Prolonged Transit Time Research Articles

Local cooling prolongs oesophageal transit in humans.

The influence of local cooling on oesophageal transit was studied in eight healthy volunteers by oesophageal radionuclide transit. Compared with lukewarm (18 degrees C) water a significantly prolonged mean transit time (MTT) was found after ingestion of cold liquid (4 degrees C) and a slightly shorter MTT with 50 degrees C. The effect was of short duration lasting less than 2 min. The effect of atropine, morphine and naloxone, on the influence of local cooling was evaluated. Morphine (7 x 5 mg i.v.) abolished the effect of cooling on MTT. Naloxone (1 x 6 mg i.v.) reduced the effect of cooling, but the difference between 4 degrees C and 19 degrees C was significant still. Atropine (1 mg i.v.) had no effect on the increase in MTT at 4 degrees C. It is concluded that in humans local cooling increases oesophageal MTT. Local warming shortened MTT slightly. The abolishment of the influence of cooling by morphine suggests that opioids may be involved.

Functional image of dynamic computed tomography in diagnostic and prognostic evaluation of ischemic stroke within the first 6 hours.

It is important to make a diagnosis before a low-density area appears on computed tomography for appropriate management of acute ischemic stroke. We report the diagnostic and prognostic usefulness of functional image of dynamic computed tomography for acute ischemic stroke. Forty-seven patients with ischemic strokes within 6 hours of ictus underwent dynamic computed tomography in which functional images were obtained. These findings were compared with angiographic findings, follow-up computed tomography, and clinical outcome. The functional images were categorized into three groups: (1) cortical type: abnormalities on time to peak image and/or corrected mean transit time image involving mainly cortical structures (29 cases); (2) noncortical type: abnormalities on either or both images limited to noncortical structures (7 cases); and (3) normal type: no abnormalities on both images (11 cases). Cortical type as a diagnostic test for arterial trunk occlusion had a good sensitivity (100%), specificity (95%), and accuracy (98%). Infarction volume on follow-up computed tomography correlated with extension of prolonged time-to-peak area (r = .80, P < .01) and that of prolonged corrected mean transit time area (r = .81, P < .01). Cortical type was associated with significantly unfavorable outcome (P < .01). Functional image of dynamic computed tomography findings predicted arterial trunk occlusion, infarction volume, and clinical outcome. Therefore, this technique would be useful not only for indicating definitive angiography and subsequent therapy but for evaluating the effectiveness of surgical or medical recanalization.

Motilitätsstörungen des Ösophagus - Diagnostik mit dem Reisbreischluck

The purpose of this study was to evaluate the role of a "barium-rice" study for diagnosis of dysphagia and oesophageal motility disorders. 203 patients with oesophageal motility disorders of various aetiologies were examined by both conventional barium study and a "barium-rice" study. During the latter, oesophageal clearance of a defined mixture of barium sulfate and boiled rice was measured. The conventional barium study revealed prolonged transit time in only 15.8% (32 of 203 cases), whereas barium-rice study was pathological in 50.8% (103 to 203 cases). In 71 of 171 patients (41.5%) with a normal barium study, barium-rice passage was prolonged. In 23 patients, radiological results were confirmed by manometric measurements. Oesophageal motility disorders are detected by a barium-rice study with high sensitivity independent of the underlying disease. The barium-rice study offers a simple diagnostic tool revealing quantitative and reliable results. The barium-rice study is a suitable method for screening and follow-up of patients with dysphagia and oesophageal motility disorders.

Non-invasive assessment of gastrointestinal motility disorders in diabetic patients with and without cardiovascular signs of autonomic neuropathy.

Twenty six patients with insulin dependent diabetes mellitus underwent a gastric emptying test, a gall bladder contraction test, an orocaecal transit study, and a colon transit test. Eleven patients had signs of cardiovascular autonomic neuropathy, 15 patients were without signs of cardiovascular autonomic neuropathy. Mean gastric clearance of radioopaque markers ingested with a meal averaged 29.5 (2.3) markers per six hours in subjects without cardiovascular autonomic neuropathy compared with 17.8 (2.3) markers per six hours in patients with cardiovascular autonomic neuropathy (p < 0.02). Gall bladder emptying in response to graded CCK8 stimulation was impaired in five of 11 patients with cardiovascular autonomic neuropathy, whereas it was normal in the patients without cardiovascular autonomic neuropathy (p < 0.01). Oral caecal transit times were not significantly different in the two patient groups, whereas colonic transit was slower in the patients with cardiovascular autonomic neuropathy compared with the group without cardiovascular autonomic neuropathy (p < 0.02). There was no correlation between disturbed gastric clearance, impaired gall bladder contraction, and prolonged colonic transit time in the patients with cardiovascular autonomic neuropathy nor was there a correlation between any disturbed motor function and age or duration of diabetes. It is concluded that autonomic neuropathy can affect motor functions throughout the gastro-intestinal tract. Any disturbed motor function in the gut could therefore be one of the numerous expressions of diabetic neuropathy affecting the cardiovascular, the endocrine or the gastrointestinal system.

