Mechanism of constipation and response to diet : novel insights from manometry and magnetic resonance imaging

Constipation is a common condition in which an individual suffers with hard stools which are infrequent and difficult to pass. It has an estimated prevalence of 15-20% however the pathophysiology of symptoms remains poorly understood and treatment is often unsatisfactory for patients. In approximately 60% of patients their constipation is associated with abdominal pain, whilst in the remaining this appears in absence of pain. This thesis is split into three sections, in the first I will review the background and current investigation and treatment strategies in constipation. The second will look at two healthy volunteer studies performed looking at the effect of different foods on gut function and how these could be relevant to treatment of constipation. In the third I will describe our patient study into the pathophysiology of constipation that take advantage of two new techniques. These are Magnetic Resonance Imaging (MRI), which allows us to see the contractions of the colon and High-Resolution Manometry (HRM) which measures the contraction using pressure sensing catheters placed into the bowel. Using these techniques, we will identify patterns of contractions in each patient and compare to healthy controls to determine whether these could be used to predict different treatment response