Prolonged Colonic Transit Time 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.

Effect of a Gluten-Free Diet on Whole Gut Transit Time in Celiac Disease (CD) and Non-Celiac Gluten Sensitivity (NCGS) Patients: A Study Using the Wireless Motility Capsule (WMC).

Background: This study explores the impact of a gluten-free diet (GFD) on regional gastrointestinal (GI) transit times in individuals with celiac disease (CD) and non-celiac gluten sensitivity (NCGS). While a GFD is established for managing CD and wheat allergy, its effects on NCGS remain controversial due to inconclusive evidence. Methods: Utilizing a wireless motility and pH capsule (WMC) to assess regional (measurements of gastric, small bowel, and colonic transit times) and whole gut transit, newly diagnosed CD (n = 12) and NCGS (n = 12) patients underwent evaluations at baseline and 4 weeks after having a GFD. Results: At baseline conditions, individuals diagnosed with CD exhibited prolonged colonic and intestinal transit times when compared to those with NCGS (p < 0.05). Following a 4-week GFD, CD patients experienced significant reductions in both intestinal and colonic transit times, along with enhanced small intestine contractility. NCGS individuals showed improvements in intestinal transit time and contractility with a GFD, although the colon exhibited no discernible effect. The GFD did not significantly impact intragastric, intestinal, or colonic pH. Conclusions: This study, employing WMC for the first time, provides novel insights into the positive effects of a GFD on intestinal and colonic transit, as well as contractility, in CD patients, and to a lesser extent, in those with NCGS.

High Prevalence of Anorectal Dysfunction in Ambulatory Patients with Chronic Constipation, Regardless of Colon Transit Time.

Classification of chronic constipation (CC) into its three subtypes of slow transit constipation, defecation disorder and normal transit constipation, may improve its multifaceted management. We assessed the merits of the London classification in patients with CC, who were studied by both wireless motility capsule (WMC) and high-resolution anorectal manometry (HR-ARM), examining their relative utilities in decision-making.s PATIENTS AND METHODS: Retrospective, community-based study of prospectively collected data on patients with CC by Rome IV criteria, who underwent WMC and HR-ARM, Balloon Expulsion Test, and Rectal Sensory Testing. Clinical assessment was made by standard questionnaires. On WMC, standard criteria for colonic transit time (CTT) were used (normal CTT < 59h). The hierarchical London classification was used for HR-ARM analyses. Of 1261 patients with CC, 166 (91M; ages 22-86) received technically satisfactory WMC and HR-ARM, formed the analyzed study cohort, of whom 84 had normal CTT and 82 had prolonged CTT (> 59h). Patients with slow CTT were significantly older and had longer duration and more severe disease. Using the London classification criteria for disorders of anorectal function, we noted a high prevalence of anorectal dysfunction, regardless of CTT. Except for lower rate of anal hypertonicity in patients with slow CTT, disorders of recto-anal coordination, and rectal sensation were seen at a comparable rate in patients with CC, regardless of CTT. There is a significant overlap of anorectal disorders in patients with slow CTT. There is questionable specificity and utility of WMC and HR-ARM in assessing patients with CC. More work is needed to demonstrate the value of these studies as surrogate markers of the disease and its response to multifaceted therapy.

Regional gastrointestinal transit times in patients with chronic pancreatitis.

The mechanisms behind disrupted gastrointestinal (GI) motor function in patients with chronic pancreatitis (CP) have not been fully elucidated. We compared regional transit times in patients with CP to those in healthy controls, and investigated whether they were associated with diabetes mellitus, exocrine dysfunction, opioid treatment or quality of life. Twenty-eight patients with CP and 28 age- and gender-matched healthy controls were included. Regional GI transit times were determined using the 3D-Transit system, which consists of an ingestible electromagnetic capsule and a detector worn in an abdominal belt for 5 days. Exocrine function was assessed using the fecal elastase-1 test, and quality of life was assessed using the European Organization for Research and Treatment of Cancer questionnaire. Transit times were analyzed for associations with diabetes mellitus, exocrine pancreatic insufficiency (EPI), opioid treatment and quality of life. Compared with healthy controls, patients with CP had prolonged transit times in the small intestine (6.6 ± 1.8 vs 4.8 ± 2.2 hours, P = .006), colon (40 ± 23 vs 28 ± 26 hours, P = .02), and total GI tract (52 ± 26 vs 36 ± 26 hours, P = .02). There was no difference in gastric emptying time (4.8 ± 5.2 vs 3.1 ± 1.3 hours, P = .9). No associations between transit times and diabetes, EPI, or opioid consumption were found (all P > .05). Quality of life and associated functional and symptom subscales were not associated with transit times, except for diarrhea (P = .03). Patients with CP have prolonged small intestinal and colonic transit times. However, these alterations do not seem to be mediated by diabetes, EPI, or opioid consumption.

