Left Colonic Transit Time Research Articles

Subtyping irritable bowel syndrome using cluster analysis: a systematic review

BackgroundIrritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder associated with a wide range of clinical symptoms. Some researchers have used cluster analysis (CA), a group of non-supervised learning methods that identifies homogenous clusters within different entities based on their similarity.Objective and methodsThis literature review aims to identify published articles that apply CA to IBS patients. We searched relevant keywords in PubMed, Embase, Web of Science, and Scopus. We reviewed studies in terms of the selected variables, participants’ characteristics, data collection, methodology, number of clusters, clusters’ profiles, and results.ResultsAmong the 14 articles focused on the heterogeneity of IBS, eight of them utilized K-means Cluster Analysis (K-means CA), four employed Hierarchical Cluster Analysis, and only two studies utilized Latent Class Analysis. Seven studies focused on clinical symptoms, while four articles examined anocolorectal functions. Two studies were centered around immunological findings, and only one study explored microbial composition. The number of clusters obtained ranged from two to seven, showing variation across the studies. Males exhibited lower symptom severity and fewer psychological findings. The association between symptom severity and rectal perception suggests that altered rectal perception serves as a biological indicator of IBS. Ultra-slow waves observed in IBS patients are linked to increased activity of the anal sphincter, higher anal pressure, dystonia, and dyschezia.ConclusionIBS has different subgroups based on different factors. Most IBS patients have low clinical severity, good QoL, high rectal sensitivity, delayed left colon transit time, increased systemic cytokines, and changes in microbial composition, including increased Firmicutes-associated taxa and depleted Bacteroidetes-related taxa. However, the number of clusters is inconsistent across studies due to the methodological heterogeneity. CA, a valuable non-supervised learning method, is sensitive to hyperparameters like the number of clusters and random initialization of cluster centers. The random nature of these parameters leads to diverse outcomes even with the same algorithm. This has implications for future research and practical applications, necessitating further studies to improve our understanding of IBS and develop personalized treatments.

Region-specific remodeling of the enteric nervous system and enteroendocrine cells in the colon of spinal cord injury patients

Patients with spinal cord injury (SCI) suffer from major bowel dysfunction, whose exact pathophysiology, particularly the involvement of the enteric nervous system or epithelial dysfunction is poorly understood. Herein, we aimed to characterize the mucosal biopsies of the right and left colon in SCI patients vs controls (CT): (1) remodeling of key enteric neurotransmitters, (2) remodeling of enteroendocrine cells, and (3) mucosal inflammation compared to those in controls. In SCI, mucosal ACh concentration was lower in the right colon as compared to CT, but no change was observed in the left colon, and AChE expression was lower in both the right and left colons than in CT. While the VIP concentration was similar in the right and left colons, VIP mRNA expression was increased in the right colon and decreased in the left colon, in SCI patients as compared to CT. Interestingly, 5-HT concentration was reduced in the left colon but not in the right colon in SCI patients. Moreover, in SCI patients, as compared to CT, SERT mRNA expression was selectively increased in the left colon while TPH1 mRNA expression was increased in the right and left colons. Although mucosal TNFα and IL-1β mRNA expression did not significantly differ between SCI and CT groups, we identified a significant positive correlation between TNFα and IL-1β mRNA expression and left colon transit time in the SCI group. In conclusion, region-specific changes occur in the enteric neurotransmitter, serotonergic, and inflammatory pathways in the colon of SCI patients. The significant correlations between these pathways and clinical parameters in the left colon further set a scientific basis for designing therapeutic targets to improve colonic motor dysfunction in patients.Biobank information: Spinal cord injury patients: PHRC ConstiCAPE—clinical trial NCT02566746. Controls: Anosain—clinical trial NCT03054415 and biobank of the “Institut des Maladies de l’Appareil Digestif (IMAD)” registered under number DC-2008-402.

Study on the characteristics of intestinal motility of constipation in patients with Parkinson's disease.

