Orocaecal Transit Time Research Articles

Radiation-free oro-caecal transit time measurement: Which substrate

Radiation-free oro-caecal transit time measurement: Which substrate

Effects of oral casokefamide on plasma levels, tolerance, and intestinal transit in man

Food-derived opioid peptides such as β-casomorphins are of interest for treatment of chronic diarrhea. The β-casomorphin analog casokefamide was administered orally at doses of 5.5, 8.0, and 16.0 mg to 10 healthy male volunteers, respectively. Dose-dependent increases of plasma levels with a maximum of 350 fmol/l were determined. No side-effects due to casokefamide has been observed. In comparison to placebo, casokefamide showed a trend toward prolongation of oro-caecal transit time. Orally applied casokefamide is well tolerated and may represent a useful tool for treatment of diarrhea in the future.

Prolonged ambulatory recording of antroduodenal motility in slow-transit constipation.

Slow-transit constipation may be part of a pan-enteric motor disorder. To test this hypothesis 24-h ambulatory antroduodenal manometry was performed and orocaecal transit time determined in patients with slow-transit constipation and in healthy controls. Antroduodenal motility was recorded with a five-channel solid-state catheter. Postprandial motility was recorded after consumption of two standardized test meals and interdigestive motility was recorded nocturnally. Manometry tracings were analysed for quantitative and qualitative abnormalities. Orocaecal transit time was determined by means of the lactulose hydrogen breath test. Postprandial motility was no different between patients and controls. However, some minor changes of interdigestive motility were observed. The proportion of phase II activity of the nocturnal cycles of the interdigestive migrating motor complex was increased in patients while phase I activity was decreased. The total number of observed phase III fronts was no different in patients and controls, although the number of phase III fronts with antral onset was decreased. Furthermore, the amplitude of phase III activity of duodenal onset was also decreased. Specific motor abnormalities such as retrograde propagation of phase III fronts were more frequent in patients. Orocaecal transit time was delayed in patients. In patients with slow-transit constipation, orocaecal transit time is delayed but antro- duodenal motility is generally well preserved with only minor alterations. Presented as a poster to the Digestive Disease Week meeting in New Orleans, Louisiana, USA, May 1998, and published in abstract form as Gastroenterology 1998; 114: A820

The effect of coffee on gastric emptying and oro‐caecal transit time

The consumption of coffee allegedly induces or aggravates gastrointestinal symptoms. In order to investigate the effect of coffee on gastrointestinal motility we studied the effect of coffee on gastric emptying and oro-caecal transit time. In a randomised, controlled, cross-over study gastric emptying and oro-caecal transit time were studied in 12 healthy volunteers, using applied potential tomography and lactulose hydrogen breath test, respectively. After 1 day of coffee abstinence and an overnight fast, coffee or the control drink (water) was drunk and 10 min thereafter a liquid nutrient meal was ingested together with lactulose. During 150 min, recordings were made with applied potential tomography and breath samples were taken every 5 min. Lag-phase duration and gastric half-emptying time were determined by two blinded observers. The lag-phase duration after coffee (median 19.8 min, range 6-47 min) was not significantly different from that after water (median 19.3 min, range 11-37.5), nor was the gastric half-emptying time (median 75.7 min, range 56-157.6 vs. median 83.4 min, range 64. 6-148.4). Likewise, coffee had no significant effect on oro-caecal transit time (median 135 min, range 60-270 vs. median 140 min, range 55-270). No significant correlation between any of these parameters and mean daily coffee intake was found. Coffee does not affect gastric emptying of a liquid meal or small bowel transit.

Evaluation of small-bowel transit for solid and liquid test meal in healthy men and women.

