Segmental Colonic Transit Time Research Articles

Effect of Rectal Distention on Lower Urinary Tract Function in Children

We investigated the effect of rectal distention on lower urinary tract function. Children were assigned to a constipation and lower urinary tract symptoms group or to a lower urinary tract symptoms only group. The definition of constipation was based on pediatric Rome III criteria. Standard urodynamics were done initially and repeated during simultaneous barostat pressure controlled rectal balloon distention and after balloon deflation. We evaluated the effects of rectal balloon inflation and deflation on urodynamic parameters. Colonic transit time measurement, anorectal manometry and the Parenting Rating Scale of child behavior were also used. We studied 7 boys and 13 girls with a median age of 7.5 years who had constipation and lower urinary tract symptoms, and 3 boys and 3 girls with a median age of 7.5 years who had lower urinary tract symptoms only. Urodynamic patterns of response to rectal distention were inhibitory in 6 children and stimulatory in 12, and did not change in 8. In 54% of the cases balloon deflation reversed balloon inflation changes while in 46% balloon inflation changes persisted or progressed. No significant differences were noted in children with vs without constipation and no clinical symptom or diagnostic study predicted the occurrence, direction or degree of bladder responses. In almost 70% of children with lower urinary tract symptoms rectal distention significantly but unpredictably affected bladder capacity, sensation and overactivity regardless of whether the children had constipation, and independent of clinical features and baseline urodynamic findings. Urodynamics and management protocols for lower urinary tract symptoms that fail to recognize the effects of rectal distention may lead to unpredictable outcomes.

Colonic transit time in patient with slow-transit constipation: Comparison of radiopaque markers and barium suspension method

Background Colonic transit study provides valuable information before surgical treatment is considered for patient with constipation. The radiopaque markers method is the most common way for evaluating colon transit time. The aim of this study is to compare the barium suspension with the radiopaque makers to assess the colonic mobility in patient with constipation. Methods Colonic transit time was measured in 11 female patients with slow-transit constipation using both radiopaque markers and barium suspension method. In radiopaque markers method, the patient ingested 20 markers on the first day, and an abdominal radiograph was performed every 24 h until 80% markers were excreted. In barium suspension method, the patient swallowed up to 50 ml of 200% (w/v) barium meal. The abdominal radiographs were taken at the same time point as the former. Results The total or segmental colonic transit time were obviously prolonged in all patients. Segmental transits time spent in the right colon, left colon and rectosigmoid for radiopaque markers and barium suspension method was, respectively, 30 ± 6 h and 34 ± 7 h; 38 ± 9 h and 32 ± 6 h; 40 ± 8 h and 38 ± 10 h. In the radiopaque markers method, total colonic transit time was 108 ± 14 h and it was 103 ± 13 h in the barium suspension method ( P > 0.05). Conclusion The barium suspension and radiopaque markers gave the similar results for colonic transit time. The barium suspension was a simple and cheap method for evaluating the colonic mobility.

Colonic transit time in mentally retarded persons

Constipation is frequently seen in patients with mental retardation (MR). Its pathophysiology is poorly understood. Measurement of colon transit time (CTT) differentiates between retentive and non-retentive constipation. To determine total and segmental CTT in MR patients compared to healthy controls. Of 250 residents, 60 patients older then 16, without swallowing disorder or scoliosis, are randomly chosen, 58 participated (intelligence quotient < 50, median age 35.5 year, 29 male). Constipation was defined as less than three defecations a week. Controls are 32 non-constipated age-matched healthy volunteers (median age 29 year, 19 male). CTT is measured by daily administration of ten radio-opaque markers during 6 days and abdominal X-ray on day 7. CTT is calculated using Bouchoucha's [7] method. Compared to controls, total CTT is significantly (P < 0.001) longer in MR (median 22.8 h vs. 57.6 h, respectively). Of the MR patients, 21/58 (36%) are constipated. The mental retardated and constipated (MRC) have a significant prolonged CTT in all segments (P < 0.01; median right CTT 19.2 h vs. 4.8 h; left CTT 14.4 h vs. 4.8 h; rectosigmoidal CTT 42 h vs. 9.6 h), whereas in mental retarded non-constipated (MRNC) persons, the rectosigmoidal CTT is prolonged (median 21.6 h vs. 9.6 h). Patients with moderate to deep MR have a significantly prolonged total CTT. In MRNC persons, rectosigmoidal CTT prolongation suggests a defecation problem. In MRC, CTT is prolonged in all segments, suggesting diffuse colonic inertia problem.

