Idiopathic megacolon and slow-transit constipation: the comparison of clinical features and quality of life

AIM: to compare the clinical features and quality of life estimation in patients with chronic constipation due to idiopathic megacolon/megarectum and slow-transit constipation.

PATIENTS AND METHODS: the comparative retrospective analysis (2003-2024) had been provided in 260 patients with chronic constipation, which were undergone barium enema to exclude/confirm megacolon/megarectum. 1 group (n=158) consisted of patients with idiopathic megacolon/megarectum. Hirschsprung’s disease was excluded in all patients based on complex of clinical features, barium enema and anorectal manometry results and (if needed) rectal Swenson’s biopsy. 102 patients with chronic slow-transit constipation and normal size of the bowel were included in 2 group.

RESULTS: In 1 group patients were statistically significant younger (Me=26.0 (19.0; 43.0) years and Me=33.0 (23.0; 48.0) years (p=0.043)) and significant male predominance were observed (87/158 (55.1%) vs 15/102 (14.7%), (p<0.0001)). Wexner constipation scale rate, burden of symptoms of  abdominal discomfort and defecation difficulties in point scale were significant higher in 2 group patients with normal size of bowel (p=0.01, p=0.013 and p=0.0005, respectively). Summary assessment of quality of life with an IBSQOL questionnaire were significant better in 1 group (p=0.0001). At the same time there were no significant difference in overall transit time between groups (p=0.789). Defecation impairment assessed by defecography (time of defecation and rest volume) were significant more in 1 group (p<0.0001 for both). In multivariate analysis (General regression models),taking into account age and gender of patients, the presence of megacolon/megarectum was significant independent predictor of better quality of life, as the young age too ((p=0,001 и p=0,013, respectively). In addition, contrary to defecography results, there was significant association between the presence of megacolon/megarectum and lower rate of “defecation difficulties” scale (p=0,002). At the same time female gender was only significant independent predictor of burden of Wexner constipation scale and “abdominal discomfort” scale (p=0.0007 и p=0.048, respectively).

CONCLUSION: patients with chronic constipation due to idiopathic megacolon/megarectum have significant better quality of life and lower burden of clinical features then slow-transit constipation ones.

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