Re: Research on link between and constipation--your thoughts?

[Guest guest]

Don't know if there is a connection, but I have achalasia and my mom has the

constipation

problem and apparently has lost motility in her intestines. Perhaps there is

some

connection, or just a coincidence?

Dayna

> I ran across a research study on biomedcentral. The link is below:

>

> http://www.biomedcentral.com/1471-230x/3/28

>

> I've been having some of the symptoms described in the study and I'm

> wondering if anyone else is having the same type problems. Even

> though it's not proven, my biggest fear has always been that the

> same type thing that is going on in my esophagus will happen in my

> colon. I've had every kind of test imaginable for my esophagus, and

> so far I've been lucky and never gone through a lower GI or

> colonoscopy. My doctor has always said that there's no link, but

> the study (published 10/2003) seems to say otherwise.

>

> I've faxed the article to my doctor and I hope to be getting his

> opinion on it soon. In the mean time, please let me know what you

> think, or if any of your doctors have ever mentioned a link between

> achalasia and constipation.

>

> Sharlene

[Guest guest]

Sharlene, I can understand your concerns. You asked for them, so here are my thoughts (I can see everyone out there rolling their eyes, thinking "here she goes again!" This is a long post, as I am so good at doing!)

There may or may not be a connection in some people, but I don't think that it will be easy to find any "real" connection between achalasia and constipation.

For starters, there are a gazillion reasons (okay, maybe just a thousand, but still a LOT!) for someone to be constipated. Even "constipation" is hard to use as a description, because it can involve so many different concepts... just like people here may say "vomitting" when what they really mean is "regurgitation of esophageal contents" rather than actual retching of stomach contents. The term 'constipated' has morphed to include basically ANY problems associated with pooping (with the exception of diarrhea, which is the opposite kind of poop problem!)

The classic definition of constipation is infrequent passage of very hard, dry poop. But as you can see in the article you mention, this doc says that the people he studied have soft stools on average of over once per day... hardly "infrequent" or "hard and dry." This doc is using the "strains to poop" definition of constipation. Other people have frequent poop that is hard, or infrequent poop that is soft.

If you poll people in general and ask if they suffer from constipation, you may get several "yes" answers, but they don't all have the same conditions/situations: some are infrequent and hard, some are infrequent and soft, some are frequent and hard, some are frequent and soft. Again, you also have people who interpret "suffer" differently. If they think, "yes, I have harder than normal stools, but no, it doesn't cause me pain/suffering" then they may answer "no" when in fact they ARE technically constipated. A better way to construct such a poll to get a Big Picture would be to ask several different types of questions, such as:

--I have infrequent stools that are hard and hard to pass that started before my achalasia symptoms.

--I have infrequent stools that are hard and hard to pass that started after my achalasia symptoms.

--I have infrequent stools that are hard but easy to pass that started before my achalasia symptoms.

--I have infrequent stools that are hard but easy to pass that started after my achalasia symptoms.

--I have infrequent stools that are soft and hard to pass that started before my achalasia symptoms.

--I have infrequent stools that are soft and hard to pass that started after my achalasia symptoms.

--I have infrequent stools that are soft but easy to pass that started before my achalasia symptoms.

--I have infrequent stools that are soft but easy to pass that started after my achalasia symptoms.

--I have frequent stools that are hard and hard to pass that started before my achalasia symptoms.

--I have frequent stools that are hard and hard to pass that started after my achalasia symptoms.

--I have frequent stools that are hard but easy to pass that started before my achalasia symptoms.

--I have frequent stools that are hard but easy to pass that started after my achalasia symptoms.

--I have frequent stools that are soft and hard to pass that started before my achalasia symptoms.

--I have frequent stools that are soft and hard to pass that started after my achalasia symptoms.

--I have frequent stools that are soft but easy to pass that started before my achalasia symptoms.

--I have frequent stools that are soft but easy to pass that started after my achalasia symptoms.

--I have normal frequency, normal consistency stools that are easy to pass.

--I have frequent extremely soft stools / diarrhea.

And even with this "multiple version" poll like above, that still doesn't give people an option to say if there's any other reason for their constipation. And there are multiple reasons for constipation. Literally dozens if not hundreds. Diet. Allergies. Physical Activity. Water Intake. Thyroid. Adrenal. Drugs. Personal Habits. Childbirth Injuries. Congenital Defects. Psychologic/Psychiatric Issues. Other Diseases. So if someone is taking a medication that causes constipation, but there's no place for them to "mention" that other cause, that can skew the poll as well.... instead of being due to achalasia, the constipation is due to the medication. Another thing is diet... if the diet is altered due to the achalasia, that can make the constipation appear to be connected to the achalasia, when in fact it is related to the changes in the diet. (Did the people in this study all eat the exact same foods and drink the same amount of water, etc?)

