J Neurogastroenterol Motil  
High Prevalence of Slow Transit Constipation in Patients With Gastroparesis
Thomas A Zikos,* Afrin N Kamal, Leila Neshatian, George Triadafilopoulos, John O Clarke, Monica Nandwani, and Linda A Nguyen
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, USA
Correspondence to: Thomas A Zikos, MD
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, 420 Broadway St., Pavilion D, Floor 2, Redwood City CA 94063, USA
Tel: +1-650-725-6511, Fax: +1-650-723-5488; E-mail: zikosta@stanford.edu
Received: December 9, 2018; Revised: January 9, 2019; Accepted: January 21, 2019; Published online: March 4, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated.
Methods
We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a highresolution anorectal manometry at our institution since January 2012. When available, Xray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups.
Results
Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings.
Conclusions
Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.
Keywords: Constipation; Dyspepsia; Gastroparesis; Pelvic floor disorders


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