Intest Res  
Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome
Takeshi Mizukami1*, Shinya Sugimoto2*, Tatsuhiro Masaoka2, Hidekazu Suzuki3, Takanori Kanai2
1Endoscopy Center, NHO Kurihama Medical and Addiction Center, Yokosuka, 2Division of Gastroenterology and Hepatology, Department of Internal Medicine and 3Medical Education Center, Keio University School of Medicine, Tokyo, Japan
Correspondence to: Takeshi Mizukami, Endoscopy Center, NHO Kurihama Medical and Addiction Center, 5-3-1 Nobi, Yokosuka, Kanagawa 239-0841, Japan. Tel: +81-4-68481550, Fax: +81-4-68497743, E-mail: mi-zukami@violin.ocn.ne.jp
*These authors contributed equally to this study.
Received: October 10, 2016; Revised: December 4, 2016; Accepted: December 6, 2016; Published online: March 20, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

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Abstract
Background/Aims: Colonoscopy and computed tomography (CT) are used primarily to exclude organic diseases in patients with irritable bowel syndrome (IBS), rather than to assess the pathophysiology of IBS. We aimed to evaluate colonic dysmotility and morphology in Japanese patients with IBS. Methods: One hundred eighty-four patients with IBS and 49 asymptomatic controls who underwent colonoscopy in combination with CT colonography or barium enema were retrospectively reviewed between 2008 and 2012. Water-aided colonoscopy was performed without sedation by a single endoscopist. The duration and pattern of colonic movement and cecal intubation time were recorded. To assess colonic morphology, barium enema or CT colonography were performed immediately after colonoscopy. Results: Colonic dysmotility was more frequent in the IBS group (28.8% vs. 2.0% in controls, P <0.001), especially in cases of IBS with diarrhea (IBS-D) (IBS with constipation [IBS-C] 27.8% vs. IBS-D 60.0% vs. mixed IBS [IBS-M] 5.1%, P <0.001). Colonic morphological abnormality was more frequent in the IBS group than in the control group (77.7% vs. 24.5%, P <0.001), especially in IBS-M and IBS-C groups (IBS-C 77.5% vs. IBS-D 48.9% vs. IBS-M 100%, P <0.001). Most patients with IBS with colonic dysmotility had experienced stress related to their symptoms. Cecal intubation time was significantly longer in the IBS group than in the control group (12.1±6.9 minutes vs. 4.6±1.9 minutes, P <0.001). Conclusions: Unsedated colonoscopy, combined with radiographic findings, can detect colonic dysmotility and morphological abnormality. Technical difficulties observed during cecal intubation may partially explain the pathophysiology of IBS.
Keywords: Colonoscopy; Irritable bowel syndrome; Water immersion; Sedation; Radiography


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