Changed integrated gastrointestinal response to a mixed meal in exocrine pancreatic insufficiency.

Using a multiple-marker dilution technique to quantitate flow volumes at a jejunal sampling site 70 cm from pylorus, propulsion and absorption of a 300-ml mixed liquid test meal were compared in seven patients with exocrine pancreatic insufficiency and in ten healthy subjects. In pancreatic insufficiency, outputs of lipase and amylase were 8% of control levels. Early gastric emptying rate was similar in both groups, but emptying was completed earlier, and less gastric acid was emptied in pancreatic insufficiency. In pancreatic insufficiency, initial biliary output was larger than in controls, and transit time through the test segment was twice that of controls. During the prolonged transit time, larger amounts of glucose (but less fat) were absorbed in pancreatic insufficiency. Forty minutes after the meal, almost a third of the fatty content of the meal was propelled to lower parts of the intestine. In conclusion, pancreatic insufficiency is associated with impaired inhibitory regulation of gastric and biliary outputs after a mixed meal. The impaired digestion of nutrients in pancreatic insufficiency is partially compensated for by slowing of intestinal transit, permitting more efficient absorption. Exposure of the gut to large quantities of fat is suggested to trigger the slowing of upper intestinal transit in pancreatic insufficiency.

Effect of pinaverium bromide on jejunal motility and colonic transit time in healthy humans

Pinaverium bromide is a specific calcium channel blocker used in the treatment of irritable bowel syndrome (IBS) for its spasmolytic activity. The aim of the present study was to evaluate the effect of orally administered pinaverium bromide on jejunal motility and total and segmental colonic transit time in control subjects. Gastrointestinal studies were performed in 10 healthy volunteers (30 ± 3 years), before and after a treatment phase of 14 days (150 mg/d). Jejunal motility was measured by prolonged manometry (14h) and colonic transit time by a multiple ingestion, single marker technique. No significant modification of phase III of the migrating motor complexes was demonstrated. On the contrary, a significant ( p < 0.01) but weak decrease of the frequency of contraction was found. Unlike previous studies, no decrease of total or segmental colonic transit time was demonstrated. Jejunum, colon / motility / calcium-channel antagonist.

Cholescintigraphy in the Diagnosis of Intrahepatic Cholestasis How Specific Is It?

Previous results from tests on a limited number of patients suggested that the combination of relatively normal hepatocyte clearance, prolonged parenchymal transit time, and eventual passage of radiotracer into the intestine or gallbladder without evidence of biliary tract dilatation were relatively specific for intrahepatic cholestasis. We reevaluated the specificity of cholescintigraphy for the diagnosis of intrahepatic cholestasis in an unselected group of patients from a general hospital. Sixteen patients had the cholescintigraphic findings of intrahepatic cholestasis and an established diagnosis of biliary tract dilatation or nondilatation by ultrasound, ERCP, or intraoperative cholangiography. Using 6 mm as the upper limits of normal for the diameter of the common hepatic duct by ultrasonography resulted in a specificity of 63% (10 correct out of 16); using 6 mm plus 1 mm for for every decade over 60 years of age gave a specificity of 75% (12 correct out of 16); and using the more liberal criterion of 8 mm as the upper limits of normal increased the specificity to 81% (13 out of 16). The data suggest that cholescintigraphy alone is unreliable in differentiating intrahepatic cholestasis from extrahepatic obstruction, even when the obstruction is partial and radiotracer eventually passes through the extrahepatic biliary tract.