BACKGROUNDConstipation is one of the most important nonmotor symptoms in Parkinson's disease (PD) patients, and constipation of different severities is closely related to the pathogenesis of PD. PD with constipation (PDC) is considered a unique type of constipation, but its mechanism of formation and factors affecting its severity have been less reported. Understanding the gastrointestinal motility characteristics and constipation classification of PDC patients is essential to guide the treatment of PDC. In this study, the colonic transit test and high-resolution anorectal manometry were used to identify the intestinal motility of PDC to provide a basis for the treatment of PDC.AIMTo investigate the clinical classification of PDC, to clarify its characteristics of colonic motility and rectal anal canal pressure, and to provide a basis for further research on the pathogenesis of PDC.METHODSTwenty PDC patients and 20 patients with functional constipation (FC) who were treated at Xuanwu Hospital of Capital Medical University from August 6, 2018 to December 2, 2019 were included. A colonic transit test and high-resolution anorectal manometry were performed to compare the differences in colonic transit time, rectal anal canal pressure, and constipation classification between the two groups. RESULTSThere were no statistically significant differences in sex, age, body mass index, or duration of constipation between the two groups. It was found that more patients in the PDC group exhibited difficulty in defecating than in the FC group, and the difference was statistically significant. The rectal resting pressure, anal sphincter resting pressure, intrarectal pressure, and anal relaxation rate in the PDC group were significantly lower than those in the FC group. The proportion of paradoxical contractions in the PDC group was significantly higher than that in the FC group. There was a statistically significant difference in the type composition ratio of defecatory disorders between the two groups (P < 0.05). The left colonic transit time, rectosigmoid colonic transit time (RSCTT), and total colonic transit time were prolonged in PDC and FC patients compared to normal values. The patients with FC had a significantly longer right colonic transit time and a significantly shorter RSCTT than patients with PDC (P < 0.05). Mixed constipation predominated in PDC patients and FC patients, and no significant difference was observed. CONCLUSIONPatients with PDC and FC have severe functional dysmotility of the colon and rectum, but there are certain differences in segmental colonic transit time and rectal anal canal pressure between the two groups.

Effects of core strengthening exercise on colon transit time in young adult women

Background/objectiveThis study investigated the effects of core strengthening exercise (CSE) on colon transit time (CTT) in young adult women. MethodsEighty women (mean age 23 years) were enrolled and randomly assigned to participate in a 12-week, instructor-led group CSE program (CSE group [CSEG]; n = 40) or to maintain usual daily activities (control group [CG]; n = 40). 27 participants in the CSEG and 21 participants in the CG completed the study. The CSE program consisted of 60-min sessions, two days a week, for 12 weeks. CTT was measured using a multiple marker technique with a radio-opaque marker. Data were analyzed with a 2-way, repeated measures ANCOVA. ResultsAfter the 12-week intervention, The CSEG showed significant improvements in trunk flexor power (P = 0.031), peak torque (P = 0.032), and endurance (P = 0.011). The CSEG also showed improvements in the sit-up (P < 0.001) and side-step (P = 0.043) tests compared to the CG. While there was not a significant group difference between the CSEG and CG, left CTT (P = 0.021) and total CTT (P = 0.006) decreased significantly within the CSEG group only. ConclusionThe 12-week CSE program increased abdominal strength but did not improve CTT compared to the control group. This study also provides preliminary data that CSE may reduce left CTT and total CTT, but additional clinical trials are needed.

Effect Of Core Strength Exercise On Colon Transit Time In Female University Students

