Sensory and autonomic neuropathy in patients with idiopathic slow-transit constipation
Methods: Thirty-three patients with STC were studied using standard neurophysiological tests and a range of quantitative sensory and autonomic tests. The findings were compared with those of 20 matched control subjects and nine diabetic patients with gastrointestinal symptoms.
Results: Twenty of the 33 patients with STC gave a family history of constipation, including an affected identical twin and Hirschsprung's disease (n = 3). None had abnormalities on neurological examination or nerve conduction studies. Fifteen of the 33 patients had abnormalities on quantitative tests, including all six who required a colectomy. Eleven patients with STC had reduced axon-reflex sweating in the presence of normal sweat gland responses (P < 0·001, all patients with STC versus controls). Twelve patients with STC had small sensory fibre dysfunction, with significantly increased thermal thresholds (cool, P < 0·05; warm, P < 0·01); these included six of nine patients with STC and rectal hyposensation. There were similar findings on quantitative testing in diabetic patients.
Conclusion: Quantitative tests in patients with STC provide evidence of a small fibre neuropathy. The high incidence of a positive family history, particularly a possible association with Hirschsprung's disease, suggests a genetic basis, which deserves further investigation.
Document Type: Research Article
Affiliations: 1: Department of Surgery, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK 2: Academic Department of Neurology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK 3: Department of Clinical Neurophysiology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK
Publication date: January 1, 1999