Constipation associated with chronic spinal cord injury: the effect of pelvic parasympathetic stimulation by the Brindley stimulator

Ten subjects with severe constipation due to complete spinal cord injury (SCI) had prolonged oro-anal transit time (p less than 0.01), diminished faecal water content (p less than 0.05) and a reduced frequency of defaecation (p less than 0.01) compared to 10 non-SCI subjects. Paraplegics with an implanted Brindley S234 anterior sacral nerve root stimulator had a significant increase in frequency of defaecation (p less than 0.01), compared to the SCI group while the faecal water content was less although not significantly so. The Brindley stimulator group also showed a more rapid colonic transit than the SCI group but this did not reach statistical significance. SCI is associated with constipation which therefore appears to be favourably influenced by the Brindley S234 anterior nerve root stimulator. The effects produced are compatible with stimulation of left colonic motility, which facilitates the emptying of the distal colon, but also suggest that part of the response restricts transit in some areas of the colon or rectum. Since the motility changes induced by the Brindley stimulator do not affect the right colon a relatively greater residence time of the faecal bolus in this part of the large bowel would enhance water absorption.

Technetium 99m diphosphonate uptake and intraosseous hemodynamics during venous congestion in bone

Venous congestion in bone is a common early feature of inflammatory and degenerative joint diseases. An experimental study was performed of the relationship between the scintigraphic appearance of joints and the intraosseous hemodynamics during venous congestion caused by obstruction of the osseous venous drainage by increased intra-articular pressure. Intra-articular pressure was raised to 75% of mean arterial pressure in one knee each of 8 immature dogs. This caused elevated intraosseous pressure in the distal femoral epiphysis but not in the metaphysis. The elevated intraosseous pressure in the affected femoral epiphysis was associated with decreased technetium 99m diphosphonate uptake and blood flow, unaltered vascular volume and tissue hematocrit, and prolonged transit time of blood in the central cancellous bone. The decreased radionuclide uptake during intraosseous venous congestion thus appeared to reflect a decreased blood supply. However, by multiple regression analysis, the diphosphonate uptake in bone generally varied positively with blood flow and plasma volume and inversely with red cell volume in a nonlinear, multifactorial relationship.

99mTc]diphosphonate uptake and hemodynamics in arthritis of the immature dog knee

The relationship between [99mTc]diphosphonate uptake and bone hemodynamics was studied in canine carrageenan-induced juvenile chronic arthritis. Blood flow was determined with microspheres, plasma and red cell volumes were measured by labeled fibrinogen and red cells, and the microvascular volume and mean transit time of blood were calculated. Normal femoral epiphyses had lower central and higher subchondral blood flow and diphosphonate uptake values. Epiphyseal vascular volume was uniform, resulting in a greater transit time of blood centrally. In arthritis, blood flow and diphosphonate uptake were increased subchondrally and unaffected centrally, while epiphyseal vascular volume was increased throughout, leading to prolonged transit time centrally. The normal metaphyses had low blood flow and diphosphonate uptake values in cancellous bone and very high values in growth plates, but a large vascular volume throughout. The mean transit time therefore was low in growth plates and high in adjacent cancellous bone. Arthritis caused decreased blood flow and diphosphonate uptake in growth plates but increased vascular volume and transit time of blood. Diphosphonate uptake correlated positively with blood flow and plasma volume and negatively with red cell volume in a nonlinear fashion. Thus, changes in diphosphonate uptake and microvascular hemodynamics occur in both epiphyseal and metaphyseal bone in chronic synovitis of the immature knee. The [99mTc]diphosphonate bone scan seems to reflect blood flow, plasma volume, and red cell volume of bone.

Sucralfate versus Cimetidine in Reflux Oesophagitis: The Effect on Oesophageal pH and Motility

Sixty patients with endoscopically verified oesophagitis entered a double-blind study comparing the effect of 1 g of sucralfate granulate given four times a day and cimetidine, 400 mg twice a day. Fifty-two patients, 26 treated with cimetidine and 26 with sucralfate, were examined with short-term pH monitoring before and after 12 weeks of treatment. In about half of the patients, 19 treated with cimetidine and 11 treated with sucralfate, the oesophageal motility was studied with a radionuclide test before and after treatment. The sucralfate treatment did not affect either mean pH or the emptying rate but reduced the number of spikes. The cimetidine treatment increased mean pH and reduced the number of spikes but did not affect emptying rates. Both groups had significantly prolonged mean transit time (MTT) compared with healthy volunteers. MTT did not change after either treatment. The residual activity in the sitting position was significantly increased after cimetidine. It is concluded that the pharmacodynamic effect on oesophageal motility is different for the two drugs in question. Primary dysmotility might be involved in the pathogenesis of oesophagitis.

