Colonic Transit Time Measurement Research Articles

Measurement of colonic transit time in patients with refractory chronic constipation referred to a tertiary center

BackgroundMeasurement of colonic transit time (CTT) of different colon segments can help to find the subtype of constipation and the appropriate treatment. This study aimed to estimate the segmental and total CTT in patients with refractory chronic constipation who attended gastrointestinal clinics. MethodsA cross-sectional study was done in patients with refractory chronic constipation according to ROME IV criteria with normal colonoscopy. Patients with underlying diseases, including diabetes, hypoparathyroidism, hypothyroidism, anemia, past intestinal surgery, metabolic disorders, and recent medication use with constipation complications, were excluded. Every patient took a gelatin capsule containing ten 1–3 ​mm angiographic catheters for six consecutive days. On the seventh day, an upright abdominal x-ray was performed. The remaining markers were counted in three divided colonic segments, and the total CTT using radio-opaque markers was measured subsequently. Results40 patients were eventually included in this study. Twenty-eight were female (70%), and 55% of patients had standard body mass index (BMI). The mean age of patients was 43 years with a standard deviation of 18 years, while the mean total CTT was 37.05 ​h with a standard deviation of 24 ​h. Additionally, 60% had a normal CTT (≤45 ​h), and 40% had abnormal and prolonged CTT. ConclusionConstipation as a complaint is more common in women than men. Total CTT is slightly higher in men than women, but there is no significant difference. CTT may be normal in patients with refractory constipation despite all investigations. Additionally, there was no correlation between BMI and prolonged total CTT.

Coffee is more than just caffeine – a single-center, randomized, double-blinded, placebo-controlled superiority trial (CaCo trial)

Abstract Objective Avoidance of prolonged postoperative bowel paralysis after colorectal surgery is of major importance due to its significant clinical implications. Postoperative caffeine consumption appears to be a promising strategy. The aim of this study was to assess whether postoperative oral caffeine intake shortens bowel hypomotility after elective laparoscopic colorectal surgery. Methods This was a single-center, randomized, double-blinded, placebo-controlled superiority trial conducted from October 1st, 2015 to August 10th, 2020. Patients aged >=18 years with malignant or benign disease undergoing elective laparoscopic colectomy were included and assigned randomly before surgery to receive 3x daily either 100 mg caffeine or 200 mg caffeine or 250 mg corn starch (placebo) after the procedure. Substances were served in indistinguishable capsules three times daily before the meals. The primary endpoint was time to first bowel movement, measured from the time of wound closure to the patient's first defecation. Secondary endpoints included colonic transit time, time to tolerance of solid food, length of hospital stay and perioperative morbidity. Results A total of 60 patients were randomized, 20 to each group. Twenty-seven patients followed the protocol and were included in the per-protocol (PP) analysis. Baseline characteristics were similarly distributed among the groups. In intention-to-treat analysis, the time to first bowel movement in the caffeine 200 mg group was 67.9 h (standard deviation [SD] 19.2), in the caffeine 100 mg group 68.2 h (SD 32.2) and in the placebo group 67.3 h (SD 22.7) (p=0.887). PP analysis and measurement of colonic transit time (41.8 h [SD 21.7] in the caffeine 200 mg group, 34.2 h [SD 22.9] in the caffeine 100 mg group and 46.3 h [SD 20.6] in the placebo group, p=0.317) confirmed non-significant differences. The time to tolerance of solid food, length of hospital stay and postoperative morbidity were comparable among the three groups and no deaths or related serious adverse events were observed during the study. Conclusion Although caffeine intake after laparoscopic colorectal surgery is safe, its administration was not associated with a shortened time to first bowel movement in contrast to previous studies. Thus, other ingredients of coffee might be responsible for the intestinal stimulatory effect previously described.

CSP01, a Novel Superabsorbent Hydrogel, Reduces Colonic Transit Time in Patients With Chronic Idiopathic Constipation in a Randomized, Double-blind, Controlled Pilot Clinical Trial.