This particular study was done on an extremely small number of achalasia patients (nine) and this doctor was specifically looking for "constipated" achalasia patients, so six of his nine subjects fit the bill. I saw no mention of "randomly selected" achalasia patients, and since this doc's specialty / area of interest seems to be constipation, it's likely that people who are already constipated would be more inclined to sign up for the study, compared to people who have no constipation issues. I particularly took issue with this statement: "This high incidence of constipation in AE patients postulates a relationship between the 2 conditions." Since he didn't randomly select achalasia patients, and since he used such a teeny tiny subject pool, nobody in their right mind should expect such a statement to be taken seriously! In this study, 66% of achalasia patients have Hirschsprung's disease..... this is WAY out of line with reality! If this were a true reflection of achalasia patients, then 2/3 of the people in this group would have Hirschsprung's. I think with all the other studies that have been done on achalasia patients over the past century, SOMEONE would have noticed if 66% of us have Hirschsprung's! (at least I HOPE someone would notice something like that!)

To hopefully ease your fears a little bit:

**This study's patients all had the constipation BEFORE the achalasia, so it's not that the achalasia "moved to their colon".

**I've never heard of anyone in this group of 500+ people who went on to develop a degenerative disease of the colon after developing achalasia. Some people here have IBS (irritable bowel syndrome), but there's been nothing to show a connection with achalasia there, either. Some people with IBS have achalasia; Most people with IBS do NOT have achalasia. Some people with achalasia have IBS; Most people with achalasia do NOT have IBS.

**It is still unknown WHAT causes achalasia. (Personally, I tend to believe that there are multiple causes which end up having the same end result of achalasia..... kinda like there are several ways to break your arm [fall off bike, get in car accident, trip down the stairs, etc.] that all result in a broken bone -- different causes, same result.) If, for example, there are 50 different viruses (or whatever) that can cause achalasia, then it could be that one or more of those causes can also affect the nerves in the rectal neck area, but that others don't.

**There may also be a pre-existing situation that makes some people (but not all people) get both conditions -- they may be predisposed, either by previous disease or simply by genetics, to having the rectum AND the esophagus be affected.

**There may be two different causes, and these six people were unlucky enough to be exposed to both.

All in all, I don't care at all for the way this study was put together. The subjects weren't randomly selected. It wasn't a blind study (the patients KNEW that they were looking at constipation, which can affect the results), let alone a double-blind study (the doctors also knew who had what symptoms/syndromes.) There wasn't a TRUE control group: they compared the achalasia / Hirschsprung's people to regular people without either condition; did they ever find non-achalasia patients with Hirschsprung's? What percentage of the population at large has this adult-onset Hirschsprung's, and how does that compare to the percentage of ALL achalasia patients with adult-onset Hirschsprung's? And while there's nothing specifically wrong with quoting material from your previous studies, 1/3 of this guy's references at the end of this article were referring to his own previous articles.... if THOSE articles are as biased and as limited as this one, then the info he's basing this current article on isn't very sound, is it?

I feel that the study is very misleading, and leaves you with more questions than answers. That may have actually been the intent, though....if this doc is trying to get funding to do a larger-scale study, then this study may have been designed to give the appearance of a connection, so that his funding request would get approved. Who knows, though?

I'd be interested in hearing what your doc has to say about this....

Debbi in Michigan (maybe I should change my screen name to "Doubting Debbi" with as cynical as I am!)

I ran across a research study on biomedcentral. The link is below: http://www.biomedcentral.com/1471-230x/3/28I've been having some of the symptoms described in the study and I'm wondering if anyone else is having the same type problems. Even though it's not proven, my biggest fear has always been that the same type thing that is going on in my esophagus will happen in my colon. I've had every kind of test imaginable for my esophagus, and so far I've been lucky and never gone through a lower GI or colonoscopy. My doctor has always said that there's no link, but the study (published 10/2003) seems to say otherwise.I've faxed the article to my doctor and I hope to be getting his opinion on it soon. In the mean time, please let me know what you think, or if any of your doctors have ever mentioned a link between achalasia and constipation.Sharlene

[Guest guest]

All I have to say is "why in the world would someone want to study poop for a living?". Cindi, whose 6th child is FINALLY POTTY TRAINED AS OF THIS WEEK!

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[Guest guest]

Congrats on the PT, Cindi! Isn't it amazing how much easier it is to do stuff spontaneously when you don't have to make sure you have dipes and wipes on hand all the time? :oD

And I hear you on the poop-subject, too.... I used to joke w/ my old manometry tech, b/c he said he wanted to go back to school and study gastroenterology. I gave him a hard time about picking the ONE specialty that dealt with the orifices and substances that are the grossest, smelliest, nastiest stuff! :oPDebbiAll I have to say is "why in the world would someone want to study poop for a living?".

Cindi, whose 6th child is FINALLY POTTY TRAINED AS OF THIS WEEK!

[Guest guest]

Jo wrote:

--What about being a proctologist? That's not too much fun either.

Good point! LOL

I agree with you on the article. Limited number of A's studied, and Hirschprung disease to boot--atypical, not proven.

Thanks for backing me up on this... I hate to sound like a cynic all the time, but I try to take everything I read with SEVERAL grains of salt (remember, I have low blood pressure, so it's ok! LOL) This study was so flawed that I couldn't even believe that the researcher had the nerve to publish it!

If this was brought up as part of the evidenced-based medicine that is so prevalent today, it would be "poo-pooed.", by the experts, so to speak.

Oh, Jo, that was AWFUL! LOLDeb