Colonic Motility in Constipation and Ageing
Colonic Motility in Constipation and Ageing
The reason chronic constipation (CC) becomes commoner with age is not fully understood. New
 studies suggest that bowel contraction patterns, dietary fibre and gut bacteria are important
 and may differ in older people. Since CC reduces quality of life and is a major reason why
 elderly are admitted to hospitals and residential care, there is a need to understand how
 these factors change with age.

 Currently, placing a pressure sensing catheter inside the large intestine (pancolonic
 manometry) is the gold standard way to measure how well it contracts. However this involves a
 camera test (colonoscopy) which is invasive with risks of bowel perforations (~80/100,000).
 The risk is higher with age (64-80yr: ~90/100,000; 80+yrs: ~120/100,000), making it unethical
 for elderly.

 A technique called the 3D-Transit System has been developed, involving a small ingestible
 capsule, containing a 'trackable' electromagnet. By tracking movements of the capsule
 swallowed by participants, it provides precise detailed information on the capsule
 progression inside the whole gut and large bowel's contractile activity in real-time. It is
 minimally-invasive and radiation-free, making it possible to assess elderly for the first
 time.

 This study aims to assess how bowel contraction patterns, dietary fibre intake and gut
 bacteria differ between young and older adults (with and without CC), to better understand
 why CC is more common in elderly.

 It is a pilot, 4 arm, single centre, observational study involving 60 women aged 18-40 years
 and 70-90 years (15 non-constipated and 15 with CC for each age group). The study lasts 3
 weeks, containing 2 weeks of run-in period and 1 week of study period.

 The four groups participants will be asked to: swallow 2 capsules to assess their large
 bowel's contractile function using the 3D-transit system; provide stool samples to analyses
 their gut bacteria; and complete questionnaires to assess their gastrointestinal symptoms.
Inclusion criteria for constipated group

 -  Aged 18-40 or 70-90 years of age

 -  Barthel index ≥11 [for elderly women only]

 -  No co-existing acute or chronic diseases at the time of recruitment (except
 hypertension and hypercholesterolemia for elderly women)

 -  Patients with self-reported problematic constipation

 -  Cleveland Clinic Constipation Score ≥8

 -  Bowel movement frequency <3 per week

 -  Stool consistency of 1-3 on the Bristol Stool Chart

 -  No evidence of organic causes of constipation

 -  Symptoms of constipation (unsatisfactory defaecation characterized by infrequent
 stool, difficult stool passage or both for at least the previous 3 months)

 Inclusion criteria for non-constipated group

 -  Healthy women aged 18-40 or 70-90 years of age

 -  No co-existing acute or chronic diseases at the time of recruitment (except
 hypertension and hypercholesterolemia for elderly women)

 -  Barthel index ≥11 [for elderly women only]

 -  Cleveland Clinic Constipation Score <8

 Exclusion Criteria:

 -  Inability to understand written and spoken English

 -  Lacking capacity to understand subject information sheet and give informed consent

 -  Vulnerable subject groups (e.g. elderly with dementia)

 -  Pregnancy, intention to become pregnant, or breastfeeding during study period

 -  Recent childbirth in the last 6 months

 -  Other causes of reduced / dysregulated GI motility and secondary constipation

 -  Conditions which make it unsafe to use the capsules