Background/AimsCSP01 is a novel superabsorbent hydrogel that absorbs gastrointestinal fluids and maintains high viscoelastic properties into the colon, where these fluids are released.MethodsWe conducted a single-center, randomized, double-blind, parallel-group, placebo-controlled pilot study comparing change in colonic transit time (CTT) among patients with chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) treated for 21 days with either CSP01 hydrogel, active control (carboxymethylcellulose [CMC]) or placebo. CTT was measured using wireless motility capsule transit testing at pre-treatment and end-of-treatment. The primary endpoint was change in CTT.ResultsForty subjects (20 CSP01, 11 CMC, 9 placebo) were enrolled and 38 completed the study. There was no significant change in mean CTT by treatment group (P = 0.297). In the placebo group, CTT increased by 15.3 minutes between baseline and end of treatment, increased by 366.4 minutes for CMC, and decreased by 727.4 minutes for CSP01. In post hoc analyses among those with CIC, mean CTT decreased by 1079 minutes for CSP01 (P = 0.025 compared to placebo), 919 minutes for CMC (P = 0.117 compared to placebo) and increased by 1113 minutes for placebo. Among patients with IBS-C, there was no significant difference in change in CTT for any treatment group. One subject in the CSP01 arm developed back pain attributed to constipation and withdrew without a second CTT measurement; there were no other adverse events.ConclusionCSP01 significantly decreased CTT compared to placebo among patients with CIC, but not in patients with IBS-C.

In vivo positron emission tomography imaging of decreased parasympathetic innervation in the gut of vagotomized patients.

Parasympathetic neuropathy is a key feature in many common disorders, including diabetes, neurological disorders, and cancers, but few objective methods exist for assessing damage to the parasympathetic nervous system, particularly in the gastrointestinal system. This study aimed to validate the use of 11 C-donepezil positron emission tomography (PET) to assess parasympathetic integrity in a group of vagotomized patients. Sixteen healthy controls and 12 patients, vagotomized due to esophagectomy, underwent 11 C-donepezil PET, measurement of colonic transit time, quantification of plasma pancreatic polypeptide (PP), and assessment of subjective long-term symptoms. Vagotomized patients had significantly decreased PET signal in the small intestine and colon compared with healthy controls (5.7 [4.4-7.9] vs 7.4 [4.5-11.3], P=.01 and 1.4 [1.1-2.1] vs 1.6 [1.4-2.4], P<.01, respectively). Vagotomized patients also displayed a significantly increased colonic transit time (2.9±0.9h vs 1.9±0.8h), P<.01 and increased volumes of the small intestine and colon (715ccm [544-1177] vs 443ccm [307-613], P<.01 and 971ccm [713-1389] vs 711ccm [486-1394], P=.01, respectively). Patients and controls did not differ in PP ratio levels after sham feeding, but PP ratio at 10minutes. after sham feeding and PET signal intensity in the small intestine was positively correlated (P=.03). We found significantly decreased 11 C-donepezil signal in the intestine of vagotomized patients, supporting that 11 C-donepezil PET is a valid measure of intestinal parasympathetic denervation.

Diagnosis of Chronic Constipation Using Measurement of Colon Transit Time

Diagnosis of Chronic Constipation Using Measurement of Colon Transit Time

Correcting for non-compliance when determining colonic transit time with radio-opaque markers.

The use of radio-opaque markers and abdominal X-ray is the standard method for determining colonic transit time (CTT). However, when there are deviations in the intake of these markers by participants in clinical trials it is desirable to improve observations by introducing corrections, where possible. To date, there is no standard procedure to adjust for such deviations. This report proposes a series of alternatives based on possible scenarios for deviations from the intended intake of radio-opaque markers. The proposed method to correct for missed or delayed consumption of radio-opaque markers can help to increase the accuracy of the CTT measurements in clinical trials.

Downregulation of neuronal vasoactive intestinal polypeptide in Parkinson's disease and chronic constipation.

Chronic constipation (CC) is a common and severe gastrointestinal complaint in Parkinson's disease (PD), but its pathogenesis remains poorly understood. This study evaluated functionally distinct submucosal neurons in relation to colonic motility and anorectal function in PD patients with constipation (PD/CC) vs both CC and controls. Twenty-nine PD/CC and 10 Rome III-defined CC patients were enrolled. Twenty asymptomatic age-sex matched subjects served as controls. Colonic transit time measurement and conventional anorectal manometry were evaluated in PD/CC and CC patients. Colonoscopy was performed in all three groups. Colonic submucosal whole mounts from PD/CC, CC, and controls were processed for immunohistochemistry with antibodies for vasoactive intestinal polypeptide (VIP) and peripheral choline acetyltransferase, markers for functionally distinct submucosal neurons. The mRNA expression of VIP and its receptors were also assessed. Four subgroups of PD/CC patients were identified: delayed colonic transit plus altered anorectal manometry (65%); delayed colonic transit (13%); altered manometric pattern (13%); and no transit and manometric impairment (9%). There were no differences in the number of neurons/ganglion between PD/CC vs CC or vs controls. A reduced number of submucosal neurons containing VIP immunoreactivity was found in PD/CC vs controls (P<.05). VIP, VIPR1, and VIPR2 mRNA expression was significantly reduced in PD/CC vs CC and controls (P<.05). Colonic motor and rectal sensory functions are impaired in most PD/CC patients. These abnormalities are associated with a decreased VIP expression in submucosal neurons. Both sensory-motor abnormalities and neurally mediated motor and secretory mechanisms are likely to contribute to PD/CC pathophysiology.