Breath Methane Production in Children With Constipation and Encopresis

Breath methane excretion is uncommon in children compared with adults. Certain intracolonic conditions, however, have been associated with enhanced methane generation. We hypothesized that encopretic and constipated children, who have abnormal colonic transit times, more likely would excrete methane than healthy children. To determine the prevalence of methane excretion among children with encopresis or simple constipation, we performed breath methane analysis on such patients and age-, race-, and sex-matched control subjects. Encopretic patients (mean age, 8.3 +/- 3.0 years) had daily, involuntary passage of feces and clinical evidence of constipation. Constipated patients (mean age, 7.1 +/- 2.9 years) had a history of hard stools and at least one of the following symptoms: infrequent defecation, dyschezia, hematochezia, difficult stool expulsion, or abdominal pain during bowel movements. Methane excretion was present in 26 of 40 (65%) encopretic patients versus 6 of 40 (15%) control patients (P less than 0.001). In contrast, 3 of 27 (11%) constipated patients were methane excreters, versus 2 of 27 (7%) controls (P = 0.4). Fourteen asymptomatic encopretic patients were retested after successful therapy; eight were methane excreters initially, but five of eight did not excrete methane after treatment. We conclude that methane is produced in a large number of children with encopresis. Treatment appears to alter methanogenesis in such patients. The prevalence of methane producers among constipated children is not different from the prevalence in healthy subjects. Methanogenesis in encopretic patients may be enhanced by prolonged colonic transit time or abnormal intracolonic conditions.

Breath Methane Production in Children With Constipation and Encopresis

SummaryBreath methane excretion is uncommon in children compared with adults. Certain intracolonic conditions, however, have been associated with enhanced methane generation. We hypothesized that encopretic and constipated children, who have abnormal colonic transit times, more likely would excrete methane than healthy children. To determine the prevalence of methane excretion among children with encopresis or simple constipation, we performed breath methane analysis on such patients and age‐, race‐, and sex‐matched control subjects. Encopretic patients (mean age, 8.3 ± 3.0 years) had daily, involuntary passage of feces and clinical evidence of constipation. Constipated patients (mean age, 7.1 ± 2.9 years) had a history of hard stools and at least one of the following symptoms: infrequent defecation, dyschezia, hematochezia, difficult stool expulsion, or abdominal pain during bowel movements. Methane excretion was present in 26 of 40 (65%) encopretic patients versus 6 of 40 (15%) control patients (P &lt; 0.001). In contrast, 3 of 27 (11%) constipated patients were methane excreters, versus 2 of 27 (7%) controls (P = 0.4). Fourteen asymptomatic encopretic patients were retested after successful therapy; eight were methane excreters initially, but five of eight did not excrete methane after treatment. We conclude that methane is produced in a large number of children with encopresis. Treatment appears to alter metha‐nogenesis in such patients. The prevalence of methane producers among constipated children is not different from the prevalence in healthy subjects. Methanogenesis in encopretic patients may be enhanced by prolonged colonic transit time or abnormal intracolonic conditions.

The Influence of Pregnancy and Contraceptive Steroids on the Biliary Tract and Its Reference to Cholesterol Gallstone Formation

The evidence that pregnancy and the use of contraceptive steroids are associated with increased risk of cholesterol gallstones is reviewed from a physiologic viewpoint. Hepatobiliary functions known to be involved in gallstone formation are physical and chemical composition of bile; nucleation retention and crystal growth; decreased gallbladder motility; enterohepatic circulation of bile acids; speed of gastric emptying and intestinal transit time. In pregnancy many changes in bile acid concentration and pool size have been documented in animals and women with conflicting results. Late pregnant women have enlarged gall bladders that empty slowly in response to food and prolonged intestinal transit time but not gastric emptying has been reported. Cholesterol saturation of bile is increased. Estrogens are known to bind to receptors in hepatocytes and gall bladder. During estrogen administration cholesterol saturation in bile increases the bile acid pool size decreases synthesis of bile acids declines and recycling of bile acids increases with increased fecal losses of bile acids. Progestins have the opposite effects favoring bile acid synthesis. Progesterone has a quieting effect on smooth muscle possibly causing some of the complaints of pregnancy and oral contraception such as heartburn and constipation. These changes with the possibility that emptying of the gall bladder is incomplete give cause for the association between oral contraception and gallstones.

Abnormal Hepatobiliary Clearance of 99mTc-N- (2, 6-Diethylphenylcarbamoylmethyl) iminodiacetic Acid in the Altered State of Thyroid

Hepatobiliary clearance of 99mTc-EHIDA was investigated in cases with altered thyroid function by deconvolution method. The results indicated that mean hepatic transit time of all control subjects revealed less than 10 minutes. On the other hand, mean hepatic transit time of cases with altered thyroid function revealed prolonged more than 13 minutes. Cases especially showing an elevated serum concentration of TSH compared with normal range (4.6 microU/ml) had a tendency of a high incidence of markedly prolonged mean hepatic transit time. These results suggest that thyroid hormone may influence on the hepatic metabolism of hepatobiliary radiopharmaceuticals. This phenomenon also could partly explain the cause of liver dysfunction seen in subjects with altered states.

