manometry (ARM) and a colonic transmit test using the Sitz marker study. Constipation-related symptoms were obtained through questionnaires. Anxiety and depression were assessed by the Hamilton anxiety rating scale and the Hamilton Depression Rating Scale-21. The clinical characteristics and colorectal motility patterns of FC and IBS-C patients were compared.
RESULTS
No significant differences in sex, age or abdominal discomfort symptoms were observed between IBS-C and FC patients (all P > 0.05). The proportion of IBS-C patients with delayed colonic transit was higher than that of patients with FC (36.63% vs 15.91%, P < 0.05), while rectosigmoid accumulation of radiopaque markers was more common in the FC group than in the IBS-C group (50% vs 26.73%, P < 0.05). Diverse proportions of these dyssynergic patterns were noted within both the FC and IBS-C groups by ARM. IBS-C patients were found to have a higher prevalence of depression than FC patients (66.30% vs 42.42%, P < 0.05). The scores for feelings of guilt, suicide, psychomotor agitation, diurnal variation, obsessive/compulsive disorder, hopelessness, self-abasedment and gastrointestinal symptoms were significantly higher in IBS-C patients than that in FC patients (P < 0.05). For IBS-C (χ2 = 5.438,P < 0.05) but not FC, patients with normal colon transit time were significantly more likely to have anxiety than those with slow colon transit time. For IBS-C patients but not FC patients, the threshold of first constant sensation, desire to defecate and sustained urgency were all weakly correlated with the degree of anxiety (r = 0.414,r = 0.404, and r = 0.418, respectively, P < 0.05). The proportion of patients with a low threshold of desire to defecate among IBS-C patients with depression was lower than that in those without depression (69.6% vs 41.9%, χ2 = 4.054, P < 0.05).
CONCLUSION
Our findings highlight both overlapping and distinctive patterns of colon transit, dyssynergic patterns, anorectal sensation, psychological distress, and associations of psychiatric and colorectal motility characteristics in FC and IBS-C patients in an Eastern Chinese population, providing valuable insights into the pathophysiological underpinnings of these disorders.
Core Tip: Functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) are the two primary subtypes of constipation. Previous clinical studies that attempted to illuminate distinctive physiological mechanisms between FC and IBS-C patients were predominantly from Western countries, with limited data originating from China. Our study has revealed distinctive elements of FC and IBS-C across multifaceted parameters, namely colonic transmit time, psychological distress, and dyssynergic patterns, and the relationship among these parameters. These findings extend our comprehension of the intricate pathophysiological mechanisms underlying FC and IBS-C. These findings could provide guidance for constipation patients to choose appropriate colorectal tests.