Evaluation of severe functional gastrointestinal motility disorders requires an investigation of the entire gastrointestinal tract. This should be possible with a single radionuclide imaging study. The purpose of this study was (1) to define normal values of small-bowel transit in men and women and (2) to assess a possible difference between gender or test meal, since it has been shown that women have slower gastric emptying than men, and gastric emptying of solids is slower than liquids. A standard gastric-emptying test for a solid (technetium-99m sulphur colloid, 230 Kcal) and liquid (indium-111 DTPA water) test meal was performed in 12 healthy male and 12 healthy female volunteers. After 135 min, the volunteer was placed in the supine position for static imaging of the abdomen every 15 min for 6 h. Decay and crossover-corrected geometric mean gastric-emptying data were fit to a modified power exponential function to determine the 10% stomach emptying time for solids and liquids separately. An ROI was drawn around the caecum and ascending colon to determine the arrival time of at least 10% of the solid and liquid test meal. Ten percent small-bowel transit time (10% SBTT) and orocaecal transit time (OCTT) were calculated. The OCTT for males and females, respectively for solids and liquids, are 294.6 +/- 18.8; 301.3 +/- 24.5; 294.6 +/- 18.8 and 301.3 +/- 24.5 min. The 10% SBTT for males and females, respectively for solids and liquids, are 280.3 +/- 18.4; 280.6 +/- 24.0; 288.2 +/- 18.9 and 297.4 +/- 24.4 (mean +/- SEM) min. We observed a simultaneous transfer of solids and liquids from the terminal ileum to caecum (correlation coefficient 0.90). There is no statistically significant difference in SBTT between gender or solids and liquids. In contrast to the gastric-emptying time, the SBTT of solids and liquids were not significantly different nor was a gender difference found. Determination of the OCTT seems to be the simplest and most accurate approach to measure SBTT. Since ileocaecal transfer occurs as a bolus phenomenon, a 111In-labelled test meal can also be used for the determination of colon transit in a single imaging study protocol.

Abnormalities of upper gut motility in patients with slow-transit constipation.

To further delineate motor activity of the upper gastrointestinal tract in patients with slow-transit constipation. A prospective study comparing healthy volunteers with patients with a clinical diagnosis of slow-transit constipation. Eighteen patients with clinical diagnosis of slow-transit constipation and 10 healthy controls were included in the study. Fasting antroduodenal motility was measured by perfusion manometry for at least one complete cycle of the migrating motor complex or a maximum of 300 min. Oesophageal manometry, gastric emptying and orocaecal transit time measurements were also performed. At least one complete cycle of the migrating motor complex was observed in all controls, but in only nine patients (P < 0.01 versus control). The migrating motor complex cycle was incomplete (n = 5) or phase 3 activity was absent (n = 4) in the other patients. The incidence of clustered contractions was significantly increased in slow-transit constipation (P = 0.05 versus controls). The area under the contraction curve during late phase 2 (1509+/-296 mmHg x s) in patients with a complete cycle was significantly smaller than that in controls (2997+/-614 mmHg x s; P = 0.05). Orocaecal transit time was not significantly different among patients and controls, but oesophageal motility was abnormal in five of 18 patients and gastric emptying was abnormal in eight of 15 patients. Abnormalities of upper gut motility occur frequently in patients with slow-transit constipation. Interdigestive antroduodenal motility is characterized by (i) absence or prolonged duration of the migrating motor complex, (ii) an increased number of clustered contractions, or (iii) a decreased motility during late phase 2 of the migrating motor complex.

Dopamine delays gastric emptying and prolongs orocaecal transit time in volunteers

Dopamine delays gastric emptying and prolongs orocaecal transit time in volunteers

Altered myoelectrical activity in noninflamed ileum of rats with colitis induced by trinitrobenzene sulphonic acid.