PURPOSE: To evaluate the benefit of core strength exercise (CSE) on colonic transit time (CTT) for female university students. METHODS: Eighty women were enrolled and randomly assigned to participate in a 12-week instructor-led group CSE program (exercise group; n = 40) or to maintain their ordinary daily activities (control group; n = 40). The final groups were composed of 27 participants (age: 22.9 years) in the exercise group and 21 participants (age: 22.9 years) in the control group (CG). The CSE program consisted of 60 minute sessions, two days a week for 12 weeks. Each session included a 10-minute warm-up, 40-minute core strengthening exercises, and 10-minute cool-down. Body composition, Trunk muscle power and endurance, physical fitness and CTT were measured twice before and twice after the exercise program. CTT was measured using a multiple marker technique with a radio-opaque marker. Data were analyzed with a 2-way, repeated measures ANOVA. RESULTS: After the 12-wk core exercise intervention, decreased intestinal transit time was observed in segment CTT of the exercise group, including the right CTT (exercise: 9.0 ± 1.8 vs 6.4 ± 1.5, control: 5.3 ± 1.3 vs 6.5 ± 1.5), left CTT (exercise: 10.9 ± 2.0 vs 6.9 ± 1.8, control: 10.6 ± 2.3 vs 8.7 ± 1.5), recto-sigmoid CTT (exercise: 17.4 ± 2.9 vs 12.1 ± 2.0, control: 8.7 ± 2.3 vs 11.9 ± 2.8), and total colonic transit time (TCTT) (exercise: 37.5 ± 4.4 vs 25.5 ± 3.8, control: 24.7 ± 4.8 vs 27.2 ± 4.8). After the 12-wk core exercise period, LCTT (mean difference, -3.7 h; 95% confidence interval [CI], -6.9 to -0.6 h; P=0.02) and TCTT (mean difference, -9.4 h; 95% CI, -16.4 to -2.4 h; P=0.01) was significantly shortened within the exercise group in mean changes from baseline to 12wk follow-up. CONCLUSIONS: The CTT was reduced due to increased physical activity via a 12-wk CSE program. In addition to eating habits, water intake, and fiber intake, the increased physical activity level as a result of the 12-wk CSE reduced the CTT. Further prospective studies will need to study the effects on CTT according to dose-response, type of exercise, and intensity.

Clinical, Physiological, and Psychological Correlates of the Improvement of Defecation during Menses in Women with Functional Gastrointestinal Disorders

Background/Aims: Little is known about the improvement in defecation frequently reported by women around menses. We aimed to describe clinical, physiological, and psychological correlates of this improvement in those with functional bowel disorders. Patients and Methods: We recruited 478 consecutive premenopausal adult females with no indication of gynecologic or psychiatric disease, who were attending an outpatient functional bowel disorders clinic. Patients completed a Rome III questionnaire, psychological evaluation stool form, and a 10-point Likert scale for constipation, diarrhea, bloating, and abdominal pain. These patients underwent physiological tests, anorectal manometry, and colonic transit time and were classified according to the presence or the absence of improvement in defecation during menses. The reverse selection procedure was used for model selection during multivariate logistic regression where statistically significant variables (p < 0.01) remained in the adjusted model. Results: Ninety-seven patients (20%) reported easier defecation during menstruation. These patients were younger (p < 0.001) but had similar body mass indices and psychological profiles as the other patients. Clinically, they only reported more frequent irritable bowel syndrome (IBS) with constipation (p = 0.007), with harder stools (p = 0.005) and delayed left colon transit time (p = 0.002). No anorectal manometric parameter was different between the 2 groups. Conclusion: Improvement of constipation during menses is mainly associated with younger age and constipation-IBS phenotype and not with functional constipation.

The evaluation of GI-pill gastrointestinal electronic capsule for colonic transit test in patients with slow transit constipation.

The evaluation of GI-pill gastrointestinal electronic capsule for colonic transit test in patients with slow transit constipation (STC) was studied. STC patients (n = 162) were randomly divided into experimental group (n = 84, orally taken GI-pill gastrointestinal electronic capsule and X-ray granule capsule) and control group (n = 78, orally taken X-ray granule capsule). Comparison of the time in colonic transit test between the two groups was conducted. The data of GI-pill gastrointestinal electronic capsule in vivo time, time of capsule passing through the colon, the number of high amplitude propagating contractions (HAPCs), and physiological response ratio were analyzed. There were no significant differences in the whole colonic transit test time, right colonic transit time, left colonic transit time, and rectosigmoid colonic transit time between experimental group and control group (p > 0.05). All patients had no abdominal pain, nausea, vomiting, black stool, difficulty in electronic capsule excretion, or any other discomfort during the test. GI-pill gastrointestinal electronic capsule can continuously evaluate the dynamic characteristics of digestive tract in STC patients and is consistent with X-ray granule capsule, which is meaningful to clinical application.