How to use a plain abdominal radiograph in children with functional defecation disorders

Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology...

Practical Methods to Assess Chronic Constipation.

Defining the pathophysiology of chronic constipation is critical for planning management. After excluding organic diseases, physician should speculate whether the constipated patient has a defecatory disorder or not. Recently, American Gastroenterology Association suggested an updated algorithm in diagnosis of chronic constipation.1 The major change was anorectal manometry and a rectal balloon expulsion test as the initial step which should be considered even before conventional laxative trial especially in patients who are highly suspected as having a defecatory disorder. This change inevitably posed the measurement of colon transit time in the last step of the algorithm and assessment of colonic transit is not recommended as early study any more. What is the rationale of this change? The American Gastroenterology Association medical position statement provided two reasonable issues. First, because near half of patients with defecatory disorders show concomitant slow colonic transit, slow transit time cannot rule out the presence of defecatory disorders and omit anorectal studies. Defecatory disorders are treated with pelvic floor retraining behavioral therapy, namely biofeedback, even if slow colonic transit is concomitant. Second reason is that the administration of laxative is the main initial therapy regardless of colon transit if there is no evidence of defecatory disorders. Normal transit constipation and slow transit constipation are treated similarly. Then, what is the clinical impact of slow colonic transit? We select very exceptional case of refractory chronic constipation as a candidate of surgical treatment according to the colonic transit. Colectomy could be effective in medically refractory constipated patients with slow colonic transit if defecatory disorders are not concomitant. The overall satisfaction rate of surgery was about 86% in a systematic review involving 39 reports and 1423 patients.2 Confirming slow colonic transit and ruling out defecatory disorders are mandatory for the successful outcome. The present study by Park et al3 suggested that the gas volume scoring could be a practical method assessing colonic transit. Even though the authors cannot find a positive correlation of colon transit time and colon gas volume score, they demonstrated that the difference of gas volume existed between slow transit and normal transit, defined as 45 hours (mean value + 1 standard deviation). The difference of gas volume score was small, 5.66% vs 4.15%, and the sensitivity and specificity of the cut-off value to diagnose slow colon transit was disappointing. The failure of presenting valuable cut-off colon gas volume score to differentiate slow colon transit is a big drawback of this study, because there was only small mean difference of colon gas volume score between the groups and this small difference can be easily made by manual processing of gas volume scoring or by confusing small bowel gas as colon gas. Also the range of colon gas volume score largely overlaps each other. Therefore the present outcome has insufficient clinical impact to replace conventional method using radiopaque markers to assess colon transit time. But primary physicians can roughly discriminate slow transit constipation based on this tendency of colon gas on simple x-ray and colon transit. When primary physicians encounter a constipated patient with a relatively larger amount of colon gas on simple abdominal x-ray, they can suspect the patient may have slow colon transit. There are some practical methods to assess constipated patient and this include digital rectal exam and Bristol stool scale. We can consider additional anorectal tests in patients of abnormal digital rectal exam.4 Abnormal digital rectal exam by skillful examiner can practically suspect defecatory disorder. Also Bristol stool scale is a practical indicator of colon transit and this simple illustration can be useful in a clinical setting of discrepancy between the bowel frequency and stool hardness.5 Besides of this physical exam and simple illustration, simple abdominal radiography may give some additional information to primary physician.

How many segments are necessary to characterize delayed colonic transit time?

