Gastrointestinal Motility in Patients with Ulcerative Colitis

In the first study 62 patients with ulcerative colitis and 20 healthy controls were fed a test meal of mashed potatoes and baked beans containing transit markers. Mouth-to-caecum transit was significantly slower in the patients than in controls; gastric emptying, however, was similar. Patients with active colitis had proximal colonic stasis, with rapid transit through the rectosigmoid region. In the patients with quiescent colitis the colonic distribution of markers was normal. Stool weight and frequency were significantly higher in the patients with active colitis. In the second study anorectal function was assessed in 29 patients with ulcerative colitis and in 12 healthy controls by measuring interluminal pressures at multiple sites in the anus and rectum before and during serial distention of a rectal balloon. Overall, resting and maximum squeeze sphincter pressures did not differ in patients with active or quiescent colitis and controls; however, in six patients with moderately severe colitis and incontinence, maximum squeeze pressure was significantly lower than in controls. The rectal volumes required to induce sensations of wind, a desire to defaecate, and pain were significantly lower in the patients with active colitis than patients with quiescent colitis and controls. Rectal pressures in response to rectal distention were higher in patients with active colitis. During disease remission rectal sensitivity decreased and rectal compliance increased. In the third study integrated pressure activity of the sigmoid colon, rectum, and anus was studied in patients with ulcerative colitis and healthy controls before and during provocation by rectal infusion of 1500 ml of warm saline. Resting motor activity was significantly lower in the patients with active colitis than in patients with quiescent colitis and controls. No anorectal contractions during the 1-h study were recorded in 7 of 18 patients with active colitis, 1 of 17 with quiescent colitis, and 1 of 18 controls. The volume of saline infused before leakage and total volume retained were significantly lower in the patients than in controls. The amplitude of regular contractions after rectal infusion of saline Was significantly higher in patients with active colitis than in patients with quiescent colitis and controls. Thus, the rectum in active colitis is tense and quiescent but responds to stimulation by generating large contractions.