Prediction of Inadequate Bowel Preparation Using Total and Segmental Colon Transit Time in Patients with Chronic Constipation: Some Different Outcomes

Aims Radio-opaque markers have been widely used in the study of colon motility in patients with chronic functional constipation (FC). Here, we evaluate the relationship between the colon transit time (CTT) and the Boston Bowel Preparation Scale (BBPS) to determine whether CTT is a sufficient predictor of bowel preparation in patients with chronic functional constipation. Methods A total of fifty-six patients with constipation and fifty-two healthy controls (HC) were enrolled in this study. All subjects underwent the colonic transit study using radio-opaque markers and were given a follow-up colonoscopy examination on day 3 to 7 to determine BBPS. The correlation between total and segmental CTT and BBPS was evaluated, and risk factors for predicting inadequate bowel preparation were determined. Results In our study, we found some distinct outcomes compared with previous studies. The mean total CTT (TCTT) was determined to be 43.37 ± 18.82 h in the FC group and 23.08 ± 10.18 h in the HC group. This difference was found to be significant for both the total and segmental CTTs between the two groups (P < 0.05). Further, TCTT was negatively correlated with BBPS both in the FC (r = −0.899, 95% CI -0.748 to -0.925, P < 0.001) and the HC (r = −0.978, 95% CI -0.854 to -1.003, P = 0.004) groups, as was segmental CTTs and segmental BBPS (P < 0.05). In the case of patients with slow transit constipation, multivariate logistic regression analysis indicated that prolonged TCTT (OR 0.722, 95% CI 0.589-0.885, P = 0.002) was independently associated with poor bowel preparation. The total and right to left CTTs were found to predict inadequate bowel preparation and exhibited the best sensitivity and specificity at 48.0 h, 15.5 h, 17.5 h, and 19.0 h, based on ROC curve analysis. Conclusions The CTT test represents a valuable method for predicting the level of bowel preparation prior to a colonoscopy examination. That is, both total and segmental CTTs can be considered an objective predictor of bowel preparation prior to colonoscopy. The present study demonstrates some distinct results relative to previous studies, including STC subtype proportion in FC, the proportion of inadequate bowel preparation in the STC subtype, and the cut-off value of TCTT for predicting inadequate bowel preparation.

Influence of Age and Body Mass Index on Total and Segmental Colonic Transit Times in Constipated Subjects.

Background/AimsDiscordant data are found in the literature for the relationships between total and segmental colonic transit time (CTT) and demographic parameters. The aim of this study is to examine the influence of age, and body mass index (BMI) on total and segmental CTT in constipated subjects.MethodsWe included 354 constipated patients on this cross-sectional study. According to the Rome III criteria, patients were classified as having irritable bowel syndrome with constipation, or functional constipation. All patients filled the Bristol stool form, and reported the severity of constipation, bloating, and abdominal pain on a 10-point Likert scale. Total and segmental CTT were measured using radiopaque markers.ResultsFemales were 84% of patients, with a mean age of 46.0 ± 15.9 years. The association between total and segmental CTT with age and BMI was significant after adjustment for gender, clinical phenotype, the presence of defecation disorders, and abdominal pain or bloating intensity despite the severity of symptoms, and the frequency of defecation disorders were higher in irritable bowel syndrome with constipation than in functional constipation patients. By comparison with subjects less than 30 years, rectosigmoid transit time (RSTT) was lower in patients between 30 and 60 years. Age was negatively associated with RSTT (P = 0.004). By comparison with patients with normal BMI, RSTT and total CTT were lower in patients of the overweight group. BMI was negatively associated with RSTT (P < 0.001). The severity of constipation was correlated with total (P < 0.001), right (P = 0.002), and left CTT (P = 0.049).ConclusionAge and BMI are both associated with RSTT in constipated patients.

The effects of maitland orthopedic manual therapy on improving constipation.

