Combined MRI, high-resolution manometry and a randomised trial of bisacodyl versus hyoscine show the significance of an enlarged colon in constipation: the RECLAIM study

Victoria Wilkinson-Smith; Mark Scott; Alex Menys; Lukasz Wiklendt; Luca Marciani; David Atkinson; Stefano Sansone; Ausra Zdanaviciene; Carol Coupland; Charles H Knowles; Philip Dinning; Stuart A Taylor; Penny Gowland; Caroline Louise Hoad; Maura Corsetti; Robin C Spiller

doi:10.1136/gutjnl-2024-332755

Combined MRI, high-resolution manometry and a randomised trial of bisacodyl versus hyoscine show the significance of an enlarged colon in constipation: the RECLAIM study

Gut. 2024 Oct 22:gutjnl-2024-332755. doi: 10.1136/gutjnl-2024-332755. Online ahead of print.

Authors

Victoria Wilkinson-Smith^{1

2}, Mark Scott³, Alex Menys⁴, Lukasz Wiklendt⁵, Luca Marciani^{6

7}, David Atkinson⁸, Stefano Sansone⁹, Ausra Zdanaviciene¹⁰, Carol Coupland¹¹, Charles H Knowles¹², Philip Dinning¹³, Stuart A Taylor¹⁴, Penny Gowland^{2

15}, Caroline Louise Hoad^{2

15}, Maura Corsetti^{2

16}, Robin C Spiller^{17

18}

Affiliations

¹ School of Medicine, University of Nottingham, Nottingham, UK.
² NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
³ Academic Surgical Unit, Barts and The London School of Medicine and Dentistry, London, UK.
⁴ Motilent Ltd, London, UK.
⁵ College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia.
⁶ Translational Medical Sciences, Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.
⁷ Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
⁸ Centre for Medical Imaging, UCL, London, UK.
⁹ Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁰ Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK.
¹¹ Centre for Academic Primary Care, University of Nottingham, Nottingham, UK.
¹² Blizzard Institute, Queen Mary University, London, UK.
¹³ Gastroenterology and Surgery, Flinders Medical Center, Adelaide, South Australia, Australia.
¹⁴ Imaging Department, University College London Hospitals NHS Foundation Trust, London, UK.
¹⁵ Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, UK.
¹⁶ Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK.
¹⁷ Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham, UK robin.spiller@nottingham.ac.uk.
¹⁸ Translational Medical Science, University of Nottingham, Nottingham, UK.

PMID: 39438126
DOI: 10.1136/gutjnl-2024-332755

Abstract

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.

Keywords: COLORECTAL MOTILITY; COLORECTAL PHYSIOLOGY; CONSTIPATION; LAXATIVES.

Associated data

ClinicalTrials.gov/NCT03226145