Bowel 'pacemaker' relieves severe constipation

A condition called "total colonic inertia" leads to severe constipation, but a device similar to a heart pacemaker can relieve the problem, an Egyptian group reports.

The team identified four sites along the bowel where natural electrical waves initiate colonic motility, which normally moves fecal matter through the gut. "In colonic inertia, however, no such waves could be recorded," Dr. Ahmed Shafik from Cairo University, Egypt told AMN Health.

To correct this lack of electrical activity, Dr. Shafik and colleagues put electrodes at each of the four sites and connected them to a pacemaker implanted in the groin area in nine patients with total colonic inertia.

The pacemaker induced defecation in six of the nine patients, and three developed spontaneous defecation without colonic pacing after 2 to 4 months of daily pacing sessions, the researchers report in the Archives of Surgery.

"We have patients in whom the electrodes and stimulators were removed with the onset of spontaneous defecation after variable periods of colonic pacing. These patients have normal bowel habits for more than 2 years after pacing was ceased," Shafik said. "We have other patients who are still pacing after 2 years and are satisfied and doing well."

He recommended that other doctors caring for similar patients try colonic pacing "before taking the decision to remove the colon."

Shafik added, "We are trying to simplify the system of colonic pacing by introducing the use of high technology electronics and remote control systems."

SOURCE: Archives of Surgery, July 2004.