[Purpose] This study aimed to examine the effects of interventions on constipation and to provide basic data for physical therapy in internal medicine. [Subjects and Methods] The colon transit times of 30 subjects were measured and after the interventions. Fifteen subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were assigned to a dietary fiber group. [Results] The analysis of changes in colon transit time showed statistically significant differences in left colon transit time, rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic manual therapy group and statistically significant differences in rectosigmoid colon transit time and total colon transit time for the dietary fiber group. An analysis of group differences in the effects of Maitland orthopedic manual therapy and dietary fiber showed that the Maitland orthopedic manual therapy group achieved statistically significantly larger declines in rectosigmoid colon transit time and total colon transit time compared with the dietary fiber group. [Conclusion] This study confirmed that Maitland orthopedic manual therapy can be an effective treatment method for internal conditions such as functional constipation by almost normalizing the colon transit time, not only by improving the symptoms of constipation but also by facilitating intestinal movements.

PWE-164 A Meta-analysis Of Randomised Controlled Trials On The Effect Of Probiotics On Functional Constipation In Adults

IntroductionConstipation is a prevalent gastrointestinal disorder whose treatment remains challenging. Patient dissatisfaction with prescribed medications is common, and there is a need for alternative methods of management. Probiotics are live...

The effect of defecate function in constipation by a 8‐week supplementation of Prunus mume fruit extract: a randomized double‐blind, placebo‐controlled trial (647.30)

In our previous study, Prunus Mume Fruit Extract (PMFE) has laxative effects in animal model induced constipation by a low‐fibre diet. The purpose of this study was to investigate whether supplementation with PMFE could improve defecate function in human subjects with constipation.We conducted a double‐blind, randomized, placebo‐controlled trial. Patients consumed PMFE (7.2 g) or a placebo before consumption of a meal every morning and evening for 8 weeks. The effects of PMFE on colon transit time (CTT) and defecation function by questionnaire were evaluated in 28 patients and compared with the placebo group (n=29).Among CTT, no significant differences in right CTT, left CTT were observed between the two groups. However, a significant decrease rectosigmoid CTT and total CTT was observed in the PMFE group. Moreover, PMFE decreased abdominal pain during defecation and significant and increase refreshing feeling after evacuation compared with compared with the placebo group at the end of the study. No adverse effects were reported in any of the patients.Based on the results of this study, PMFE supplementation improved defecate function in human subjects with constipation. 2

Pathophysiology of chronic childhood constipation: Functional and morphological evaluation by anorectal manometry and endosonography and colonic transit study

BackgroundChronic idiopathic constipation (IC) is a common problem in children. We hypothesised that hypertonicity and overactivity of the internal anal sphincter (IAS) contributed to childhood IC. MethodThis was a prospective study of children who were admitted for investigation and treatment of chronic constipation at the gastrointestinal motility clinic in Guy's and St. Thomas’ Hospital, NHS Foundation Trust, London. All children had a colonic transit marker study followed by anorectal manometry and anal endosonography under ketamine anesthesia. We used a validated symptom severity (SS) score questionnaire for assessment of constipation and fecal incontinence on admission to hospital and during follow-up for 12months. The SS score of 0 was the best and 65 the worst. ResultsOf 92 children, 57 were male and median (range) age was 8.46years (3.35–14.97). Duration of symptoms was 4.7years (0.3–13). Soiling was present in 88 (96%) patients, delay in defecation of once every 2 to 3days or less frequently in 86 (93%) and a palpable fecaloma (megarectum) on abdominal examination in 76 (83%). 42 children had ‘fecal impaction’ requiring disimpaction of stool from the rectum under general anesthesia and 50 had ‘no impaction’.The median IAS resting pressure was within the normal range measuring 55mm Hg (25–107) and median amplitude and frequency of the IAS contractions were 10mm Hg (2.0–58) and 17cycles per min (5.0–34), respectively. The median IAS thickness was 0.93mm (0.5–2.0). There was no correlation between amplitude and frequency of anorectal contractions and anal sphincter resting pressure. The mean right colonic transit time was 8.55 (standard deviation ±13.22) h, left colonic transit time was 11.51h (±13.21), rectosigmoid transit time was 25.91h (±18.89) and total colonic transit time was 45.97h (±17.69). ConclusionThe anal sphincter resting pressure is normal in children with chronic IC. Increased frequency and amplitude of IAS contractions seen in these patients do not cause raised anal sphincter resting pressure or obstructive defecation. Further studies should be done to investigate the role of external anal sphincter dysfunction in pathophysiology of childhood constipation and fecal incontinence.