Comparison of colonic transit time between patients with constipation-predominant irritable bowel syndrome and functional constipation

Functional constipation (FC) and constipation-predominant IBS (C-IBS) are two main subtypes of constipation. Using radio-opaque markers is an easy and cost effective method to measure colonic transit time (CTT). We designed this study to compare the CTT between these two groups of constipated patients. Patients with chronic constipation of no organic etiology were classified as having FC or C-IBS according to the Rome II criteria. All patients ingested 10 radio opaque markers daily for six days. A plain abdominal X-ray was taken on the seventh day. To calculate the total and segmental colonic transit time in hours, number of markers in right and left colonic and rectosigmoid area were counted and multiplied by 2.4. The mean total and segmental colonic transit time were compared between the two groups. A total of 100 patients (50 FC and 50 C-IBS) were enrolled. The mean (SD) total CTT was not significantly different between FC patients (52.2 [35.5] h) and C-IBS patients (41.2 [31.6] h; p = 0.10). The mean rectosigmoid transit time was significantly slower in FC patients (19.9 [15.5] h) compared to C-IBS patients (11.9 [10.6] h; p = 0.003). Rectosigmoid transit time in FC patients is slower than in C-IBS patients.

Clinical Characteristics of Constipation with Hypothyroidism

목적: 변비는 치료 받지 않은 갑상선기능저하증의 잘 알려진 위장관 증상이다. 변비의 초기 평가 때 갑상선기능저하증을 배제하기 위한 갑상선기능 검사를 시행하는 것이 추천되고 있으나, 아직까지 변비 환자에서 갑상선기능의 의미에 대해서는 잘 알려져 있지 않다. 따라서 변비를 주소로 3차 의료기관의 변비 클리닉을 방문한 환자에서 갑상선기능저하증의 유병률과 갑상선기능저하증이 동반된 변비 환자의 임상적 특징을 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법: 2000년 8월부터 2008년 12월까지 서울아산병원 변비 클리닉을 방문한 환자 중 로마 기준 II를 만족하는 기능성 변비를 가지고 있으며, 갑상선기능 검사를 시행했던 1,481명의 환자를 대상으로 하였다. 갑상선 기능 검사 결과에 따라 현성 갑상선기능저하증을 동반한 환자, 불현성 갑상선기능저하증을 동반한 환자, 정상 갑상선기능 환자로 분류하였다. 의무기록, 대장통과시간 검사, 항문직장 내압검사, 풍선 배출 검사, 배변조영술 결과 및 바이오피드백 치료에 대한 반응을 후향적으로 분석하였다. 결과: 현성 갑상선기능저 하증의 유병률은 0.41% (남자 0.36%, 여자 0.53%), 불현성 갑상선기능저하증의 유병률은 1.76% (남자 1.28%, 여자 2.03%)였다. 현성 갑상선기능저하증 군(n=4), 불현성 갑상선기능저하증 군(n=21), 정상 갑상선기능 군(n=54) 사이에 전체 대장통과시간, 부분별 통과시간 및 변비의 유형은 차이가 없었으며, 항문직장 내압검사에서 관찰된 배변 형태의 차이도 없었다. 직장감각저하는 현성 갑상선기능저하증 군에서 더 흔했지만(현성 갑상선기능저하증 군, 50.0%; 불현성 갑상선기능저하증 군, 19.0%; 정상 갑상선기능 군, 20.4%), 통계적으로 유의하지 않았다(P=0.372). 결론: 3차 의료기관을 내원한 변비 환자의 갑상선기능 검사에서 현성 갑상선기능저하증과 불현성 갑상선기능저 하증의 유병률은 매우 낮았다. 갑상선기능저하증을 동반환 변비 환자에서 대장통과시간은 갑상선기능이 정상인 변비 환자에 비하여 지연되지 않는 것으로 생각된다.

Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar

To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time.A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration.At admission, colonic dysmotility was found in 71.9% (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6% (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014).The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.

Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus

Background/Purpose In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. Methods Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. Results Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). Conclusions In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.