Measuring colonic transit time with radiopaque markers is simple, inexpensive, and very useful in constipated patients. Yet, the algorithm used to identify colonic segments is subjective, rather than founded on prior experimentation. The aim of the present study is to describe a rational way to determine the colonic partition in the measurement of colonic transit time. Colonic transit time was measured in seven segments: ascending colon, hepatic flexure, right and left transverse colon, splenic flexure, descending colon, and rectosigmoid in 852 patients with functional bowel and anorectal disorders. An unsupervised algorithm for modeling Gaussian mixtures served to estimate the number of subgroups from this oversegmented colonic transit time. After that, we performed a k-means clustering that separated the observations into homogenous groups of patients according to their oversegmented colonic transit time. The Gaussian mixture followed by the k-means clustering defined 4 populations of patients: "normal and fast transit" (n = 548) and three groups of patients with delayed colonic transit time "right delay" (n = 82) in which transit is delayed in the right part of the colon, "left delay" (n = 87) with transit delayed in the left part of colon and "outlet constipation" (n = 135) for patients with transit delayed in the terminal intestine. Only 3.7 % of patients were "erroneously" classified in the 4 groups recognized by clustering. This unsupervised analysis of segmental colonic transit time shows that the classical division of the colon and the rectum into three segments is sufficient to characterize delayed segmental colonic transit time.

Effect of bowel cleansing on colonic transit time measurement in constipated children

Effect of bowel cleansing on colonic transit time measurement in constipated children

Measurement of colonic transit time based on radio opaque markers in patients with chronic idiopathic constipation; a cross-sectional study

Background:Constipation is one of the most common gastrointestinal disorders particularly in industrialized countries. Incidence of constipation varies from 3.4 % to 27.2% in different societies. Increase in urban population, industrialization of communities, changes in behavioral and nutritional habits and inactivity have increased the number of patients suffering from constipation.Objectives:The aim of the study was to measure colonic transit time in patients with chronic idiopathic constipation.Patients and Methods:Fifty-two patients with chronic idiopathic constipation (according to ROME III criteria) were selected. Patients with diabetes mellitus, hypothyroidism, and hypoparathyroidism were excluded. Each patient took a capsule containing ten 1-3 mm long angiographic guide daily for 6 days. Abdominal x-ray was performed on the seventh day. Remaining markers in each segment were counted and segmental and total colonic transit time was calculated. The analysis was performed by SPSS version 18. In all tests, a P-value less than 0.05 was considered statistically significant.Results:The mean age of patients was 36.9 ± 10.1 years. 80.8 % of patients were female. The mean total colonic transit time was 40.8 ±35.1 hours. 34.6 % of patients and 36.5 % of them had prolonged total and segmental colonic transit time.Conclusions:We found that prolonged total and segmental colonic transit time is common in patients with chronic idiopathic constipation.

Patients with irritable bowel syndrome and constipation are more depressed than patients with functional constipation

Psychosocial factors, such as depression, have been shown to be associated with gastrointestinal disorders like constipation. We retrospectively compared the depression and anxiety profiles of patients with irritable bowel syndrome with constipation versus those of patients with functional constipation using validated questionnaires. Subjects rated the intensity of digestive symptoms experienced during the previous month using visual analogue scales. Colonic transit time measurements and anorectal manometry were performed. Of the 128 consecutive, constipated patients included (84% females, mean age 49.7 ± 15.5 years) 66 suffered from irritable bowel syndrome with constipation and 62 from functional constipation. Demographic and physiological traits were similar in the two groups. Patients suffering from irritable bowel syndrome with constipation reported higher depression scores (18.8 ± 1.4 vs 12.7 ± 1.3, P=0.002) and higher symptom intensity scores for constipation (6.2 ± 0.3 vs 4.3 ± 0.4, P<0.001), bloating (6.7 ± 0.3 vs 3.3 ± 0.4, P<0.001) and abdominal pain (6.0 ± 0.3 vs 2.7 ± 0.4, P<0.001) than patients with functional constipation. Multiple linear regression showed positive correlations between symptom intensity and depression and anxiety scores for functionally constipated patients only. Our results support the integration of a psychosocial component to the traditional treatment of constipated patients; however, further research exploring causality between psychosocial factors and specific gastrointestinal disorders would contribute to developing a tailored therapeutic approach.