Gastrocolic Reflex Is Delayed and Diminished in Adults with Type 1 Diabetes.

Constipation is a prevalent gastrointestinal complication in diabetes. The pathophysiology may include neural dysfunction and impaired gastrocolic reflex; however, investigation of the latter has been limited in diabetes. Using the wireless motility capsule, we investigated whether the gastrocolic reflex was impaired in adults with type 1 diabetes compared to healthy. One hundred and four adults with type 1 diabetes underwent investigation with the wireless motility capsule and recorded sleep cycle, eating habits, and bowel movements in a diary. Colonic motility index, contraction amplitudes, time-to-peak, peak motility, and colonic transit time were investigated directly in response to a meal. Diagnosis of peripheral (nerve conduction) and autonomic (orthostatic hypotension) polyneuropathy was verified. In comparison with health, people with diabetes had at the time of ingestion decreased motility index and contraction amplitudes (p < 0.001), prolonged time-to-peak (p = 0.01), and borderline decreased peak motility (p = 0.06), which taken together indicate impaired coordination of the gastrocolic reflex. These features were most prominent in those with concomitant peripheral or autonomic neuropathy. Additionally, they were associated with prolonged colonic transit time (p > 0.01). In type 1 diabetes, the gastrocolic reflex was delayed and diminished and further associated with the presence of neuropathy and constipation. These results suggest that impaired reflex is part of the underlying pathogenesis in the development of constipation.

M1 macrophages-derived exosomes miR-34c-5p regulates interstitial cells of Cajal through targeting SCF

Slow transit constipation (STC) is a gastrointestinal disorder characterized by abnormal prolonged colonic transit time, which affects the life quality of many people. The decrease number of interstitial cells of Cajal (ICCs) is involved in the pathogenesis of STC. However, the molecular mechanism of loss of ICCs in STC remains unclear, making it difficult to develop new agents for the disease. In this study, we investigated the mechanism of decreasing ICCs in the pathogenesis of STC. We constructed the STC model rats by using atropine and diphenoxylate. A series of methods were used including immunofluorescence and immunochemistry staining, western blot, qRT-PCR, exosomes extraction and exosomes labeling. The results indicate that ICCs decreased in the STC rats accompanied with the macrophages activation. Further studies suggested that macrophages decreased the cell viability of ICCs by secretion exosomes containing miR-34c-5p. miR-34c5p targeted the 3Ꞌ -UTR of stem cell factor(SCF) mRNA and regulated the expression of SCF negatively. In conclusion, we demonstrated a novel regulatory mechanism of ICCs cell viability in STC. We found that exosome miR-34c-5p mediate macrophage-ICCs cross-talk. M1 macrophages derived exosomes miR-34c-5p decreased ICCs cell viability by directly targeting SCF.

Increased colon transit time and faecal load in irritable bowel syndrome.

BACKGROUNDIrritable bowel syndrome (IBS) is a bowel disorder involving abdominal pain or discomfort along with irregularity of stool form and passage frequency. The pathophysiology is poorly understood and seems to be multifactorial. Investigations of possible causes of IBS have included only a few colonic transit studies and no simultaneous determination of the colonic faecal content.AIMTo compare colon transit time and faecal load between IBS-patients and healthy control subjects. METHODSThe study included 140 patients with IBS, with a mean age of 50.0 years. The control group comprised 44 healthy persons with a mean age of 43.4 years, who were selected at random from the National Civil Register. Both the patient group and the control group underwent a marker study to measure colon transit time (CTT) and to calculate a faecal loading score. The patient group underwent treatment with a combined prokinetic regime, after which their CTT and faecal loading were reassessed. Analyses were performed to compare measurements between the control group and the patient group before and after treatment.RESULTSCompared to healthy controls, IBS-patients exhibited a significantly prolonged mean CTT (45.48 h vs 24.75 h, P = 0.0002) and significantly greater mean faecal loading scores in all colonic segments (P < 0.001). Among IBS patients, we found no significant differences between the 48 h and 96 h radiographs. Among patients exhibiting increased CTT and faecal loading, approximately half exhibited a palpable mass in the right iliac fossa. After intervention with a prokinetic treatment, the mean CTT among IBS patients was reduced from 45.48 h to 34.50 h (P = 0.091), with the post-treatment CTT not significantly differing from the CTT among control subjects (P = 0.095). The faecal loading score among IBS patients did not significantly differ before and after treatment (P = 0.442). The post-treatment faecal loading score in IBS patients remained significantly higher compared to that in controls (5.3 vs 4.3, P = 0.014). After treatment, half of the IBS-patients were relieved of bloating, while the majority no longer experienced abdominal pain and achieved a daily consistent stool. CONCLUSIONIBS-patients exhibited prolonged CTT and heavier faecal loading. These assessments may aid in diagnosis. Faecal retention may contribute to IBS symptoms, which can be treated using a prokinetic regime.