Reproducibility and validity of radiographically determined gastrointestinal and segmental colonic transit times in spinal cord-injured patients

Total gastrointestinal transit times (GITT) and segmental colonic transit times (CTT) are commonly used to describe bowel function in individuals with spinal cord injury (SCI). Reproducibility study. To describe inter- and intrasubjective as well as interobserver variations in GITT and segmental CTT in patients with SCI. Furthermore, to study associations between GITT or segmental CTT and colorectal symptoms. Spinal Cord Unit, Viborg Hospital, Denmark. Thirty SCI patients took 10 radio-opaque markers on 6 consecutive days and an abdominal X-ray was taken on day 7. The same procedure was repeated after 3 months. GITT and CTT were computed from the number of markers in the entire colorectum and in the left and the right colon. Intra- and interobserver variations were described as dispersion (numerical difference/mean). Intersubjective variation was large for GITT (range: 0.6-6.3 days), right CTT (range: 0.1-5.5 days) and left CTT (range: 0-4.9 days). Intrasubjective variation was acceptable for GITT (dispersion: 0.28) but less good for right (dispersion: 0.63) and left CTT (dispersion: 0.68). Interobserver variation was very small. No correlations were found between GITT, right or left CTT and colorectal symptoms. GITT and right and left CTT are of limited value for clinical decision-making in individual patients but may be useful for comparison of groups of patients with SCI.

Outcome of Functional Constipation in Childhood: A 10-Year Follow-Up Study

To assess the outcome of patients presenting with functional constipation in childhood during a 10-year period and to determine any risk factors for developing persistent constipation throughout adolescence and adulthood. 72 children (mean age 4 years; 40 boys) referred for constipation were included in a longitudinal set of observations. Initial workup included segmental colonic transit time and anorectal manometry; 45 of the 72 patients could be reevaluated 10 to 12 years later. 21 of 45 patients (46%; 95% confidence interval 29% to 67%) remained constipated at follow-up. Encopresis and recurrent abdominal pain were present in 25% and 56% of patients, respectively. Patients with anorectal dyssynergia remained more frequently constipated at follow-up than the others: 61% versus 29% (P < .05). Almost 50% of patients presenting with constipation during childhood remained constipated on long-term follow-up. Anorectal dyssynergia is associated with a worse prognosis.

Effect of tegaserod on colonic transit time in male patients with constipation‐predominant irritable bowel syndrome

Tegaserod is approved for the treatment of constipation-predominant irritable bowel syndrome (C-IBS) in females. The aim of this study was to evaluate the effect of tegaserod on colonic transit time (CTT) and symptoms in male patients with C-IBS. Forty-four males with C-IBS (Rome II) were enrolled. After a baseline washout period of 2 weeks, 40 patients were randomized to 6 mg twice daily of tegaserod or placebo for 12 weeks. Daily bowel habits and weekly satisfactory relief of symptoms were recorded. Total and segmental CTT were measured using radiopaque markers at baseline and after treatment. The mean +/- SD for the total colonic, right colonic, left colonic and rectosigmoid transit time (in hours) were 18.96 +/- 3.92, 7.74 +/- 1.55, 5.64 +/- 1.51 and 5.58 +/- 2.2 in the tegaserod group compared to 22.47 +/- 3.73, 9.69 +/- 2.33, 6.6 +/- 1.32 and 6.18 +/- 2.22 in the placebo group at the end of 12 weeks. There was a statistically significant difference in the total, right and left CTT in the tegaserod group (P < 0.05) at the end of treatment. Global satisfactory relief at the end of 12 weeks was 75% in the tegaserod group and 50% in the placebo group (P > 0.05). Greater stool frequency occurred in the tegaserod group (P > 0.05). There was a significant decrease in the stool consistency at the end of 12 weeks in patients treated with tegaserod (P < 0.05). Tegaserod causes significant acceleration of CTT in male patients with C-IBS. Although there was a trend towards improvement in bowel symptoms in the treated group, this effect was not statistically significant.

Long-term outcome, colonic motility, and sphincter performance after Swenson’s procedure for Hirschsprung’s disease: a single-center 2-decade experience with 346 cases

Background The aim of this study is to explore the long-term outcome and the colon and sphincter function in children undergoing the Swenson’s operation for Hirschsprung’s disease (HD). Methods Three hundred forty-six children (266 males and 80 females) undergoing Swenson’s operation for HD for 8 to 20 years were followed up. Barium enema and defecography, total and segmental colonic transit time with the simplified radioopaque markers, and the anorectal vector manometry were used. Results Stooling patterns were fair in most patients, and the functional examinations were abnormal in few cases. Conclusions The long-term outcome is satisfactory in most of the children undergoing the Swenson’s operation for HD, but it is still not as good as what the surgeons have expected. This is probably because of the abnormal colonic motility and/or the dysfunctions of the internal anal sphincter.