Mo2040 Association of Polymorphisms in 5-HT2A and 5-HT2C Receptors Genes With Depressive and Anxiety Disorders in Patients With Irritable Bowel Syndrome

BACKGROUND: Subgroups of patients with irritable bowel syndrome (IBS) may have low grade mucosal immune activity. Fecal calprotectin (f-calprotectin) levels are considered a marker for mucosal neutrophil inflammation and may be used as a biomarker for disease activity in inflammatory diseases. IBS patients are reported to have normal levels of calprotectin, but the levels may vary within the patient group, and it is not known whether this variation within or slightly above the normal range may reflect pathology or symptoms of the patients. AIM: To determine if levels of f-calprotectin may reflect the clinical and pathophysiological phenotype of IBS patients. METHODS: Analyses of f-calprotectin in stool samples of 98 IBS patients and 35 healthy controls were performed with Buhlmann ELISA (lower detection limit 10 ug/g). All IBS subjects completed the Bristol stool form (BSF) scale and the IBS symptom severity scale (IBS-SSS) questionnaire to assess gastrointestinal symptom severity. Patients also underwent a rectal barostat test with ballon distentions and colonic transit time measurement with ingestion of radiopaque rings. RESULTS: IBS patients had comparable levels of f-calprotectin to controls (17.5 (10-47.0) vs. 11(10-44.0) (median (2575%) percentiles) ug/g; p=0.21)). Among IBS patients, 13 subjects (13.2%) had f-calprotectin levels above the 90th percentile in the controls (98.8ug/g). There was no difference in IBS subgroup according to Rome III (IBS-C, IBS-D, IBS-M, IBS-U) in patients with high as compared to normal f-calprotectin. Also the disease duration was comparable in the two groups (9.5 (2-15) vs. 10 (5-15.3) years; p=0.46). There was no difference between IBS patients with high vs. normal levels of f-calprotectin regarding intensity or frequency of pain, bloating severity, bowel habit dissatisfaction, or daily life as estimated by IBS-SSS (Table 1). Also, total IBS-SSS score was comparable in the two groups (Table 1). The average stool form according to BSF (3.7 (2.9-4.4) vs. 4.1 (3.3-4.9); p=0.2) and stool frequency (1.5 (0.75-1.9) vs. 1.6 (1.2-2.3); p=0.29) were also similar in patients with high respective normal calprotectin levels. The pain threshold in rectal barostat test was comparable in IBS patients with high respective normal levels of f-calprotectin (24 (24-28) vs. 24 (20-32) mmHg; p=0.65). Moreover, oroanal transit time (OATT) was comparable in the two groups (1.5 (0.5-1.9) vs. 1.2(0.7-1.9) days; p=0.95) CONCLUSION: Fecal calprotectin within the normal range is not associated with the severity of IBS symptoms or key pathophysiological factors. Our data do not support that mucosal neutrophil inflammation is of major importance for symptom generation in IBS. Table 1. Symptom severity assessed by -IBS-SSS in IBS patients with high respective normal levels of fecal calprotectin.

Mo2039 The Pathophysiology and Severity of Symptoms in IBS Patients Are Not Associated With Mucosal Immune Activity As Determined by Fecal Calprotectin

BACKGROUND: Subgroups of patients with irritable bowel syndrome (IBS) may have low grade mucosal immune activity. Fecal calprotectin (f-calprotectin) levels are considered a marker for mucosal neutrophil inflammation and may be used as a biomarker for disease activity in inflammatory diseases. IBS patients are reported to have normal levels of calprotectin, but the levels may vary within the patient group, and it is not known whether this variation within or slightly above the normal range may reflect pathology or symptoms of the patients. AIM: To determine if levels of f-calprotectin may reflect the clinical and pathophysiological phenotype of IBS patients. METHODS: Analyses of f-calprotectin in stool samples of 98 IBS patients and 35 healthy controls were performed with Buhlmann ELISA (lower detection limit 10 ug/g). All IBS subjects completed the Bristol stool form (BSF) scale and the IBS symptom severity scale (IBS-SSS) questionnaire to assess gastrointestinal symptom severity. Patients also underwent a rectal barostat test with ballon distentions and colonic transit time measurement with ingestion of radiopaque rings. RESULTS: IBS patients had comparable levels of f-calprotectin to controls (17.5 (10-47.0) vs. 11(10-44.0) (median (2575%) percentiles) ug/g; p=0.21)). Among IBS patients, 13 subjects (13.2%) had f-calprotectin levels above the 90th percentile in the controls (98.8ug/g). There was no difference in IBS subgroup according to Rome III (IBS-C, IBS-D, IBS-M, IBS-U) in patients with high as compared to normal f-calprotectin. Also the disease duration was comparable in the two groups (9.5 (2-15) vs. 10 (5-15.3) years; p=0.46). There was no difference between IBS patients with high vs. normal levels of f-calprotectin regarding intensity or frequency of pain, bloating severity, bowel habit dissatisfaction, or daily life as estimated by IBS-SSS (Table 1). Also, total IBS-SSS score was comparable in the two groups (Table 1). The average stool form according to BSF (3.7 (2.9-4.4) vs. 4.1 (3.3-4.9); p=0.2) and stool frequency (1.5 (0.75-1.9) vs. 1.6 (1.2-2.3); p=0.29) were also similar in patients with high respective normal calprotectin levels. The pain threshold in rectal barostat test was comparable in IBS patients with high respective normal levels of f-calprotectin (24 (24-28) vs. 24 (20-32) mmHg; p=0.65). Moreover, oroanal transit time (OATT) was comparable in the two groups (1.5 (0.5-1.9) vs. 1.2(0.7-1.9) days; p=0.95) CONCLUSION: Fecal calprotectin within the normal range is not associated with the severity of IBS symptoms or key pathophysiological factors. Our data do not support that mucosal neutrophil inflammation is of major importance for symptom generation in IBS. Table 1. Symptom severity assessed by -IBS-SSS in IBS patients with high respective normal levels of fecal calprotectin.

