Upper and lower gastrointestinal motor and sensory dysfunction after human spinal cord injury.

This chapter describes the results of investigations of the upper and lower gastrointestinal tract in subjects with complete and incomplete spinal cord injury. In one study, gastric emptying was investigated and found delayed. The delay was tentatively attributed to a colo-gastric inhibitory reflex triggered by inappropriate colonic emptying. In another study, anorectal motor and sensory functions were measured. Decreased tone of the internal anal sphincter, exaggerated recto-anal reflexes following rectal distension and spontaneous high-amplitude rectal contractions at low distension volumes were among the findings of the study. Some of the subjects, classified as having a complete injury according to usual clinical criteria (American Spinal Injury Association, ASIA), reported sensation of distension of the rectum. This raises the issue of the need for better methods for the clinical assessment of sensory transmission in the spinal cord. Promising results obtained with functional magnetic resonance imaging of the brain during rectal stimulation in a small group of paraplegics, with complete injuries by ASIA criteria, showed evidence of activation of several brain regions.