Effect of Yogurt Enriched Water-soluble Fiber on Functional Constipation

Purpose: Although a diet that is rich in fiber is widely recommended to prevent and treat constipation, the efficacy of fiber supplements with yogurt has not been studied sufficiently. The aim of this study was to evaluate the effect of a yogurt enriched water-soluble fiber on the various symptoms of constipation in female adults with functional constipation. Methods: We did a double-blind and case-controlled study between two groups (placebo vs. fiber group), which were randomly allocated out of 42 subjects with functional constipation by using Rome II criteria. Bowel habits, daily nutritional intakes and physical activities were determined by using a questionnaire, and the segmental colonic transit time was evaluated three times: before treatment, after 4 weeks of treatment, and at the end of the study (2 weeks after treatment). Results: After 4 weeks of treatment, all defecation symptoms tested, except manual evacuation, showed significant improvements in the fiber group; fiber-enriched yogurt increased the number of bowel movements (P=0.002), reduced the presence of hard stools (P=0.001), improved the frequency of straining (P=0.048), the sense of incomplete evacuation (P= 0.013), and the sense of anorectal obstruction (P= 0.032). The total colonic transit time was shortened after intake of fiber-enriched yogurt (P=0.023). Satisfactory relief was significantly higher in the fiber group (P= 0.011). Conclusions: Functional constipation may be improved with water-soluble fiber supplements in yogurt without serious side effects.

A Controlled, Randomized, Double-Blind Trial to Evaluate the Effect of a Supplement of Cocoa Husk That Is Rich in Dietary Fiber on Colonic Transit in Constipated Pediatric Patients

Although a diet that is rich in fiber is widely recommended for preventing and treating constipation, the efficacy of fiber supplements have not been tested sufficiently in children. Our aim with this pilot study was to evaluate if fiber supplementation is beneficial for the treatment of children with idiopathic chronic constipation. Using a parallel, randomized, double-blind, controlled trial, we conducted an interventional study to evaluate the efficacy of a supplement of cocoa husk rich in dietary fiber on intestinal transit time and other indices of constipation in children with constipation. After screening, the patients were randomly allocated to receive, for a period of 4 weeks, either a cocoa husk supplement or placebo plus standardized toilet training procedures. Before and after 4 weeks of treatment, we (1) performed anthropometry, a physical examination, and routine laboratory measurements, (2) determined total and segmental colonic transit time, (3) evaluated bowel movement habits and stool consistency using a diary, and (4) received a subjective evaluation from the parents regarding the efficacy of the treatment. The main variable for verifying the efficacy of the treatment was the total colonic transit time. Fifty-six chronically constipated children were randomly assigned into the study, but only 48 children completed it. These children, who were aged between 3 and 10 years, had a diagnosis of chronic idiopathic constipation. With respect to total, partial colon, and rectum transit time, there seemed to be a trend, although statistically nonsignificant, toward faster transit times in the cocoa husk group than in the placebo group. When we analyzed the evolution of the intestinal transit time throughout the study of children whose total basal intestinal transit time was > 50th percentile, significant differences were observed between the groups. The total transit time decreased by 45.4 +/- 38.4 hours in the cocoa husk group and by 8.7 +/- 28.9 hours in the placebo group (-38.1 hours). In the case of the right colon, changes in transit time also were significant between groups. Mean changes tended toward faster transit times in the left colon and the rectum, although the differences were not statistically significant. The children who received cocoa husk supplements tended to increase the number of bowel movements by more than that of the children of the placebo group. We also observed a reduction in the percentage of patients who reported hard stools (hard scybalous or pebble-like stools), although this reduction was significantly greater in the cocoa husk group. At the end of the intervention, 41.7% and 75.0% of the patients who received cocoa husk supplementation or placebo, respectively, reported having hard stools. Moreover, a significantly higher number of children (or their parents) reported a subjective improvement in stool consistency. No significant adverse effects were reported during the study. This study confirms the beneficial effect of a supplement of cocoa husk that is rich in dietary fiber on chronic idiopathic constipation in children. These benefits seem to be more evident in pediatric constipated patients with slow colonic transit time.

Sacral neuromodulation; does it affect colonic transit time in patients with faecal incontinence?