Mo2042 Atopic IBS: Is It Really Different From Non-Atopic IBS?

BACKGROUND: Subgroups of patients with irritable bowel syndrome (IBS) may have low grade mucosal immune activity. Fecal calprotectin (f-calprotectin) levels are considered a marker for mucosal neutrophil inflammation and may be used as a biomarker for disease activity in inflammatory diseases. IBS patients are reported to have normal levels of calprotectin, but the levels may vary within the patient group, and it is not known whether this variation within or slightly above the normal range may reflect pathology or symptoms of the patients. AIM: To determine if levels of f-calprotectin may reflect the clinical and pathophysiological phenotype of IBS patients. METHODS: Analyses of f-calprotectin in stool samples of 98 IBS patients and 35 healthy controls were performed with Buhlmann ELISA (lower detection limit 10 ug/g). All IBS subjects completed the Bristol stool form (BSF) scale and the IBS symptom severity scale (IBS-SSS) questionnaire to assess gastrointestinal symptom severity. Patients also underwent a rectal barostat test with ballon distentions and colonic transit time measurement with ingestion of radiopaque rings. RESULTS: IBS patients had comparable levels of f-calprotectin to controls (17.5 (10-47.0) vs. 11(10-44.0) (median (2575%) percentiles) ug/g; p=0.21)). Among IBS patients, 13 subjects (13.2%) had f-calprotectin levels above the 90th percentile in the controls (98.8ug/g). There was no difference in IBS subgroup according to Rome III (IBS-C, IBS-D, IBS-M, IBS-U) in patients with high as compared to normal f-calprotectin. Also the disease duration was comparable in the two groups (9.5 (2-15) vs. 10 (5-15.3) years; p=0.46). There was no difference between IBS patients with high vs. normal levels of f-calprotectin regarding intensity or frequency of pain, bloating severity, bowel habit dissatisfaction, or daily life as estimated by IBS-SSS (Table 1). Also, total IBS-SSS score was comparable in the two groups (Table 1). The average stool form according to BSF (3.7 (2.9-4.4) vs. 4.1 (3.3-4.9); p=0.2) and stool frequency (1.5 (0.75-1.9) vs. 1.6 (1.2-2.3); p=0.29) were also similar in patients with high respective normal calprotectin levels. The pain threshold in rectal barostat test was comparable in IBS patients with high respective normal levels of f-calprotectin (24 (24-28) vs. 24 (20-32) mmHg; p=0.65). Moreover, oroanal transit time (OATT) was comparable in the two groups (1.5 (0.5-1.9) vs. 1.2(0.7-1.9) days; p=0.95) CONCLUSION: Fecal calprotectin within the normal range is not associated with the severity of IBS symptoms or key pathophysiological factors. Our data do not support that mucosal neutrophil inflammation is of major importance for symptom generation in IBS. Table 1. Symptom severity assessed by -IBS-SSS in IBS patients with high respective normal levels of fecal calprotectin.

Does lack of glottic closure affect quality of life as a cause of constipation in laryngectomized patients?

