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LETTER
Slow transit constipation: more than one disease?
  1. C Pehl1,
  2. T Schmidt1,
  3. W Schepp1
  1. 1Department of Gastroenterology, Hepatology, and Gastrointestinal Oncology, Bogenhausen Academic Teaching Hospital, Englschalkinger Str 77, 81925 Munich, Germany
  1. Correspondence to:
    C Pehl;
    Christian.pehl{at}extern.lrz-muenchen.de

https://doi.org/10.1136/gut.51.4.610

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    Emmanuel and Kamm reported on the response of behavioural treatment, biofeedback, in constipated patients (Gut 2001;49:214–19). Biofeedback is an established therapy for outlet obstruction due to paradoxical anal sphincter contraction.1 Beyond that, Emmanuel and Kamm demonstrated that slow transit constipation (STC) can also be improved by biofeedback with normalisation of the slow transit in most symptomatic responders. These results contrast with the common belief of STC as a manifestation of a panenteric disease, presumably of the enteric nervous system.

    Disturbances of oesophageal motility, gastric emptying, small bowel transit, and gall bladder motility have been described.2 Dysmotility of the small intestine has been thoroughly investigated by manometry in STC patients3,4 Disturbed motility—for example, abnormal configuration or disturbed aboral migration of phase III of the migrating motor complex, bursts, and sustained uncoordinated activity—occur in up to 60% of these patients. In our recent study5 using long term small bowel manometry in 30 clinical STC patients, disturbed aboral migration of phase III was present in 47%, and bursts/sustained uncoordinated activity occurred in 33% of patients, respectively.

    It is well established that these manometric findings are markers of a neuropathy of the myenteric plexus and …

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