Colonic transit time in progressive supranuclear palsy and Parkinson's disease

AbstractObjectiveGastrointestinal (GI) function in progressive supranuclear palsy (PSP) has not been reported, in contrast with extensive studies of GI function in Parkinson's disease (PD). We aimed to investigate GI function in PSP and PD.MethodsA GI questionnaire for constipation and an objective colonic transit time (CTT) test were performed in 8 patients with PSP (6 men and 2 women; mean age, 74.6 years, mean duration of disease, 2.9 years), 36 patients with PD (19 men and 17 women; mean age, 75.6 years, mean duration of disease, 2.6 years), and 8 age‐matched normal control subjects (4 men and 4 women; mean age, 73.6 years).ResultsA GI questionnaire showed constipation in 2 (25%) PSP; 23 (64%) PD; and none (0%) control, without statistical significance. A CTT test showed total CTT of 63.2 ± 33.9 hours in PSP; 69.6 ± 42.8 hours in PD; and 45.2 ± 40.3 hours in control, without statistical significance. In contrast, right CTT in PSP (P &lt; .05) and PD (P &lt; .01) was significantly prolonged from that in control.ConclusionsSubjective constipation is uncommon, but prolonged CTT is observed in PSP. This GI feature needs appropriate management and care, which might reflect PSP’s brainstem/sacral spinal cord pathology.

Dyssynergic patterns of defecation in constipated adolescents and young adults with anorectal malformations

We aimed to evaluate the etiologies of constipation in patients with anorectal malformations having a good prognosis for bowel control but a high risk of constipation. We included twenty-five patients from the Odense university hospital in Denmark. Patients were subjected to colon transit time examination and high resolution anorectal manometry (HRAM). The median age was 18 (14–24) and 48% (12/25) were females. Fifty-two % (13/25) of patients were diagnosed with constipation. Types of anorectal malformation were perineal fistula (9/25), rectovestibular fistula (8/25), rectourethral bulbar fistula (5/25) and no fistula (3/25). No difference in neither total colon transit time nor segmental colon transit times were found based on the presence of constipation. Only four of the constipated patients fulfilled criteria for dyssynergic defecation with a dyssynergic pattern at HRAM and prolonged colon transit time. A Type I dyssynergic pattern was dominant in constipated patients (7/13). A Dyssynergic defecation pattern was due to isolated contraction of puborectalis muscle in 9 out of 13constipated patients. We found a dyssynergic pattern during attempted defecation in patients with anorectal malformations disregarded the presence of constipation. In the majority of constipated patients an isolated contraction of the puborectalis muscle was visualized with HRAM.

491 Wireless Motility Capsule Testing Results in New Diagnostic Information in 38% of Patients With Suspected GI Dysmotility: A 6-Year Review

