Orocecal Transit Research Articles

Gastric emptying and small intestinal transit time in preterm infants: a scintigraphic method.

Practical methods to determine gastric emptying (GE) and small intestinal transit time in preterm infants are required. The aim of this study was to develop a scintigraphic method to determine GE and small intestinal transit time in preterm infants which produce minimal radiation exposure and physical disturbance in these infants. Ten premature infants were studied. Median (and range) for gestational age was 28.9 (26-33) weeks, postnatal age was 19 (6-37) days, birth weight was 1194 (687-2300) grams and feeding volume was 173 (6-205) mL/kg/day. Nine of the patients were on nasal continuous positive airway pressure; one patient was on mechanical ventilation. A dose (0.2-0.4 MBq) of 99mTc-DTPA (0.5 mL) was given at the end of a meal administered by naso-gastric tube. Static images were obtained with a mobile gamma camera during the next 9 to 12 hours. The radiation dose was at most 0.30 mSv. Regions of interest (ROIs) were drawn around the stomach and the cecum. Time-activity curves were generated. Gastric emptying half-time (T(1/2)GE) was calculated. Residual gastric activity after 1 hour (R(1h)) and after 2 hours (R(2h)) was determined. Orocecal transit time was defined as the time until significant increase in activity was detected in the cecal ROI. Images showed gastric emptying in all cases. Median (range) half time was 1.0 (0.5-3.0) h. R(1h) was 37.5% (19% to 100%), R(2h) was 23% (6% to 61%). In one patient the tracer did not reach the cecum within 12 hours. In the remaining nine patients orocecal transit time was 3.1 (1.3-6.1) h. We present a new scintigraphic method to determine GE and orocecal transit time. It appears safe and practicable as a research tool in preterm infants.

Gastric Emptying and Small Intestinal Transit Time in Preterm Infants: a Scintigraphic Method

ABSTRACTObjectives:Practical methods to determine gastric emptying (GE) and small intestinal transit time in preterm infants are required. The aim of this study was to develop a scintigraphic method to determine GE and small intestinal transit time in preterm infants which produce minimal radiation exposure and physical disturbance in these infants.Methods:Ten premature infants were studied. Median (and range) for gestational age was 28.9 (26–33) weeks, postnatal age was 19 (6–37) days, birth weight was 1194 (687–2300) grams and feeding volume was 173 (6–205) mL/kg/day. Nine of the patients were on nasal continuous positive airway pressure; one patient was on mechanical ventilation. A dose (0.2–0.4 MBq) of 99mTc‐DTPA (0.5 mL) was given at the end of a meal administered by naso‐gastric tube. Static images were obtained with a mobile gamma camera during the next 9 to 12 hours. The radiation dose was at most 0.30 mSv. Regions of interest (ROIs) were drawn around the stomach and the cecum. Time‐activity curves were generated. Gastric emptying half‐time (T½GE) was calculated. Residual gastric activity after 1 hour (R (1h)) and after 2 hours (R (2h)) was determined. Orocecal transit time was defined as the time until significant increase in activity was detected in the cecal ROI.Results:Images showed gastric emptying in all cases. Median (range) half time was 1.0 (0.5–3.0) h. R (1h) was 37.5% (19% to 100%), R (2h) was 23% (6% to 61%). In one patient the tracer did not reach the cecum within 12 hours. In the remaining nine patients orocecal transit time was 3.1 (1.3–6.1) h.Conclusions:We present a new scintigraphic method to determine GE and orocecal transit time. It appears safe and practicable as a research tool in preterm infants.

Spontaneous bacterial peritonitis: a historical perspective: Kerr DNS, Pearson DT, Read AE. Infection of ascitic fluid in patients with hepatic cirrhosis [Gut 1963; 4: 394–398]; Conn HO. Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome [Ann Intern Med 1964; 60: 568–580

Spontaneous bacterial peritonitis: a historical perspective: Kerr DNS, Pearson DT, Read AE. Infection of ascitic fluid in patients with hepatic cirrhosis [Gut 1963; 4: 394–398]; Conn HO. Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome [Ann Intern Med 1964; 60: 568–580

Gastrointestinal motility disturbances in celiac disease.