The permanent disappearance of glottic closure eventually causes inadequate defecatory propulsion resulting in functional constipation. The aim of this study is to reveal functional constipation probably induced by lack of glottic closure in laryngectomized patients. The study was conducted in a prospective, tertiary care center. Forty patients who had undergone total laryngectomy (study group) and 30 who had undergone microlaryngoscopic surgery (control group) were evaluated. Based on the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaires C30, the presence of functional constipation was investigated using the Rome II diagnostic criteria and was confirmed by measurement of colonic transit time using a radiopaque marker test. Functional constipation and colonic transit time were found to be increased and statistically significant in laryngectomized patients (70 %) compared with the control group (26 %) (p < 0.01). Functional constipation is more prevalent among laryngectomized patients. When evaluating quality of life of patients undergoing laryngectomy, colorectal functions must be taken into consideration.

How to Interpret a Functional or Motility Test - Colon Transit Study

Measurement of colon transit time is the most basic and primary tool in evaluating disorders of colonic motility. In particular, it is helpful in pathologic diagnosis and for planning management in patients with constipation. Several techniques for measuring colon transit time currently exist. The standard measurement of colon transit time has been performed using radioopaque marker test. The radioopaque marker test is the most widely used method; it is simple to perform as well as being cost effective. But, this technique produces radiation exposure. Radionuclide scintigraphy and wireless motility capsules are other techniques used to measure colon transit time. In radionuclide scintigraphy, the transit of radioisotope is viewed by gamma camera; this approach has an advantage in that it uses minimal radiation and it allows a physiological assessment of gastrointestinal transit. Wireless motility capsules have been validated most recently, but this technique is not useful in Korea. This review presents the techniques used to measure colon transit time and the interpretations provided in different colon transit studies.

Pathophysiological approach to bowel dysfunction after segmental colorectal resection for deep endometriosis infiltrating the rectum: a preliminary study

Colorectal segmental resection is performed worldwide in a majority of women presenting with symptomatic deep endometriosis infiltrating the rectum. The aim of the present study was to investigate the pathophysiological mechanisms involved in post-operative digestive dysfunction. We selected patients managed by colorectal resection for rectal endometriosis, who had developed post-operative severe constipation and whose follow up was superior to 24 months. To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step work up including: low digestive tract endoscopy, colonic transit time measurement and when appropriate anorectal manometry, electromyography and defecographic evaluation. Five out of 25 (20%) patients, whose age ranged from 27 to 41 years, were investigated for severe post-operative terminal constipation. Four different mechanisms responsible for terminal constipation were identified: tight stenosis of the colorectal anastomosis, post-operative neurological sequelae, colonic intussusception through the colorectal anastomosis and transit constipation that developed post surgery. Post-operative constipation is a frequent complaint in women managed by colorectal resection for rectal endometriosis. A multidisciplinary approach is mandatory as pathophysiologic mechanisms may vary and prove difficult to understand. The risk of post-operative bowel dysfunction following colorectal endometriosis must be taken into account whenever this technique is proposed in young women presenting with a benign disease such as deep endometriosis.

Determination of the frequency of dyssynergic defecation and patient characteristics in patients with functional constipation

Dyssynergic defecation, a subgroup of functional constipation, is a relatively new definition, diagnostic criteria of which have recently been described. Distribution of subgroups of functional constipation in our population is scarcely known. We aimed to evaluate the demographic characteristics and defecation features of patients as we determined the frequency of dyssynergic defecation in patients with functional constipation in our community. Eighty-two patients, 52 women and 30 men, with functional constipation were included in the study by using a questionnaire after secondary causes were excluded. Colonic transit time and balloon expulsion tests were performed to determine sub-groups of functional constipation. Colonoscopy and/or sigmoidoscopy in all patients and double contrast colonography in some patients were obtained at the beginning of the study to exclude anatomic and organic causes and patients with constipation predominant irritable bowel syndrome were also excluded from the study. The results of the study revealed that functional constipation in our community occurs more frequently in women and at relatively older (middle to old) age. Patients with normal transit constipation pattern are the largest portion (52.4%) of patients with functional constipation, whereas dyssynergic defecation is the second most frequent (25.6%) reason among this population. The frequency of dyssynergic constipation is lower in our population compared to western communities, but the symptoms are similar. We believe that the questionnaire we used is helpful in revealing defecation characteristics and when combined with balloon expulsion test and colonic transit time measurements it can be a valuable tool in the diagnosis of dyssynergic defecation.