INTRODUCTION: GI motility disturbances often present with upper and lower GI symptoms or a combination of both. Wireless Motility Capsule (WMC) is a standardized pH based test that can measure regional and whole gut actual transit times. Aims: 1. Determine the prevalence of transit time abnormalities in patients with GI dysmotility symptoms. 2. Correlate regional transit abnormality with clinical symptoms. 3. Assess change in patients' diagnosis based on WMC testing. METHODS: A prospective study of patients with suspected GI dysmotility who underwent WMC testing between 2012 and 2018. Patients were placed into three groups: 1) Upper GI symptoms: nausea, vomiting, bloating, and abdominal pain. 2) Lower GI symptoms: constipation and diarrhea. 3) Both upper and lower GI symptoms. Assessments of gastric emptying time (GET), small bowel transit time (SBTT), and colonic transit time (CTT) were recorded in each group and the diagnostic yield was evaluated. RESULTS: 72 patients were evaluated with WMC. 59 patients had complete study data and were included in the analysis. Mean age was 46 ± 14 years. 62 (86 %) were female. 21 (29%) had a h/o cancer. 22 (31%) were diabetic. 43/59 (73%) patients had an abnormal WMC result (Table 1). In patients with upper GI symptoms (n = 31), 15 (48%) had delayed GET (Table 2). New diagnostic information was obtained in 14/31 (45%). Of the 13 patients with lower GI symptoms, only 3 (23%) had a prolonged CTT. No patients had isolated abnormality of GET or SBTT. New diagnostic information was obtained in 5/13 (38%). In the group with overlapping upper and lower GI symptoms, only 2 (13%) had multiregional dysmotility. 8/15 (53%) patients had normal transit studies. This resulted in 5 patients (33%) with new diagnostic information. CONCLUSION: GI symptoms are not an accurate predictor of disease localization. Only15 (48%) of the patients with upper GI symptoms had gastroparesis, and 3 (23%) of the patients with lower GI symptoms had slow transit constipation. WMC study resulted in new diagnostic information in 45% of patients with upper GI symptoms, 38% of patients with lower GI symptoms and 33 % of patients with pan GI symptoms, including the presence of isolated and whole gut dysmotility that was not suspected based on the patient's presentation. Therefore patients with suspected GI dysmotility should undergo tests of the entire GI tract, as reported symptoms are poor indicators of the affected gut region.

Longer colonic transit time is associated with laxative and drug use, lifestyle factors, and symptoms of constipation.

BackgroundGastrointestinal symptoms and changes in colonic transit time (CTT) are common in the population.PurposeTo evaluate consecutive patients who had been examined for CTT, along with completion of a diary about laxative and drug use, lifestyle factors, and gastrointestinal symptoms, to identify possible associations with longer or prolonged CTT.Material and MethodsA total of 610 consecutive patients had undergone the radiopaque marker method with an abdominal X-ray for clinical purposes. The patients had completed a diary regarding medical treatment, lifestyle factors, stool habits, and their perceived constipation and abdominal pain during the examination period. The associations between CTT and laxative use, lifestyle factors, stool habits, and symptoms were calculated by logistic regression.ResultsWomen had longer CTT (2.5 [1.6–3.9] vs. 1.7 [1.1–3.0] days, P < 0.001), lower weekly stool frequency (6 [3–10] vs. 8 [5–12], P = 0.001), and perceived more constipation (P = 0.025) and abdominal pain (P = 0.001) than men. High coffee consumption (P = 0.045), bulk-forming (P = 0.007) and osmotic (P = 0.001) laxatives, and lower stool frequency, shaped stool, and perceived constipation (P for trend < 0.001) were associated with longer CTT. In total, 382 patients (63%) were treated with drugs affecting motility. In the 228 patients without drug treatment, longer CTT was associated with female sex and smoking, and lower frequency of symptoms and prolonged CTT were observed compared to patients using drugs. Tea, alcohol, and abdominal pain did not associate with CTT.ConclusionsFemale sex, coffee, smoking, drug use, infrequent stools, shaped stool, and perception of constipation are associated with longer or prolonged CTT.

Objective Colonic Dysfunction is Far more Prevalent than Subjective Constipation in Parkinson's Disease: A Colon Transit and Volume Study.

Gastrointestinal function has received increased interest in the context of Parkinson's disease (PD). Constipation is among the most frequent non-motor symptoms, but our understanding of the underlying pathology is limited. Subjective constipation correlates poorly with objective markers. The aims were to evaluate colonic transit time and volume in PD and to correlate these measures with subjective symptoms and gastric emptying. Thirty-two PD patients and 26 controls were included. Colonic transit time, computed tomography-based volume estimation, and gastric emptying were performed as objective markers of gastrointestinal function. Subjective gastrointestinal symptoms were evaluated by three different questionnaires. Seventy-nine percent of PD patients displayed prolonged colonic transit time (p < 0.0001) and 66% of patients had significantly increased colonic volume (p = 0.0002). Particularly the transverse and rectosigmoid segments were affected. There was no difference in gastric emptying time between groups. The prevalence of subjective constipation in PD patients was significantly lower and ranged from 3% to 38% depending on the type of questionnaire. Significantly delayed colonic transit time and increased volume were frequent findings in PD patients, and objective dysfunction was considerably more prevalent than subjective constipation symptoms. Also, the prevalence of subjective constipation varied widely depending upon which questionnaire was employed. These findings highlight the need for more research on how to define constipation in PD and also the need for improved understanding of the relationship between subjective symptoms and objective dysfunction.