Changes in gastric emptying and orocaecal transit time in patients with ulcerative colitis suggest that disturbances in gut motility may not be restricted to inflamed sites. This study sought to characterize changes in the motility of noninflamed ileum in a rat colitis model and to explore the mechanism(s) potentially involved. The myoelectrical activity of the ileum was recorded in rats with trinitrobenzene sulphonic acid (TNBS)-induced colitis. The degree of ileal and colonic inflammation was assessed by quantification of macroscopic damage and myeloperoxidase activity (MPO). The effect on ileal motility of pretreatment with atropine, indomethacin and NG-nitro-L-arginine-methyl ester (L-NAME) was investigated. TNBS-induced inflammation was restricted to the distal colon, as evidenced by morphological scores and MPO. Colitis was associated with increased frequency of ileal migrating motor complexes, characterized mainly by a decrease in the duration of phases I and III. The occurrence of ileal giant migrating complexes remained unchanged. The myoelectrical changes observed in the ileum persisted after treatment with atropine, indomethacin and L-NAME. Distal colitis is associated with abnormal myoelectrical activity in the noninflamed ileum of rats. Neither acetylcholine nor prostaglandins and nitric oxide seem to be involved.

Coffee has no effect on gastric emptying or oro-caecal transit time

Boekema, P. J.; Lo, B.; Samsom, M.; Akkermans, L. M.A.; Smout, A. J.P.M. Author Information

Rarity of colorectal adenomas in the African black population.

In South African blacks colorectal cancers are uncommon and adenomatous polyps are rare, despite major changes in diet and lifestyle in the large urbanized community of Soweto (population over 3 million). Factors favouring adenomas formation are changes in bowel function. Thus, stool weights, defaecation frequencies, oro-caecal transit times and whole-gut transit times in Sowetans approximate those of western populations. Moreover a measure of westernization of diet has occurred, the salient feature being a greatly reduced fibre intake (14 g daily). Factors thought to inhibit adenoma formation are physiological malabsorption of maize, lactose and fructose. Sucrose activity is significantly lowered compared with whites. With regard to diet, fat consumption is well below that of western societies. There are differences in colon cell proliferation, faecal short chain fatty acids, faecal pH and colonic microflora compared with white groups. Equivocal factors that may be involved in adenoma formation are time trends and genetic background. In the context of the above it is apparent that in South African blacks inhibiting factors outweigh promotive factors in adenoma formation.

Coffee has no effect on gastric emptying or orocaecal transit time

(43.5%) was 44.8 ( + 18.8) year. Mean age of the 242 women (56.5%) was 51.5 (_+19.8) year. Ninety-one subjects (21A%) had gastrointestinal symptoms >6 times/last year. Fifty-nine subjects (13.8%) had dyspepsia and 11 subjects (2.6%) had IBS. No differences between men and women were observed. Of the men, 83.9% drank alcohol; 12.9 (_+ 11.5) glasses/week, 92.0% drank coffee; 4.8 ( _+ 4.2) cups/day, and 52.2% smoked; 14.6 ( _+ 8.4) (nearly exclusively) cigarettes. Of the women 62.4% drank alcohol; 6.4 _+ 6.5 glasses/week, 88.1% drank coffee; 4.1 ± 2.7 cups/day and 29.8% smoked; 15.3 _+7.6 cigarettes/day. Use of alcohol or coffee were not related to dyspepsia. Current smokers had a 2.3 fold increased risk [95% CI 1.13, 4.82] (p=0.02) and former smokers a 2.7 increased risk [95% CI 1.25, 5.79] (p=0.009) compared to never smokers. No association between IBS and use of alcohol, coffee or smoking could be demonstrated. Subjects with gastrointestinal symptoms >6 times/last year, who believed that their symptoms were associated with use of alcohol (16.5%), coffee (37.4%) or smoking (6.6%) did not differ from non-believers in consumption of these determinants. Conclusions: The prevalence of dyspepsia (13.8%) and of IBS (2.6%) in the general Dutch adult population appears to be lower than are found in other countries. Use of alcohol and coffee was not associated with functional bowel symptoms. Former and current smoking were strongly related to dyspepsia.

Bowel dysfunction in cystic fibrosis: importance of breath testing.