It is quite frequent to recognize celiac patients who show gastrointestinal motor abnormalities in clinical practice. In fact, in 30 to 60% of patients, physical examination and dyspeptic symptoms (epigastric discomfort, early satiety) suggest a gastrointestinal motility disorder. Consistent data are now available on the presence of a disturbed motility of the esophagus, stomach, small intestine, gallbladder, and colon of untreated celiac patients. Gastrointestinal abnormalities differ in different gastrointestinal districts. In fact, esophageal transit, gastric and gallbladder emptying, and orocecal transit time are delayed, while colonic transit is faster. These findings are related to the complex interactions among reduced absorption of food constituent (in particular, fat), neurologic alteration, and hormonal derangement. Motility disorders of the gut are also a predisposing factor in the development of small intestinal bacterial overgrowth and may contribute both to development of symptoms in some untreated celiacs and to the persistence of symptoms after gluten-free diet in some of them. All these alterations fortunately disappear after gluten-free diet, and patients return to well being status. Whatever the initial event in the pathogenesis of the celiac lesions may be, we know for certain at this time that gastrointestinal disturbances play an important role in the genesis of gastrointestinal symptoms in celiac disease and that surveillance for celiac disease in patients complaining of dysmotility-like dyspeptic symptoms should be increased.

HPLC Assay for Paracetamol and Sulfapyridine in Human Plasma as Markers of Gastric Emptying and Orocecal Transit

HPLC Assay for Paracetamol and Sulfapyridine in Human Plasma as Markers of Gastric Emptying and Orocecal Transit

Oro-cecal transit time: influence of a subsequent meal.

Small intestinal and oro-cecal transit time (OCTT) is determined for clinical diagnostics and research purposes. Experimental protocols used vary with respect to the inclusion of a subsequent meal during the test period. This study was conducted to elucidate whether the ingestion of a subsequent meal during the test period influences the OCTT of the test meal. The OCTT of a liquid test meal, measured with the lactose-[(13)C]ureide breath test, was compared between four groups of healthy volunteers (n = 36) who consumed the subsequent meal at different time points. Also, the OCTT was determined twice in eight subjects; a subsequent meal was ingested after 180 min (test A) and after 360 min (test B). An apparently meal-related increase in median OCTT was observed. The OCTT of the eight volunteers measured in test A (210; 210-349 median; quartiles) was significantly shorter than that found in test B (345; 300-375 min, P = 0.016). As result of the ingestion of the subsequent meal at 180 min the OCTT was shortened by 90; 64-116 min in 7/8 subjects. These data indicate that the ingestion of a subsequent meal affects the OCTT of a liquid test meal. This phenomenon could be explained by the increased intestinal motility in response to a meal, and should be taken into account when designing protocols for measurements of the OCTT and in the interpretation of small intestinal absorption studies.

Loss of sympathetic coordination appears to delay gastrointestinal transit in patients with spinal cord injury.

Patients with spinal cord injury (SCI) often suffer from many gastrointestinal (GI) complaints, while delayed GI transit exists in these patients. We are interested in whether the lost sympathetic activity is one of the mechanisms leading to disturbed GI transit in these subjects. Using a noninvasive hydrogen breath test representing orocecal transit time (OCTT) to study GI transit, 36 SCI patients and 12 age- and sex-matched healthy volunteers were enrolled in our study. Meanwhile, electrocardiogram was performed for all subjects. Finally, spectral analysis of heart rate variability (HRV) was then obtained to assess their sympathovagal balance. SCI patients had higher occurrences of GI symptoms, e.g., nausea/vomiting, belching/hiccup, and constipation, compared to controls (P < 0.05). OCTT was delayed in SCI patients compared to controls (180.8 +/- 10.7 vs 98.3 +/- 14.4 min; P < 0.001). The OCTTs of SCI patients were negatively correlated with their low frequencies of HRV (r = -0.384, P = 0.021). In addition, OCTT was further delayed in quadriplegic patients than paraplegic patients (195.8 +/- 14.5 vs 143.6 +/- 19.4 min; P = 0.031). However, neither the SCI etiology, the injury duration, nor the high frequency of HRV had any influence on the delayed OCTT in SCI patients. We conclude that the GI transit of SCI patients is delayed. This transit disturbance is probably due to loss of sympathetic activity, which is one of the essential components in the coordination of GI peristalsis.