Advanced Glycation End Products Impair Ca2+ Mobilization and Sensitization in Colonic Smooth Muscle Cells via the CAMP/PKA Pathway

Background/Aims: Excessive production of advanced glycation end products (AGEs) has been implicated in diabetes-related complications. This study aimed to investigate the mechanism by which AGEs potentially contribute to diabetes-associated colonic dysmotility. Methods: Control and streptozotocin (STZ)-induced diabetic groups were treated with aminoguanidine (AG). The colonic transit time and contractility of circular muscle strips was measured. ELISA, immunohistochemistry and western blotting were used to measure N^ε-carboxymethyl-lysine (CML) levels. Primary cultured colonic smooth muscle cells (SMCs) were used in complementary in vitro studies. Results: Diabetic rats showed prolonged colonic transit time, weak contractility of colonic smooth muscle strips, and elevated levels of AGEs in the serum and colon tissues. cAMP levels, protein kinase-A (PKA) activities, and inositol 1,4,5-trisphosphate receptor type 3 (IP₃R3) phosphorylation were increased in the colon muscle tissues of diabetic rats, whereas RhoA/Rho kinase activity and myosin phosphatase target subunit 1 (MYPT1) phosphorylation were reduced. The inhibition of the production of AGEs (AG treatment) reduced these effects. In cultured colonic SMCs, AGE-BSA treatment increased IP₃R3 phosphorylation and reduced intracellular Ca²⁺ concentration, myosin light chain (MLC) phosphorylation, RhoA/Rho kinase activity, and MYPT1 phosphorylation. The PKA inhibitor H-89 and anti-RAGE antibody inhibited the AGE-BSA–induced impairment of Ca²⁺ signaling and cAMP/PKA activation. Conclusion: AGEs/RAGE participate in diabetes-associated colonic dysmotility by interfering with Ca²⁺ signaling in colonic SMCs through targeting IP₃R3-mediated Ca²⁺ mobilization and RhoA/Rho kinase-mediated Ca²⁺ sensitization via the cAMP/PKA pathway.

Constipation in parkinson's disease: Subjective symptoms, objective markers, and new perspectives.

Constipation is among the first nonmotor symptoms to develop in the prodromal phase of PD. Pathological alpha-synuclein deposition is present throughout the gastrointestinal tract up to 20 years preceding diagnosis. Nevertheless, constipation in the context of PD remains ill defined and poorly understood. In this review, we summarize current knowledge of subjective symptoms and objective measures of constipation in PD. More than 10 different definitions of constipation have been used in the PD literature, making generalizations difficult. When pooling results from the most homogeneous studies in PD, a median constipation prevalence of 40% to 50% emerges, but with large variation across individual studies. Also, constipation prevalence tends to increase with disease progression. A similar prevalence is observed among patients with idiopathic rapid eye movement sleep behavior disorder. Interestingly, we detected a correlation between constipation prevalence in PD patients and healthy control groups in individual studies, raising concerns about how various constipation questionnaires are implemented across study populations. More than 80% of PD patients exhibit prolonged colonic transit time, and the same is probably true for de novo PD patients. Thus, the prevalence of objective colonic dysfunction exceeds the prevalence of subjective constipation. Colonic transit time measures are simple, widely available, and hold promise as a useful biomarker in manifest PD. More research is needed to elucidate the role of gastrointestinal dysfunction in disease progression of PD. Moreover, colonic transit measures may have utility as a more accurate risk factor for predicting PD in the prodromal phase. © 2016 International Parkinson and Movement Disorder Society.

Digestive sensitivity varies according to size of dogs: a review.