To investigate the prevalence of carbohydrate malabsorption and bacterial overgrowth in children with cystic fibrosis (CF) and abnormal stool pattern referred for breath hydrogen testing. Results from 89 tests using lactose, sucrose and lactulose in 54 children with CF were compared with 5430 tests on children with non-CF-related stool abnormalities. Children with CF were more frequently unable to ferment lactulose to hydrogen (39% vs. 20%, P<0.03); they had significantly longer oro-caecal transit times (mean 99 vs. 68 min, P<0.0003); they had a higher incidence of bacterial overgrowth (32% vs. 7%, P<0.003) and sucrose malabsorption (47% vs. 14.5%, P<0.004); but they had no increase in lactose malabsorption (40% vs. 31%). Children with bacterial overgrowth in both groups had longer transit times (CF 123 min, non-CF 108 min) compared to the non-CF children without overgrowth (68 min) and reference normal children (69 min). Bacterial overgrowth and carbohydrate malabsorption, particularly of sucrose, should be considered when assessing children with CF and abnormal stool patterns.

Aetiology of running-related gastrointestinal dysfunction. How far is the finishing line?

30 to 65% of long distance runners experience gastrointestinal (GI) symptoms related to exercise. Several hypotheses have been postulated; however, the aetiology and pathophysiology are far from clear. The mechanical effect of running on the viscera must be involved in the development of GI symptoms in this sport. Reduction of splanchnic blood flow due to visceral vasoconstriction is another widely supported theory; nevertheless, it does not explain many of the clinical findings. Examination of the GI tract during exercise is a difficult task, and measurements of both orocaecal and whole-gut transit time have shown equivocal results. GI hormones, and especially prostaglandins, may be of crucial importance for the production of symptoms. Intestinal absorption, secretion and permeability may also be altered during exercise, provoking intestinal dysfunction. Factors such as stress, diet, dehydration, infections and other factors need to be analysed in order to present a global view of the hypotheses regarding the aetiology of this common and often overlooked problem.

Depression, alcohol abuse and orocaecal transit time

Depression, alcohol abuse and orocaecal transit time

Reference ranges for gastrointestinal transit of barium-impregnated polyethylene spheres in healthy cats.

Commercial barium-impregnated polyethylene spheres (BIPS) were administered to 12 healthy adult cats according to the manufacturer's instructions (30 small BIPS and 10 large BIPS to each cat) together with 60 g of a canned food. Radiographs were taken at hourly intervals until seven hours after feeding, and then at eight, 10, 12, 14, 17, 23 and 30 hours or until all the BIPS had left the stomach and at least 50 per cent had entered the colon. Six cats were sedated immediately after being fed the BIPS and six cats remained unsedated. For small BIPS (1.5 mm diameter), the gastric transit time (first exit of BIPS from the stomach) in the sedated cats had a median of 6 hours (range 3 to 8) and in the unsedated cats a median of 2.5 hours (range 2 to 6). Values for other transit times were not significantly different between the two groups, and the pooled data revealed a median 50 per cent gastric emptying time of 6.4 hours (range 2.5 to 10.9), a complete gastric emptying time of 12 hours (range 6 to 27), an orocaecal transit time (first appearance of BIPS in the colon) of 6.5 hours (range 4.0 to 12.0) and a 50 per cent orocaecal transit time of 8.8 hours (range 4.6 to 12.8). The gastrointestinal transit of large BIPS (5 mm diameter) was significantly correlated with the passage of small BIPS but, except for the complete gastric emptying time, was significantly slower.