Impaired gallbladder motility and delayed orocecal transit contribute to pigment gallstone and biliary sludge formation in beta-thalassemia major adults.

Gallbladder and gastrointestinal motility defects exist in gallstones patients and to a lesser extent in pigment gallstone patients. To investigated the role of gallbladder and gastrointestinal motility disorders in pigment gallstone formation in beta-thalassemia major. Twenty-three patients with beta-thalassemia major (16 females; age range 18-37 years) and 70 controls (47 females, age range 18-40 years) were studied for gallbladder and gastric emptying (functional ultrasonography), orocecal transit (OCTT, H(2)-breath test), autonomic dysfunction (sweat-spot, cardiorespiratory reflex tests), bowel habits, gastrointestinal symptoms and quality of life (all with questionnaires). Gallbladder content (ultrasonography) was examined before and during 8-12 mo follow-up. Gallstones and/or biliary sludge were found in 13 (56%) patients. beta-thalassemia major patients had increased fasting (38.0+/-4.8 mL vs 20.3+/-0.7 mL, P = 0.0001) and residual (7.9+/-1.3 mL vs 5.1+/-0.3 mL, P = 0.002) volume and slightly slower emptying (24.9+/-1.7 min vs 20.1+/-0.7 min, P = 0.04) of the gallbladder, together with longer OCTT (132.2+/-7.8 min vs 99.7+/-2.3 min, P = 0.00003) than controls. No differences in gastric emptying and bowel habits were found. Also, patients had higher dyspepsia (score: 6.7+/-1.2 vs 4.9+/-0.2, P = 0.027), greater appetite (P = 0.000004) and lower health perception (P = 0.00002) than controls. Autonomic dysfunction was diagnosed in 52% of patients (positive tests: 76.2% and 66.7% for parasympathetic and sympathetic involvement, respectively). Patients developing sludge during follow-up (38%, 2 with prior stones) had increased fasting and residual gallbladder volume. Adult beta-thalassemia major patients have gallbladder dysmotility associated with delayed small intestinal transit and autonomic dysfunction. These abnormalities apparently contribute together with haemolytic hyperbilirubinemia to the pathogenesis of pigment gallstones/sludge in beta-thalassemia major.

Lactulose breath testing, bacterial overgrowth, and IBS: just a lot of hot air?

Lactulose breath testing, bacterial overgrowth, and IBS: just a lot of hot air?

Influence of age and body size on orocecal transit time as assessed by use of the sulfasalazine method in healthy dogs.

To compare orocecal transit time (OCTT) as assessed by use of the sulfapyridine appearance time in plasma after oral administration of sulfasalazine in dogs of varying age and body size and determine whether OCTT correlates with fecal quality. 6 Miniature Poodles (MP), 6 Standard Schnauzers (SS), 6 Giant Schnauzers (GS), and 6 Great Danes (GD). Determinations of OCTT were made at 12, 22, 36, and 60 weeks of age. Dogs were fed sulfasalazine mixed with a meal. Blood samples were then collected for 6 hours. The OCTT was the time from ingestion of the meal to detection of sulfapyridine in plasma. Fecal moisture content and consistency were recorded during the same periods. Mean OCTT decreased during growth of GS and GD dogs. No correlation was found between OCTT and fecal variables during growth in the 4 breeds. Effect of body size was observed at 12 and 22 weeks of age, with a longer OCTT in GS and GD than in MP and SS dogs. Similar OCTTs were observed at 36 and 60 weeks of age in all breeds, although GS and GD dogs had poorer fecal quality during those periods. An effect of age on OCTT was observed only in large-breed dogs, with longer transit times in puppies (12 weeks old) than in adults (60 weeks old). Mean OCTT is not correlated with body size in adult dogs. No relationship was detected between OCTT and fecal variables in healthy dogs.