Field observations on food tolerance have repeatedly shown that when fed an identical diet, large breed (>25kg) dogs present softer and moister faeces than small breed ones (<15kg). The purpose of this review is to highlight the findings of four PhD theses, carried out between 1998 and 2013, whose objectives were to investigate the anatomical and physiological peculiarities that would explain, at least in part, this observation, as well as their nutritional implication. This work showed that large breed dogs, in contrast with smaller breeds, present a highly developed caecum and colon, which could explain the relatively longer colonic transit time. A prolonged colonic transit time could explain higher colonic fermentative activity, as supported by higher faecal concentrations of fermentative by-products. This effect would be reinforced by increased intestinal permeability and reduced sodium net-absorption. Taken together, these elements could be a possible cause of higher digestive sensitivity in large breed dogs. When prescribing a diet to a small or large breed dog, several aspects of the formulation must be taken into account. For a large breed dog, the general goal is to limit any ingredient that could increase the level of fermentable undigested residues and, in fine, exacerbate colonic fermentation. Highly digestible sources of proteins and starches are therefore strongly recommended to maintain an optimal digestive tolerance. Fermentable fibre sources (i.e. beet pulp and FOS) must also be used in limited quantity in their diet. Conversely, the incorporation of non-fermentable fibre (i.e. cellulose) appears useful to increase their stool quality. For a small breed dog, the general objective is to minimize any ingredient that could excessively limit colonic fermentation and induce in fine constipation. Purified starches and cellulose are therefore not really suitable for them. In contrast, cereals flours as well as non-fermentable fibre provided by cereals are recommended.

Clozapine-induced Gastrointestinal Hypomotility — New Objective Evidence for an Underestimated Side-effect

Clozapine-induced Gastrointestinal Hypomotility — New Objective Evidence for an Underestimated Side-effect

Acromegaly can be associated with impairment of LES relaxation in the oesophagus.

Although prolonged small intestine and colonic transit time has been demonstrated in acromegaly patients, the influence of acromegaly on oesophagus motility and the pathological mechanisms involved are still not clarified. We aimed to investigate manometric measurements to ascertain whether oesophagus motility is affected in active acromegaly patients. The study was performed in an institutional referral centre at a tertiary care hospital. Twenty-three acromegaly patients (mean age 43.2 ± 13.2 years) and 25 sex- and age-matched healthy control subjects (mean age 48.6 ± 7.9 years) were recruited to a case-control study. Oesophageal manometry was performed using MMS (Medical Measurement Systems, Netherlands) Solar GI - Air Charged Intelligent Gastrointestinal Conventional Manometry. In manometric measurements the lower oesophageal sphincter pressure was 18 ± 7 mmHg in acromegaly patients and 15.6 ± 4.4 mm Hg in controls, and there was no significant difference (p = 0.17). The percentage of relaxation was 64.8% and 81.8%, respectively, and it was significantly lower in acromegaly patients than in controls (p < 0.001). Additionally, the duration of relaxation was found to be 4 ± 1.9 seconds and 5 ± 1.7 seconds in patients and controls, respectively (p = 0.049). Our study has demonstrated a significant reduction in the percentage and duration of lower oesophageal sphincter relaxation in oesophagus motility even in acromegaly patients without any gastrointestinal symptoms. Further clinical and pathophysiological studies are required to clarify the underlying mechanisms of gastrointestinal motility disorders in acromegaly.

Small Intestinal Transit Time Is Delayed in Small Intestinal Bacterial Overgrowth.