Sa1161 The High Prevalence of the Positivity to the Lactulose Methane Breath Test in Constipated Patients With Delayed Colonic Transit

Background: Methane (CH4) producing small intestinal bacterial overgrowth (SIBO) is related with constipation, however its relationship with colonic motility is unclear. The aims were to evaluate breath CH4 associated with colonic transit and anorectal pressure in constipated patients. Methods: The study with prospectively collected database involved 51 constipated patients who underwent lactulose CH4 breath test (LMBT), colon marker study, and anorectal manometry. The profile of LMBT in patients were compared to 49 healthy controls. The positivity to LMBT was CH4≥10 ppm in baseline or above baseline within 90 min. The types of constipationwere defined as normal transit and delayed transit constipation according to retention of ≥20% colonic markers. Results: The mean age of the patient was 57.3 years (range: 41 ~ 80 years) and 13 patients (23.8%) were men. There were significant differences in the breath CH4 at the time points of 0, 15, 30, 45, 60, 75, 90, 105, 120, and 135 minute intervals between the delayed transit patients and 1) normal transit patients, or 2) healthy controls, respectively (Fig 1). The positivity to LMBT were higher in delayed transit patients (53.3%, 8/15), than in healthy controls (13.9%, 5/36) or in normal transit patients (53.3%, 8/15), respectively (P < 0.01). The delayed transit was the only independent factor for the positivity to LMBT (OR (95% CI), 142.86 (3.44 9090.9), P < 0.01). The left and total colonic transit time were significantly increased in LMBT-positive patients than in -negative patients (16.4±13.4 vs. 32.5±16.9, P < 0.01, and 48.1±40.2 vs. 82.4±36.7, P < 0.01). The significant correlation was shown between total breath CH4 and time of left colonic transit (γ = 0.39, P < 0.01) (Fig 2), or total colonic transit (γ = 0.33, P = 0.02). However, no significant difference was observed in parameters of anorectal manometry according to LMBT status. Conclusions: SIBO was associated with delayed colonic transit, especially with left colonic transit time, accordingly, which might create a vicious cycle. Further investigation is needed to break the link by therapeutic modality such as antibiotics to target the CH4 producing intestinal bacteria.

The Clinical Implications of Childhood Traumatic Events in Irritable Bowel Syndrome.

G A A b st ra ct s correlations were noted between abdominal pain and right colon transit time (r=-0.18; p<0.05) and bloating and left colon transit time (r=0.16; p<0.05). No associations were found between CTT and other GI symptoms, age, anxiety or depression. Conclusion: Total and segmental colonic transit alterations are of importance for the abnormal bowel habit seen in men and women with IBS, but of no or minor importance for other IBS symptoms. Colonic transit is not associated with psychological symptoms.

Colonic transit time in mentally retarded persons

Constipation is frequently seen in patients with mental retardation (MR). Its pathophysiology is poorly understood. Measurement of colon transit time (CTT) differentiates between retentive and non-retentive constipation. To determine total and segmental CTT in MR patients compared to healthy controls. Of 250 residents, 60 patients older then 16, without swallowing disorder or scoliosis, are randomly chosen, 58 participated (intelligence quotient < 50, median age 35.5 year, 29 male). Constipation was defined as less than three defecations a week. Controls are 32 non-constipated age-matched healthy volunteers (median age 29 year, 19 male). CTT is measured by daily administration of ten radio-opaque markers during 6 days and abdominal X-ray on day 7. CTT is calculated using Bouchoucha's [7] method. Compared to controls, total CTT is significantly (P < 0.001) longer in MR (median 22.8 h vs. 57.6 h, respectively). Of the MR patients, 21/58 (36%) are constipated. The mental retardated and constipated (MRC) have a significant prolonged CTT in all segments (P < 0.01; median right CTT 19.2 h vs. 4.8 h; left CTT 14.4 h vs. 4.8 h; rectosigmoidal CTT 42 h vs. 9.6 h), whereas in mental retarded non-constipated (MRNC) persons, the rectosigmoidal CTT is prolonged (median 21.6 h vs. 9.6 h). Patients with moderate to deep MR have a significantly prolonged total CTT. In MRNC persons, rectosigmoidal CTT prolongation suggests a defecation problem. In MRC, CTT is prolonged in all segments, suggesting diffuse colonic inertia problem.

