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][1]. Data are available on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03226145&atom=%2Fgutjnl%2F74%2F1%2F35.atom

中文翻译：

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联合 MRI、高分辨率测压和比沙可啶与东莨菪碱的随机试验显示结肠肿大对便秘的意义：RECLAIM 研究


背景 便秘中的结肠运动可以使用 MRI 进行无创评估。目的 比较 MRI 与高分辨率结肠测压 （HRCM） 预测治疗反应的效果。设计第 1 部分：44 名健康志愿者 （HV）、43 名便秘肠易激综合征 （IBS-C） 患者和 37 名功能性便秘 （FC） 患者完成了大便日记和问卷调查，并接受了口服聚乙二醇 （500-1000 mL） 激发。使用 MRI 评估全肠通过时间 （WGTT） 、节段性结肠体积 （CV） 、MRI 衍生的运动指数和通过“标记”进行的食糜运动以及记录聚乙二醇后排便的时间。记录 700 kcal 餐前和餐后左结肠 HRCM。然后患者继续进行第 2 部分：一项随机交叉研究，比较 10 天比沙可啶 10 毫克/天与东莨菪碱 20 毫克/天 3 次，评估每日疼痛和便秘。结果第 1 部分：IBS-C （776 （595–1033）） 和 FC （802 （633–951）） 与 HV （645 （467–780）） 相比，总 CV 中位数（范围）显着更高，p<0.001。患者在 Alexoll 后 WGTT 也更长且排便延迟。与 HV 相比，IBS-C 患者在 HRCM 期间表现出标记指数显著降低和传播压力波 （PPW） 活性减少。与 FC 相比，IBS-C 患者更焦虑，报告更多的疼痛。异常大的结肠预示着聚乙二醇攻击后排便显著延迟 （p<0.02），测压进餐反应受损，比沙可啶减轻疼痛 （p<0.05）。第 2 部分：与东莨菪碱相比，比沙可啶增加了排便，但引起了两组的疼痛更多 （p<0.03）。结论 结肠异常大是便秘的一个重要特征，它预测了对喂养和治疗反应的测压反应受损。 HRCM 显示 IBS-C 患者的 PPW 活性降低。试验注册号 该研究于 ClinicalTrials.gov 进行预注册，参考文献：[NCT03226145][1]。数据可应合理要求提供。[1]： /lookup/external-ref？link_type=CLINTRIALGOV&access_num=NCT03226145&atom=%2Fgutjnl%2F74%2F1%2F35.原子