Consumption of Raw Potato Starch Alters Intestinal Function and Colonic Cell Proliferation in the Rat

Raw potato starch (RPS) may escape complete digestion to enter the colon and produce alterations in colonic function, while cooked potato starch (CPS) is nearly completely digested in the rat small intestine. Effects of RPS and CPS on colonic function [fecal weight, transmit time and thymidine kinase (TK) activity (a marker for cell proliferation)] were contrasted in a 6-wk feeding study. Male F344 rats consumed either dextrose/sucrose (DS; control), 30% CPS or 30% RPS diet. RPS feeding resulted in a 3-fold increase in fecal weight and a 30% prolongation in transit time, as well as elevated levels of colonic mucosal total protein (50%) and TK activity (4- to 7-fold) compared to DS-fed rats. A second study revealed normal large intestinal histology in rats fed CPS or RPS, with elongated colonic crypts (33% increased over CPS) in group RPS. Large intestinal contents were heavier in group RPS than in group CPS. These studies demonstrate that RPS feeding significantly enhances fecal weight yet prolongs total gastrointestinal transit time. Enhanced colonic TK and elongated colonic crypts suggest that RPS stimulates colonic mucosal growth.

Effects of cimetropium bromide on gastrointestinal transit time in patients with irritable bowel syndrome

Cimetropium bromide is a new antimuscarinic compound with strong antispasmodic activity. The aim of this study was to evaluate the effects of oral cimetropium bromide on total gut transit time in patients with irritable bowel syndrome. Forty patients, divided according to their initial total gastrointestinal transit times and presenting symptoms, were treated with cimetropium bromide 50 mg t.d.s. or placebo for 1 month according to a double-blind, parallel group design. Before and after treatment all subjects ingested 24 radio-opaque markers. The total intestinal transit time was determined by evaluating the rate of disappearance of markers from plain X-ray films of the abdomen taken every 24 h for 4 days. Pain and bowel habits were also monitored. Seven patients did not complete the study. Cimetropium bromide significantly (P less than 0.01) shortened the whole gut transit time in patients with prolonged transit time (80.8 +/- 4.0 h before vs 60.8 +/- 6.7 h after treatment) and improved the global clinical condition significantly compared with placebo (P = 0.029). In patients with a short total intestinal transit time, cimetropium bromide had no effect on whole gut transit time and did not significantly improve symptoms. The results of this study indicate that oral cimetropium bromide is effective both objectively and subjectively in a subgroup of irritable bowel syndrome patients with constipation.

Esophageal Motor Function Evaluated by Scintigraphy, Video-Radiography and Manometry in Diabetic Patients

Prolonged esophageal scintigraphic transit time is frequent in diabetic patients and is related to autonomic neuropathy. In this study, esophageal scintigraphic transit time was correlated to esophageal motor function as evaluated by video-radiography and manometry in 13 diabetic patients. An abnormal scintigraphic transit time (greater than 15 s) occurred in 6 patients. All patients with abnormal transit time showed abnormal results at video-radiography (n = 4) and/or manometry (n = 5), which were observed in only 2 of 7 patients with normal transit time (both with abnormal video-radiography and manometry). A prolonged scintigraphic transit appears reliable as an indicator of disturbed esophageal smooth muscle function since it is well correlated with abnormalities shown by a combination of video-radiography and manometry.

Dysphagia After Total Laryngectomy

Quantitative analysis of swallowing after total laryngectomy has been compared with the data obtained in normal subjects. Lack of negative pressure production in the PE segment has been related to the dysphagia and prolonged bolus transit times. High pressures in the oropharynx may be a cause of fistulas.

The action of cisapride on the chronic constipation of paraplegia.

Paraplegic patients have intractable constipation associated with prolonged colonic transit time. The agent Cisapride significantly reduced the colonic transit time from 7.7 days to 5.1 days. It also improved the intraluminal tone in the rectum, resulting in a significant reduction in maximal rectal capacity from 305.8 ml to 224.3 ml. There was a reduction in residual urine volume from 51.5 ml to 27.7 ml. The increased number of stools containing transit markers showed that intraluminal mixing was increased by cisapride. Faecal water remained unchanged. A side effect was retention of urine in one subject after sudden withdrawal of the drug but this was avoided by its gradual reduction over 2 days.