Reproducibility and validity of radiographically determined gastrointestinal and segmental colonic transit times in spinal cord-injured patients

Total gastrointestinal transit times (GITT) and segmental colonic transit times (CTT) are commonly used to describe bowel function in individuals with spinal cord injury (SCI). Reproducibility study. To describe inter- and intrasubjective as well as interobserver variations in GITT and segmental CTT in patients with SCI. Furthermore, to study associations between GITT or segmental CTT and colorectal symptoms. Spinal Cord Unit, Viborg Hospital, Denmark. Thirty SCI patients took 10 radio-opaque markers on 6 consecutive days and an abdominal X-ray was taken on day 7. The same procedure was repeated after 3 months. GITT and CTT were computed from the number of markers in the entire colorectum and in the left and the right colon. Intra- and interobserver variations were described as dispersion (numerical difference/mean). Intersubjective variation was large for GITT (range: 0.6-6.3 days), right CTT (range: 0.1-5.5 days) and left CTT (range: 0-4.9 days). Intrasubjective variation was acceptable for GITT (dispersion: 0.28) but less good for right (dispersion: 0.63) and left CTT (dispersion: 0.68). Interobserver variation was very small. No correlations were found between GITT, right or left CTT and colorectal symptoms. GITT and right and left CTT are of limited value for clinical decision-making in individual patients but may be useful for comparison of groups of patients with SCI.

Effect of tegaserod on colonic transit time in male patients with constipation‐predominant irritable bowel syndrome

Tegaserod is approved for the treatment of constipation-predominant irritable bowel syndrome (C-IBS) in females. The aim of this study was to evaluate the effect of tegaserod on colonic transit time (CTT) and symptoms in male patients with C-IBS. Forty-four males with C-IBS (Rome II) were enrolled. After a baseline washout period of 2 weeks, 40 patients were randomized to 6 mg twice daily of tegaserod or placebo for 12 weeks. Daily bowel habits and weekly satisfactory relief of symptoms were recorded. Total and segmental CTT were measured using radiopaque markers at baseline and after treatment. The mean +/- SD for the total colonic, right colonic, left colonic and rectosigmoid transit time (in hours) were 18.96 +/- 3.92, 7.74 +/- 1.55, 5.64 +/- 1.51 and 5.58 +/- 2.2 in the tegaserod group compared to 22.47 +/- 3.73, 9.69 +/- 2.33, 6.6 +/- 1.32 and 6.18 +/- 2.22 in the placebo group at the end of 12 weeks. There was a statistically significant difference in the total, right and left CTT in the tegaserod group (P < 0.05) at the end of treatment. Global satisfactory relief at the end of 12 weeks was 75% in the tegaserod group and 50% in the placebo group (P > 0.05). Greater stool frequency occurred in the tegaserod group (P > 0.05). There was a significant decrease in the stool consistency at the end of 12 weeks in patients treated with tegaserod (P < 0.05). Tegaserod causes significant acceleration of CTT in male patients with C-IBS. Although there was a trend towards improvement in bowel symptoms in the treated group, this effect was not statistically significant.