Bacterial overgrowth and orocecal transit time in inflammatory bowel disease

Bacterial overgrowth and orocecal transit time in inflammatory bowel disease

Orocecal transit times (OCTT) in healthy subjects assessed by magnet-tracing (MT) and lactulose breath hydrogen test (LBHT)

Orocecal transit times (OCTT) in healthy subjects assessed by magnet-tracing (MT) and lactulose breath hydrogen test (LBHT)

Lactose intolerance: analysis of underlying factors.

We studied the degree of lactose digestion and orocecal transit time (OCTT) as possible causes for the variability of symptoms of lactose intolerance (LI) in a sample of a population with genetically determined low lactase activity. Lactose digestion index (LDI) was measured by the recently developed 13C-lactose/2H-glucose test. The OCTT was determined using the breath hydrogen test. Based on a 6-h symptom score (SSC) after a challenge dose of 25 g of lactose the subjects were divided into a tolerant group (T: n= 15; SSC = 0) and an intolerant group (IT: n= 28; SSC 1-40). The intolerant group was subdivided according to the severity of symptoms: group ITa (n = 17; mild symptoms without diarrhoea) and group ITb (n = 11; with diarrhoea). The LDI was lower in the intolerant group (0.34 +/- 0.14) (mean +/- SD) than in the tolerant group (0.47 +/- 0.14) (P = 0.008). The OCTT of group IT (60, 30-90 min) (median, quartiles) was significantly shorter than that of group T (105, 60-120 min) (P = 0.003) and was positively correlated with the LDI (P = 0.050). In groups ITa and ITb the OCTT (60, 30-90 min; 60, 26-83 min) and LDI (0.30 +/- 0.14; 0.39 +/- 0.14) were similar. Lactose digestion capacity, which is determined by small intestinal lactase activity as well as by OCTT, affects the occurrence of lactose intolerance. However, the major difference in intolerance symptoms is caused by differences in the colonic processing of maldigested lactose.

Delayed gastrointestinal transit in patients with hepatocellular carcinoma.

Disturbed gastrointestinal (GI) motility exists in cirrhotic patients; however, less is known about the character of GI transit in hepatocellular carcinoma (HCC) patients. It is interesting to study the GI transit in HCC patients and to explore the patient factors modulating GI transit. A non-invasive hydrogen breath test, which measured the orocecal transit time (OCTT), was used to study GI transit in 40 HCC patients, 20 cirrhotics and 40 age- and sex-matched healthy volunteers with normal bowel habits. Meanwhile, their clinical manifestations and various blood parameters, such as platelet count, prothrombin time, erythrocyte sedimentation rate etc. were collected. The plasma endothelin-1 and nitrate/nitrite levels were also measured. The OCTT were delayed in HCC and cirrhotic patients compared with controls (116.3 +/- 7.8 and 104.5 +/- 10.6 vs 75.3 +/- 5.1 min, P < 0.05). Neither the severity of liver damage, presence of ascites, tumor size, portal hypertension, nor various blood parameters, such as nitrate/nitrite, endothelin-1, platelet count etc., had any influence on GI transit. Only serum alpha-fetoprotein levels exhibited a trend toward positive correlation with the OCTT (r = 0.271, P = 0.091). Hepatocellular carcinoma patients have delayed GI transit. The confounding factor responsible for the disturbance of GI transit in HCC patients needs further exploration.

A systematic review of tegaserod for the treatment of irritable bowel syndrome.

To assess the clinical effectiveness of tegaserod for the treatment of irritable bowel syndrome (IBS). Systematic review. Six placebo-controlled, randomized controlled trials (RCTs) retrieved from electronic searches (Medline, Embase, FDA website) and hand-searching. Any outcome was accepted. In a small pharmacodynamic study, tegaserod 4 mg/day accelerated orocecal transit compared with placebo, but did not affect gastric emptying rate and colonic transit. Five placebo-controlled studies evaluated Subject's Global Assessment of gastrointestinal (GI) symptoms in predominantly female patients who fulfilled Rome criteria for constipation-predominant IBS. Responder rates were higher with tegaserod 1-24 mg/day than with placebo, although it was not possible in this review to evaluate the consistency of this effect, to fully quantify the effect size, or identify patients who may gain most benefit from this treatment. Currently published data on tegaserod for IBS are limited (two of six RCTs published in full, four as abstracts). Tegaserod may be an appropriate treatment for occasional use for relief of GI symptoms associated with constipation-predominant IBS. Further research, comparing tegaserod with alternative treatments for GI symptoms of IBS, should help define the place of this drug in therapy.

