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Electric Activity of the Colon in Subjects With Constipation Due to Total Colonic Inertia
An Electrophysiologic Study
Ahmed Shafik, MD, PhD;
Ali A. Shafik, MD;
Olfat El-Sibai, MD, PhD;
Randa M. Mostafa, MD, PhD
Arch Surg. 2003;138:1007-1011.
Background Idiopathic constipation may result from colonic inertia, which affects the whole colon or is localized to an area of the colon. The colon exhibits electric activity in the form of slow waves or pacesetter potentials (PPs) and action potentials (APs), which are coupled with elevated colonic pressure. The APs are claimed to be responsible for colonic motor activity.
Hypothesis Colonic electric activity is disordered in patients with constipation due to colonic inertia.
Methods Electric activity was studied in 11 patients with colonic inertia and constipation (mean ± SD age, 42.8 ± 6.6 years; 7 women) who underwent total colectomy. Eight volunteers who had no gastrointestinal complaints (mean ± SD age, 40.6 ± 5.8 years; 5 women) acted as controls. Control subjects underwent laparotomy for hernia repair (n = 7 patients) and for removal of a mesenteric cyst (n = 1 patient). During the operation, 2 monopolar silver–silver chloride electrodes were applied to the cecum and the ascending, transverse, descending, and sigmoid colon.
Results Electric waves (PPs and APs) were recorded from all parts of the colon in control subjects. The waves were monophasic, negatively deflected, and had regular rhythm. The wave variables from the 2 electrodes of each segment of the colon were identical and reproducible. They progressively increased aborally. In the colonic inertia group, 5 patients had recorded waves from the cecum and ascending colon but no waves from the rest of the colon. The wave variables were significantly lower than those of the controls (P = .02). In the remaining 6 patients, no waves were registered from the whole colon.
Conclusions Regular electric waves were recorded from the colons of control subjects. The aboral increase of their frequency, amplitude, and conduction velocity suggests that colonic motile activity increases analward, reaching its maximum in the sigmoid colon to expel its solid contents. We postulate that constipation in patients with colonic inertia is attributable to weak or absent electric activity, the cause of which is unknown. A disorder of the interstitial cells of Cajal, which generate electric activity, is suggested to have a role in inducing diminished or absent colonic motor activity, a point that should be investigated.
From the Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo (Drs A. Shafik and A. A. Shafik), the Department of Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom (Dr El-Sibai), and the Department of Physiology, Faculty of Medicine, Zagazig University, Benha (Dr Mostafa), Egypt.
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