Assessment of orocaecal transit time in cats by the breath hydrogen method: the effects of sedation and a comparison of definitions

Oro-caecal transit times ( OCTTs) were assessed in 10 healthy adult cats by the lactulose breath hydrogen method with either no sedation (group A), or after the intramuscular administration of three sedative regimens: a combination of acetylpromazine at 0·1 mg kg −1 with buprenorphine at 10 μg kg −1 (group B), ketamine at 5 mg kg −1 with midazolam at 0·1 mg kg −1 (group C), or medetomidine at 50 μg kg −1 (group D). For each test, the OCTT was defined by four methods: a visual assessment, the first maintained 4 ppm increase in hydrogen production, and the first maintained 0·5 ml hr −1 increase in hydrogen production assessed by two cumulative sum methods. Depending on the definition, the median OCTTs of the cats were between 113 and 131·5 minutes in group A, 86·5 and 97·5 minutes in group B, 218 and 235·5 minutes in group C and 86·5 and 97·5 minutes in group D. By two of the definitions, the median OCTTs in group C were significantly longer than in group A (P≤0·037) and approached significance by the other two definitions. The use of sedatives significantly increased the inter-individual variability of the OCTTs, particularly in groups C and D. There were significant differences between the median OCTTs defined by the four different methods, but all the methods were very highly and significantly correlated ( r s ≤0·9503, P<0·0001).

Radiological bile acid absorption test 75SeHCAT in patients with diarrhoea of unknown cause.

The purpose with this study was to investigate the usefulness of the 75SeHCAT test in patients suffering from "functional" diarrhoea and to disclose earlier radiological investigations performed in the course of disease. Twenty patients with chronic diarrhoea of unknown cause were investigated with the 75SeHCAT test. The cholestyramine test and an estimation of oro-caecal transit time (OCTT) were also performed in 13 and 10 patients respectively. Ten patients had low 7-day retention (< or = 15%). Nine of these were tested with cholestyramine and 8 showed complete relief from the diarrhoea. The cholestyramine test had no effect on the 4 patients with normal bile acid retention. No correlation was found between the retention of 75SeHCAT and OCCT. A total of 80 inconclusive gastrointestinal barium examinations were performed during the course of disease. Pathological bile acid retention, studied with the radiological 75SeHCAT test, is common in patients with diarrhoea of unknown cause. The test should be performed earlier in the course of disease in order to prevent unnecessary radiological investigations and to reduce patient suffering and distress.

Intestinal permeability and orocaecal transit time in elderly patients with Parkinson's disease.

The aetiology of weight loss in patients with Parkinson's disease is likely to be multifactorial. We studied 15 patients with Parkinson's disease and 15 age- and sex-matched controls and looked for evidence of malabsorption due to small bowel bacterial overgrowth or alteration of intestinal permeability. There was a marked increase in orocaecal transit time in the patients with Parkinson's disease, although lactulose hydrogen breath testing did not show evidence of small bowel bacterial contamination. Intestinal permeability measured by the differential sugar absorption test was also deranged. There was reduced absorption of mannitol in patients with Parkinson's disease while lactulose absorption was similar in both groups, suggesting decreased non-mediated uptake across the enterocyte brush border membrane in patients with Parkinson's disease.

A comparison of orocaecal transit times assessed by the breath hydrogen test and the sulphasalazine/sulphapyridine method in healthy beagle dogs

Orocaecal transit time ( octt) was assessed in six healthy beagles by means of the breath hydrogen test ( bh 2 t) and the sulphasalazine/sulphapyridine method ( slz) after the administration of a test meal of canned food mixed with sulphasalazine. Orocaecal transit time was defined as the time taken from the oral administration of the test meal to the time when the first portion of the meal reached the colon. In five of the dogs the octts assessed by the bh 2 t were shorter than those measured by the slz method by 30, 15, 45, 30 and 45 minutes. However, the median octt assessed by the bh 2 t (135 minutes, range 120 to 195 minutes) was not significantly different from that measured by the slz (180 minutes, range 150 to 210 minutes) and was highly correlated with it r=0·94, P=0·016). The sixth dog maintained baseline hydrogen and plasma sulphapyridine readings throughout the monitoring period and the octt could not be measured.

Analysis and development of AC biosusceptometer for orocaecal transit time measurements.

Analysis and development of AC biosusceptometer for orocaecal transit time measurements.