Altered small intestinal motility is thought to contribute to the development of small intestinal bacterial overgrowth (SIBO). The clinical manifestations of SIBO and consequent malabsorption are wide ranging and include abdominal pain, bloating, diarrhea, weight loss, and nutritional deficiencies. However, due to the nonspecific nature of symptoms, the diagnosis may often be overlooked. To date, few studies have illustrated a direct relationship between impaired small intestinal motility and SIBO. In addition, further study has been limited by the technical challenges and lack of widespread availability of antroduodenal manometry. The development of a wireless motility capsule (WMC) (SmartPill) that evaluates pressure, pH, and temperature throughout the GI tract offers the potential to identify patients with small bowel transit delays who may be at risk for bacterial overgrowth. The primary aims of this study were to: (1) characterize the relationship of prolonged small bowel transit time (SBTT) in patients undergoing WMC with SIBO as based on a positive lactulose breath testing (LBT); and (2) to assess the relationship of prolonged gastric, colonic, and whole gut transit times (WGTT) and additional motility parameters with SIBO (positive LBT). We also sought to evaluate the relationship of small bowel motility parameters (SB motility index, contractions per minute, and SB peak amplitudes) with LBT results. We performed a retrospective study of consecutive patients who were referred for wireless motility testing at a single, tertiary care institution from April 2009 to December 2012. Of the 72 total patients identified, 34 underwent both WMC and LBT. Gastric, small bowel, colonic, WGTT, and SB motility parameters were measured and correlated with LBT results. Statistical methods utilized for data analysis include ANOVA, 2-sample t tests, nonparametric Kruskal Wallis test, Wilcoxon rank-sum test, and the Fisher exact test. Of the 37 patients who underwent both WMC and LBT, 24 (65%) were LBT positive. The mean SBTT among those who were LBT positive was 6.6 hours as compared with 4.2 hours in those who were LBT negative (P=0.04). Among patients who were LBT positive, 47.6% had prolonged SBTT (≥6 h), whereas only 7.7% of those who were LBT negative had a delay in their SBTT (P=0.01). In addition, patients who were LBT positive were more likely to have prolongation of both colonic and WGTT versus those who were LBT negative (CTT: positive LBT=64.4 h vs. negative LBT=35.5 h, P=0.02; WGTT: positive LBT=70.5 h vs. negative LBT=44.1 h, P=0.02). However, there were no statistical differences observed between the groups for gastric emptying times or other small intestinal motility parameters (SB motility index, contractions per minute, and peak amplitudes) between the 2 groups. Patients with underlying SIBO have significant delays in SBTT as compared with those without. The association between prolonged SBTT and positive LBT may be useful in identifying those patients with SIBO diagnosed by LBT and potentially target therapeutic options for those refractory to standard therapy. Interestingly, patients with positive LBT did not necessarily have a generalized gastrointestinal motility (similar GETs among groups), suggesting that small bowel transit specifically predisposes to the development of SIBO. Future, prospective studies are needed to further characterize intestinal dysmotility and other contributing pathophysiological mechanisms in SIBO and to investigate the potential benefits of prokinetics in this challenging patient population.

Nutrition support treatment for refractory constipation patients complicated with superior mesenteric artery syndrome

To determine the incidence and risk factors associated to with refractory constipation patients complicated with superior mesenteric artery syndrome (SMAS), and to observe the role of nutritional support in its treatment. A prospective nested case-control study was conducted from a constipation cohort(n=973) to assess the incidence and risk factors of SMAS. Pitents with SMAS were matched to controls with a ratio of 1:4 by age and gender. Cases developed SMAS in long-term follow-up(n=26) and controls did not(n=104). Nutritional support was used in 26 patients with SMAS. The efficacy of nutritional support was evaluated by retrospective analysis. The incidence of SMAS in this cohort of patients was 2.7%. Multivariate logistic analysis revealed BMI≤18 kg/m(2) (OR=2.89, 95%CI:1.14-7.31) and prolonged colon transit time(OR=3.57, 95%CI:1.36-9.35) were independent risk factors of SMAS in patients with refractory constipation. A total of 22 patients recovered after treatment of nutritional support. The successful rate of conservative treatment was 84.6%. The clinical symptoms, gastrointestinal quality of life index, Wexner constipation score and nutritional status were all significantly improved after treatment. A BMI of less than 18 kg/m(2) and prolonged colon transit time are independent risk factors in refractory constipation patients complicated with SMAS. Nutrition support should be carried out according to illness condition and nutritional status, and combined with theatment of constipation simultaneously.

Colonic transit before and after resection rectopexy for full-thickness rectal prolapse

The objective of this study was to measure the change in colonic transit time after resection rectopexy for complete rectal prolapse. We prospectively carried out isotope colonic transit studies before resection rectopexy in 38 patients with full-thickness complete rectal prolapse and invited them to attend for a postoperative transit study at least 1year after resection rectopexy. Preoperatively, 27 (70%) patients had abnormally prolonged colonic transit times, while 11 had normal colonic transit. Twenty-two (61%) patients agreed to attend for a three-day colonic transit study. Resection rectopexy failed to correct delayed colonic transit in all patients with abnormal preoperative tests, while 4 patients developed new delayed transit and 2 with normal transit were unchanged. The study suggests that most prolapse patients have a pan-colonic motility disorder that is not corrected by rectopexy and resection of most of the left colon. If resection rectopexy fails to correct abnormal transit, this study questions the rationale for continuing to offer resection and supports less invasive surgical procedures such as ventral rectopexy.