Intest Res.  2017 Apr;15(2):236-243. 10.5217/ir.2017.15.2.236.

Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome

• Mizukami T
• Sugimoto S
• Masaoka T
• Suzuki H
• Kanai T

• KMID: 2425167
• DOI: http://doi.org/10.5217/ir.2017.15.2.236

Abstract

BACKGROUND/AIMS
Colonoscopy and computed tomography (CT) are used primarily to exclude organic diseases in patients with irritable bowel syndrome (IBS), rather than to assess the pathophysiology of IBS. We aimed to evaluate colonic dysmotility and morphology in Japanese patients with IBS.
METHODS
One hundred eighty-four patients with IBS and 49 asymptomatic controls who underwent colonoscopy in combination with CT colonography or barium enema were retrospectively reviewed between 2008 and 2012. Water-aided colonoscopy was performed without sedation by a single endoscopist. The duration and pattern of colonic movement and cecal intubation time were recorded. To assess colonic morphology, barium enema or CT colonography were performed immediately after colonoscopy.
RESULTS
Colonic dysmotility was more frequent in the IBS group (28.8% vs. 2.0% in controls, P<0.001), especially in cases of IBS with diarrhea (IBS-D) (IBS with constipation [IBS-C] 28.8% vs. IBS-D 60.0% vs. mixed IBS [IBS-M] 5.1%, P<0.001). Colonic morphological abnormality was more frequent in the IBS group than in the control group (77.7% vs. 24.5%, P<0.001), especially in IBS-M and IBS-C groups (IBS-C 77.5% vs. IBS-D 48.9% vs. IBS-M 100%, P<0.001). Most patients with IBS with colonic dysmotility had experienced stress related to their symptoms. Cecal intubation time was significantly longer in the IBS group than in the control group (12.1±6.9 minutes vs. 4.6±1.9 minutes, P<0.001).
CONCLUSIONS
Unsedated colonoscopy, combined with radiographic findings, can detect colonic dysmotility and morphological abnormality. Technical difficulties observed during cecal intubation may partially explain the pathophysiology of IBS.

Keyword

Colonoscopy; Irritable bowel syndrome; Water immersion; Sedation; Radiography

MeSH Terms

Asian Continental Ancestry Group*
Barium
Colon*
Colonography, Computed Tomographic
Colonoscopy
Constipation
Diarrhea
Enema
Humans
Intubation
Irritable Bowel Syndrome*
Radiography
Retrospective Studies
Barium

Figure

• 

  Fig. 1 Colonoscopic view of colonic dysmotility. (A) Normal view without colonoscopic dysmotility. (B) Spontaneous colonic excessive peristalsis, as frequently observed during colonoscopy in patients with IBS with diarrhea. (C) Colonic dysmotility with segmental features, as observed during colonoscopy in a proportion of patients with IBS with constipation.

• 

  Fig. 2 Three-dimensional colonic morphology from CT colonography. Representative figures of sigmoid colon malrotation (A), and mesocolon descendens (B, C). White lines represent the center-lines for endoluminal navigation that shows unusual colonic course. White arrows indicate acute angulation of colon due to mesocolon descendens.

• 

  Fig. 3 Characteristics of patients with IBS evaluated using CTC or barium enema. IBS-D, IBS with diarrhea; M, male; F, female; BE, barium enema; CTC, CT colonography; IBS-M, mixed IBS; IBS-C, IBS with constipation.

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