Orocecal transit time in patients with functional dyspepsia.

The importance of intestinal dysmotility in functional dyspepsia is a controversial issue. To investigate the orocecal transit time in patients with functional dyspepsia, as well as a possible association between intestinal transit and the presence of anxiety or Helicobacter pylori infection in these patients. The participants in this study were 23 patients with dysmotility-like functional dyspepsia and 24 control subjects. Orocecal transit time was measured by the lactulose hydrogen breath test. The presence of anxiety was assessed by the Hospital Anxiety and Depression (HAD) scale. No significant difference in orocecal transit times was found between patients (median, 55 minutes; 95% confidence interval [CI], 40-60 minutes) and control subjects (median, 50 minutes; 95% CI, 40-60 minutes; p = 1). In the assessment, 15 patients (73%) scored for anxiety on the HAD scale, and 15 patients (65%) had positive test results for H. pylori. There was no significant difference in orocecal transit times between the patients with (median, 55 minutes; 95% CI, 40-63 minutes) and those without H. pylori infection (50 minutes; 95% CI, 40-68 minutes; p = 0.85), or between the patients with (median, 45 minutes; 95% CI, 40-68 minutes) and those without (60 minutes; 95% CI, 40-63 minutes; p = 0.77) anxiety. Orocecal transit time is within the normal range in patients with functional dyspepsia. Anxiety and H. pylori infection do not seem to influence orocecal transit time in these patients.

Efficacy of lactulose plus 13C-acetate breath test in the diagnosis of gastrointestinal motility disorders.

We designed a new method of measuring gastric emptying and orocecal transit time (OCTT) at the same time to assess the influence of gastric emptying upon OCTT. Twenty-five dyspeptic patients (6 men, 19 women) with a mean age of 64.8 years (range, 25-80 years) were studied. The patients received a liquid test meal, containing 100 mg of 13C-acetate and 12g of lactulose, while they were in the sitting position after an overnight fast. Breath samples were collected at 10-min intervals of 120 min and both 13CO2 and hydrogen (H2) levels were measured. Subsequently, H2 concentrations were measured at 30-min intervals, for a total of 240 min. The results of gastric emptying were expressed as the time of peak 13CO2 excretion. OCTT was defined as the period between the ingestion of lactulose and a H2 peak rise of 5 ppm above the baseline value. The onset of H2 enrichment in the breath began at 90-110 min, whereas 13CO2 levels increased from the beginning, with peak enrichment values being reached after 60-80 min. OCTT was related to 13CO2 peak time. In 5 of the 25 patients, H2 breath enrichment in the 10-min sample was more than 5 ppm over the baseline value. All these 5 patients had double or triple peaks in serial breath H2 concentrations. The combination of the lactulose hydrogen breath test (LHBT) with the 13C-acetate breath test, which requires only breath samples, provides us with much information on the gastrointestinal tract; gastric emptying, OCTT, bacterial overgrowth in the small intestine, colonic fermentation, and oropharyngeal flora. The 13C-acetate breath test can be useful as an adjuvant test when LHBT is performed for measuring OCTT.

