Published online Nov 7, 2023. doi: 10.3748/wjg.v29.i41.5657
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
Processing time: 120 Days and 3.2 Hours
The comparation of colorectal motility, psychiatric features, and the association of colorectal motility patterns and psychiatric traits between functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) groups, especially in the Chinese population has not been fully studied.
Controversy persists regarding the correlation between high-resolution anorectal manometry (HR-ARM) and the colonic transmit test (CTT), and it remains unclear which test provides more meaningful data for IBS-C or FC.
We aimed to compare the psychiatric and colorectal motility characteristics between FC and IBS-C patients in an Eastern Chinese population. We also sought to investigate the correlations between psychiatric and colorectal motility characteristics in both FC and IBS-C patients.
Colorectal motility patterns were obtained by HR-ARM and CTT. Anxiety and depression were assessed by the Hamilton anxiety rating scale (HAMA) and the Hamilton Depression Rating Scale (HAMD)-21.
Our study indicated a higher prevalence of rectosigmoid accumulation of radiopaque markers (RSARM) and elevated anal resting pressure in FC patients compared to IBS-C patients. Furthermore, we observed that nearly half of the FC patients with RSARM exhibited type IV dyssynergia, a prevalence nearly double that of IBS-C patients. Our data also showed that IBS-C patients with normal transit time were more likely to experience anxiety compared to those with slow transit time. However, we found no significant correlations between psychological stress and colonic motility in FC patients. FC patients with type IV dyssynergia and IBS-C patients with type III dyssynergia are more likely to have dyssynergic defecation. Type I or II dyssynergia cannot rule out the need for CTT in chronic constipation patients, while it might not be necessary for FC patients with type IV dyssynergia and IBS-C patients with type III dyssynergia to undergo CTT, but further balloon expulsion test or defecography might still be necessary.
The associations of psychological stress and colonic motility in our study are discrepant from results of Western studies, indicating that emotional factors may have varying effects on colonic motility between these two patient groups. The associations we found between CTT results and dyssynergia patterns by ARM could provide guidance for different constipation groups to choose appropriate colorectal tests.
We compared not only colorectal motility and psychiatric features, but also the correlations between psychiatric and colorectal motility characteristics in FC and IBS-C patients. What we found could provide guidance for constipation patients to choose appropriate colorectal tests.