J Neurogastroenterol Motil 2019; 25(2): 267-275  
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: April 30, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

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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 high-resolution anorectal manometry at our institution since January 2012. When available, X-ray 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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