Reply to Measurement of Oro-Cecal Transit Time in Young Children Using Lactose [13C] Ureide Requires Further Validation

Reply to Measurement of Oro-Cecal Transit Time in Young Children Using Lactose [13C] Ureide Requires Further Validation To the Editors: In reply to the letter to the editor by Christian et al. concerning our article entitled “The Lactose-[13C]Ureide Breath Test: A New, Non-Invasive Technique to Determine Orocecal Transit Time in Children,” we have the following comments. First of all, we are delighted by their shared interest and meaningful input. In our article, we demonstrated by incubating stools that infants before complete weaning do not have the appropriate bacterial enzymatic activity (Clostridium innocuum) to hydrolyze lactose ureide. Results of 11 LU breath tests on 10 children performed by Christian et al. showed that although these children were weaned, they did not all produce a clear 13CO2 rise above baseline. This result can be due to the difference in pre-dose and dose of testmeal. They gave 1×100 mg pre-dose, whereas we administered 3×500 mg the day before the test. Their testmeal contained 100 mg 13C LU; our testmeal 250 mg 13C LU. Since the literature in adults and our own experience showed that pre-dosing is important (no predose corresponds with no or a low response), the low dosages might be the reason for a lack of response. In vitro induction with unlabeled LU one hour before the 13CO2 collection showed no difference with no induced stools. We fully agree with the comment of Christian that in addition to weaning, the type of weaning foods may be important and that further investigation is required. M. Van Den Driessche G. Veereman-Wauters

Gastric emptying and orocecal transit time in pregnancy

To evaluate the effects of pregnancy on gastrointestinal function, we determined gastric emptying time, orocecal transit time, and fasting gastrointestinal hormone levels (cholecystokinin, gastrin, pancreatic polypeptide, neurotensin) in 11 women with mild dyspeptic symptoms during the first and third trimesters of their pregnancies, and again 4-6 months after delivery. After the women ingested a disaccharide solution, orocecal transit time was determined by monitoring breath hydrogen concentrations at 10-min intervals, and values were compared with the postpartum value. Ultrasound examinations of gastric emptying were performed during the same intervals. The half-emptying time and the final gastric emptying time did not differ in the first and third trimesters and postpartum, but gastrointestinal transit time was significantly longer in the third trimester of pregnancy than postpartum (100.0 min [range, 50.5-240.0 min] vs 70.0 min [range, 40.5-240.0 min; P < 0.05]), respectively. Mean plasma pancreatic polypeptide values were lower in the third trimester of pregnancy than postpartum. and a negative correlation was observed between pancreatic polypeptide levels and transit time in the third trimester (r = -0.65; P = 0.0261). The plasma levels of other gastrointestinal hormones did not differ in the various periods studied. Our study shows that, despite evident dyspeptic symptoms, there were no significant alterations in gastric emptying or orocecal transit time during the first trimester of pregnancy. Conversely, in the third trimester, orocecal transit time was significantly longer.

Gastrointestinal transit and anorectal manometry in children with colonic substance P deficiency.

Severe intractable constipation in children may be associated with a reduction of substance P (SP)- containing fibers in colonic circular muscle. The aim of this study was to characterize gastrointestinal transit (GIT), anorectal manometry (ARM) and electromyographic (EMG) changes in these children. Seromuscular laparoscopic biopsies of the colon were obtained from 35 children with severe constipation. Immunofluorescent staining for SP and vasoactive intestinal peptide (VIP) were then performed on these specimens. The cohort of patients studied included a SP-deficient group (SPD, n = 25) who had reduced numbers of SP-immunoreactive nerve fibers. The other group consisted of patients with normal staining for both SP and VIP (SPN, n = 10). Gastrointestinal transit studies (gastric emptying, orocecal and colonic transit) suitable for analysis were available for 17 patients (SPD, n = 9 and SPN, n = 8). The colon was divided into segments and radioactivity counts in each segment were expressed as a percentage of the total colonic count at each time point (6, 24, 32 and 48 h). The geometric center (GC), ARM, EMG, clinical and demographic data characteristics of both groups of patients were compared. There were no differences in demographic data, gastric emptying, orocecal transit or geometric center of transit in the colon between the two patient groups. The ARM and EMG studies suggested that the SPN group have a higher mean threshold volume of balloon distension required to initiate a rectoanal inhibitory reflex, and a higher incidence of anismus; however, this did not reach statistical significance. These data suggest a trend that the SPN patients have a greater problem with obstructive defecation and abnormal rectal sensation than those with SPD. We were unable to confirm any defect in colonic transit in the SPD patients compared with the SPN group.