Short‐term effects of magnetic sacral dermatome stimulation for idiopathic slow transit constipation: Sham‐controlled, cross‐over pilot study

An increase in recto-sigmoid colon activity through electrical stimulation of the sacral dermatomes has previously been reported. It has not been evaluated whether or not sacral dermatome stimulation has beneficial effects on constipation symptoms and anorectal function in constipated patients. Our aim was to evaluate short-term effects of magnetic stimulation of the sacral dermatomes on constipation symptoms and anorectal function in patients with idiopathic slow transit constipation. Fourteen patients with idiopathic slow transit constipation were enrolled. Constipation symptoms, stool form and anorectal function were assessed before treatment, and at 3 and 6 weeks of treatment. Six-week treatment consisted of either a 3-week period of sham treatment or a 3-week period of magnetic stimulation of the S2-S3 dermatomes, which was performed in a randomized cross-over design. During the stimulation period, the frequency score of spontaneous bowel movements decreased in eight of the 14 patients (2.9 [2-3]vs 1.4 [0-2]), whose threshold volumes for urge to defecate and maximum tolerable volumes were significantly greater than those of the non-responders, and significantly decreased at the end of treatment. The degree of straining on defecation also significantly decreased in the responders. Responders had shorter right colonic transit time and longer left colonic transit time compared to the non-responders. Sham treatment did not affect constipation symptoms, stool form and rectal sensation. Sacral dermatome stimulation may offer potential for therapeutic benefit for a subset of patients with idiopathic slow transit constipation, particularly constipated patients with rectal hyposensation or hindgut dysfunction.

Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children

Background The transanal one-stage endorectal pull-through operation for Hirschsprung's disease is relatively new and makes assessment of the functional outcome and colonic motility difficult. The aim of this study was to evaluate the stooling patterns and colonic motility after a one-stage transanal pull-through operation for Hirschsprung's disease in children. Methods Twenty-two children who underwent a one-stage transanal pull-through operation for Hirschsprung's disease were followed up for at least 6 months. The children (17 boys and 5 girls) were from 12 months to 13 years of age (mean age, 4 years). All patients had an aganglionic segment confined to the rectosigmoid area (confirmed by preoperative barium enema and postoperative histology). Clinical outcome was assessed by interviews and questionnaires, and children were divided into symptomatic and nonsymptomatic groups. Contrast barium enema and defecography and determination of total and segmental colonic transit time (using radio-opaque markers) were performed on all 22 children. Results The stooling patterns were considered satisfactory in 17 children. Of all the children, the mean stool times were 1 to 2 per day and only 2 were 8 to 10 per day; postoperative soiling was found in 4, constipation was observed in 2, and Hirschsprung-associated enterocolitis in 1. There was no incontinence, cuff infection, anastomotic leak, or mortality noted. Barium enema showed that the dilated and spastic colonic segment disappeared in all 22 children. The dilated sigmoid loops decreased in 17 (2 symptomatic, 15 nonsymptomatic) and disappeared in 5 (4 symptomatic, 1 nonsymptomatic). There was a significant difference between the decreasing and disappearing loop group in regard to stooling disorders ( P < .05). Postoperative defecography showed that the anorectal angle of all children was open, fixed, and significantly larger than that of the preoperative and control groups (123.3° ± 15.1° vs 84.7° ± 8.3° vs 79.0° ± 11.6°, P < .01) and larger in the symptomatic group when compared with the nonsymptomatic group (135.6° ± 15.9° vs 111.0° ± 14.3°, P < .05). Postoperatively, the total gastrointestinal transit time, left colonic transit time, and rectosigmoid colonic transit time of all the children were shorter than preoperatively (26.8 ± 8.2 vs >188 hours, P < .01; 6.3 ± 4.1 vs >60 hours, P < .01; 11.8 ± 4.4 vs >120 hours, P < .01) and similar to controls. The total gastrointestinal transit time and rectosigmoid colonic transit time of the symptomatic group were significantly shorter than the nonsymptomatic group (25.2 ± 5.6 vs 28.1 ± 10.1 hours, P < .05; 12.2 ± 6.7 vs 9.8 ± 4.0 hours, P < .05). Conclusions The stooling pattern and colonic motility are satisfactory in most children after the one-stage transanal pull-through operation for Hirschsprung's disease. Normalization of colon appearance and total and segmental colonic transit time are signs of recovery of colonic motility. Stooling disorders were noted in a few cases and may be related to decrease or disappearance of the sigmoid loop, dysfunction of the “neorectosigmoid”, an open and fixed anorectal angle, and ischemia of the pull-through segment.