Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity

R. E. Burgell, D. Lelic, E. V. Carrington, P. J. Lunniss, S. S. Olesen, S. Surguy, A. M. Drewes, S. M. Scott

Research output: Contribution to journalArticleResearchpeer-review

21 Citations (Scopus)

Abstract

Background Blunted rectal sensation (rectal hyposensitivity: RH) is present in almost one-quarter of patients with chronic constipation. The mechanisms of its development are not fully understood, but in a proportion, afferent dysfunction is likely. To determine if, in patients with RH, alteration of rectal sensory pathways exists, rectal evoked potentials (EPs) and inverse modeling of cortical dipoles were examined. Methods Rectal EPs (64 channels) were recorded in 13 patients with constipation and RH (elevated thresholds to balloon distension) and 11 healthy controls, in response to electrical stimulation of the rectum at 10cm from the anal verge using a bipolar stimulating electrode. Stimuli were delivered at pain threshold. Evoked potential peak latencies and amplitudes were analyzed, and inverse modeling was performed on traces obtained to determine the location of cortical generators. Key Results Pain threshold was higher in patients than controls [median 59 (range 23-80) mA vs 24 (10-55) mA; P=0.007]. Median latency to the first negative peak was 142 (±24) ms in subjects compared with 116 (±15) ms in controls (P=0.004). There was no difference in topographic analysis of EPs or location of cortical activity demonstrated by inverse modeling between groups. Conclusions & Inferences This study is the first showing objective evidence of alteration in the rectal afferent pathway of individuals with RH and constipation. Prolonged latencies suggest a primary defect in sensory neuronal function, while cerebral processing of visceral sensory information appears normal.

Original languageEnglish
Pages (from-to)260-269
Number of pages10
JournalNeurogastroenterology and Motility
Volume25
Issue number3
DOIs
Publication statusPublished - 1 Mar 2013
Externally publishedYes

Keywords

  • Constipation
  • Cortical processing
  • Electroencephalography
  • Inverse modeling
  • Rectal evoked potentials
  • Rectal hyposensitivity

Cite this

Burgell, R. E. ; Lelic, D. ; Carrington, E. V. ; Lunniss, P. J. ; Olesen, S. S. ; Surguy, S. ; Drewes, A. M. ; Scott, S. M. / Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity. In: Neurogastroenterology and Motility. 2013 ; Vol. 25, No. 3. pp. 260-269.
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Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity. / Burgell, R. E.; Lelic, D.; Carrington, E. V.; Lunniss, P. J.; Olesen, S. S.; Surguy, S.; Drewes, A. M.; Scott, S. M.

In: Neurogastroenterology and Motility, Vol. 25, No. 3, 01.03.2013, p. 260-269.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity

AU - Burgell, R. E.

AU - Lelic, D.

AU - Carrington, E. V.

AU - Lunniss, P. J.

AU - Olesen, S. S.

AU - Surguy, S.

AU - Drewes, A. M.

AU - Scott, S. M.

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N2 - Background Blunted rectal sensation (rectal hyposensitivity: RH) is present in almost one-quarter of patients with chronic constipation. The mechanisms of its development are not fully understood, but in a proportion, afferent dysfunction is likely. To determine if, in patients with RH, alteration of rectal sensory pathways exists, rectal evoked potentials (EPs) and inverse modeling of cortical dipoles were examined. Methods Rectal EPs (64 channels) were recorded in 13 patients with constipation and RH (elevated thresholds to balloon distension) and 11 healthy controls, in response to electrical stimulation of the rectum at 10cm from the anal verge using a bipolar stimulating electrode. Stimuli were delivered at pain threshold. Evoked potential peak latencies and amplitudes were analyzed, and inverse modeling was performed on traces obtained to determine the location of cortical generators. Key Results Pain threshold was higher in patients than controls [median 59 (range 23-80) mA vs 24 (10-55) mA; P=0.007]. Median latency to the first negative peak was 142 (±24) ms in subjects compared with 116 (±15) ms in controls (P=0.004). There was no difference in topographic analysis of EPs or location of cortical activity demonstrated by inverse modeling between groups. Conclusions & Inferences This study is the first showing objective evidence of alteration in the rectal afferent pathway of individuals with RH and constipation. Prolonged latencies suggest a primary defect in sensory neuronal function, while cerebral processing of visceral sensory information appears normal.

AB - Background Blunted rectal sensation (rectal hyposensitivity: RH) is present in almost one-quarter of patients with chronic constipation. The mechanisms of its development are not fully understood, but in a proportion, afferent dysfunction is likely. To determine if, in patients with RH, alteration of rectal sensory pathways exists, rectal evoked potentials (EPs) and inverse modeling of cortical dipoles were examined. Methods Rectal EPs (64 channels) were recorded in 13 patients with constipation and RH (elevated thresholds to balloon distension) and 11 healthy controls, in response to electrical stimulation of the rectum at 10cm from the anal verge using a bipolar stimulating electrode. Stimuli were delivered at pain threshold. Evoked potential peak latencies and amplitudes were analyzed, and inverse modeling was performed on traces obtained to determine the location of cortical generators. Key Results Pain threshold was higher in patients than controls [median 59 (range 23-80) mA vs 24 (10-55) mA; P=0.007]. Median latency to the first negative peak was 142 (±24) ms in subjects compared with 116 (±15) ms in controls (P=0.004). There was no difference in topographic analysis of EPs or location of cortical activity demonstrated by inverse modeling between groups. Conclusions & Inferences This study is the first showing objective evidence of alteration in the rectal afferent pathway of individuals with RH and constipation. Prolonged latencies suggest a primary defect in sensory neuronal function, while cerebral processing of visceral sensory information appears normal.

KW - Constipation

KW - Cortical processing

KW - Electroencephalography

KW - Inverse modeling

KW - Rectal evoked potentials

KW - Rectal hyposensitivity

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U2 - 10.1111/nmo.12047

DO - 10.1111/nmo.12047

M3 - Article

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SN - 1350-1925

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