Sacral neuromodulation (SNM) has been a successful treatment in urinary voiding disorders for years. A concomitant effect on bowel function was observed leading to the treatment of faecal incontinence with SNM. In this study we describe the effect of SNM on bowel frequency and (segmental) colonic transit time. Fourteen patients with faecal incontinence who qualified for permanent SNM underwent a colon transit study before and one month after permanent implant. Patients completed a three-week bowel habits diary before and during stimulation. Median incontinence episodes and days per week before SNM were, 8.7 and 4.2, respectively, and both decreased significantly to 0.67 (P = 0001) and 0.5 (P = 0001) during trial screening and to 0.33 (P = 0001) and 0.33 (P = 0001) after permanent implant. The median number of bowel movements per week decreased from 14.7 (6.7-41.7) to 10.0 (3.7-22.7)(P = 0005) during trial screening and to 10.0 (6.0-24.3)(P = 0008) during permanent stimulation. Resting and squeeze pressures did not change significantly during stimulation. Segmental colonic transit time before and during stimulation for right colon, left colon and recto sigmoid were, respectively, 6 (0-25) vs 5 (0-16) hours, 2 (0-29) vs 4 (0-45) hours and 7 (28) vs 8 (0-23) hours. No significant changes were found in both segmental and total colonic transit time; 17 (1-65) vs 25 (0-67) hours. SNM in patients with fecal incontinence led to a significant decrease of bowel movements however (segmental) colonic transit time was not influenced.

Non-invasive measurement of pan-colonic pressure over a whole digestive cycle: Clinical applications of a capsule-style manometric system

To study the prolonged colonic motility under normal conditions with a novel capsule-style micro-system and to assess its clinical significance. A single use telemetry capsule (10 mm in diameter, 20 mm in length) embedded with a pressure sensor was ingested by the subjects. The sensor is capable of transmitting colonic pressure wirelessly for more than 130 h. The time of capsule entering the segmental colon was detected by ultrasound. The ultrasonic electrodes were mounted on the surface of the ileocecum and navel and at the junction of the left and rectosigmoid colon of the subjects in sequence, which were identified by abdominal X-rays with radiopaque markers. To verify the accuracy and reliability of ultrasonic detection of telemetry capsules at key points of colon, the segmental colonic transit time was simultaneously recorded by using radiopaque markers. The signal lamp showed that all recorders could receive the radio signal transmitted by the telemetry capsule. The X-rays showed that all telemetry capsules were detected successfully when they were passing through the key points of colon. There was a significant correlation between the transit results obtained by ultrasonic detection or by radiopaque markers. Colorectal recording was obtained from 20 healthy subjects during 613 h (411 h during waking, 202 h during sleep). Compared to waking, the number of pressure contractions and the area under pressure contractions were significantly (P < 0.05) decreased during sleep (21 +/- 5 h(-1) vs 15 +/- 4 h(-1), 463 +/- 54 mmHg x s/min vs 342 +/- 45 mmHg x s/min). The colonic motility exhibited significant regional variations both in the circadian behavior and in response to waking and meal. The capsule-style micro-system is reliable and noninvasive, and may represent a useful tool for the study of physiology and pathology of colonic motor disorders.

Role of segmental colonic transit time studies to select patients with slow transit constipation for partial left-sided or subtotal colectomy.

This prospective study investigated the value of segmental colonic transit time studies in the surgical treatment of slow transit constipation. Overall, 346 patients with chronic constipation were analysed; slow transit constipation was diagnosed in 86 (25 per cent). Based on the results of segmental colonic transit time studies, 18 patients underwent partial left-sided colectomy and 24 subtotal colectomy. Recurrent constipation was seen in three of 18 patients and seven of 24 respectively. Severe abdominal discomfort was noted in six of 18 and 15 of 24 respectively. Disabling diarrhoea and faecal incontinence developed in two of 14 and five of 20 patients with an anastomosis respectively. Although these results indicate that segmental colonic transit time studies are useful in selecting patients with slow transit constipation for partial left-sided or subtotal colectomy, both procedures should be performed with prudence.

Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children

Background The transanal one-stage endorectal pull-through operation for Hirschsprung's disease is relatively new and makes assessment of the functional outcome and colonic motility difficult. The aim of this study was to evaluate the stooling patterns and colonic motility after a one-stage transanal pull-through operation for Hirschsprung's disease in children. Methods Twenty-two children who underwent a one-stage transanal pull-through operation for Hirschsprung's disease were followed up for at least 6 months. The children (17 boys and 5 girls) were from 12 months to 13 years of age (mean age, 4 years). All patients had an aganglionic segment confined to the rectosigmoid area (confirmed by preoperative barium enema and postoperative histology). Clinical outcome was assessed by interviews and questionnaires, and children were divided into symptomatic and nonsymptomatic groups. Contrast barium enema and defecography and determination of total and segmental colonic transit time (using radio-opaque markers) were performed on all 22 children. Results The stooling patterns were considered satisfactory in 17 children. Of all the children, the mean stool times were 1 to 2 per day and only 2 were 8 to 10 per day; postoperative soiling was found in 4, constipation was observed in 2, and Hirschsprung-associated enterocolitis in 1. There was no incontinence, cuff infection, anastomotic leak, or mortality noted. Barium enema showed that the dilated and spastic colonic segment disappeared in all 22 children. The dilated sigmoid loops decreased in 17 (2 symptomatic, 15 nonsymptomatic) and disappeared in 5 (4 symptomatic, 1 nonsymptomatic). There was a significant difference between the decreasing and disappearing loop group in regard to stooling disorders ( P < .05). Postoperative defecography showed that the anorectal angle of all children was open, fixed, and significantly larger than that of the preoperative and control groups (123.3° ± 15.1° vs 84.7° ± 8.3° vs 79.0° ± 11.6°, P < .01) and larger in the symptomatic group when compared with the nonsymptomatic group (135.6° ± 15.9° vs 111.0° ± 14.3°, P < .05). Postoperatively, the total gastrointestinal transit time, left colonic transit time, and rectosigmoid colonic transit time of all the children were shorter than preoperatively (26.8 ± 8.2 vs >188 hours, P < .01; 6.3 ± 4.1 vs >60 hours, P < .01; 11.8 ± 4.4 vs >120 hours, P < .01) and similar to controls. The total gastrointestinal transit time and rectosigmoid colonic transit time of the symptomatic group were significantly shorter than the nonsymptomatic group (25.2 ± 5.6 vs 28.1 ± 10.1 hours, P < .05; 12.2 ± 6.7 vs 9.8 ± 4.0 hours, P < .05). Conclusions The stooling pattern and colonic motility are satisfactory in most children after the one-stage transanal pull-through operation for Hirschsprung's disease. Normalization of colon appearance and total and segmental colonic transit time are signs of recovery of colonic motility. Stooling disorders were noted in a few cases and may be related to decrease or disappearance of the sigmoid loop, dysfunction of the “neorectosigmoid”, an open and fixed anorectal angle, and ischemia of the pull-through segment.

Breath Hydrogen Test After a Bean Meal Demonstrates Delayed Oro‐Cecal Transit Time in Children with Chronic Constipation

To evaluate oro-cecal transit time in children with chronic constipation. 34 patients with chronic functional constipation age 3 to 13 years and 15 controls without constipation. Oro-cecal transit time was evaluated using the hydrogen breath test after ingestion of lactulose and after a standard meal of cooked beans. Total and segmental colonic transit times were measured with radiopaque markers. Of 34 patients with chronic constipation 61.8% had increased total colonic transit time (>62 hours). Oro-cecal transit time measured with lactulose as substrate was similar (p=0.727) in constipated patients with increased colonic transit time (63.8+/-16.3 minutes), in constipated patients with normal colonic transit time (66.9+/-22.9 minutes), and in controls (65.3+/-15.5 minutes). Using a test meal of beans, the hydrogen breath test showed that oro-cecal transit time of constipated patients with increased total colon transit time was higher (252.4+/-23.2 minutes) than oro-cecal transit time of constipated patients with normal colonic transit time (227.7+/-39.6 minutes) or controls (205.3+/-23.3 minutes) (p<.05). Hydrogen excretion in breath after a bean test meal showed delayed oro-cecal transit time in children with chronic constipation with abnormal total colonic transit time.

Breath Methane Associated With Slow Colonic Transit Time in Children With Chronic Constipation

This study analyzed the relationship between methane production and colonic transit time in children with chronic constipation. Forty children, from 3 to 13 years of age, suffering from chronic constipation were included. Methane production was defined when the breath methane concentration was greater than 3 ppm. The total and segmental colonic transit times were measured with radio-opaque markers. Soiling was present in 34 (85.0%) of 40 patients with constipation. Methane production was present in 25 of 34 (73.5%) patients with constipation and soiling and only in 1 (16.7%) of 6 with constipation but without soiling (P = 0.014). The medians of total colonic transit time were 80.5 and 61.0 hours, respectively (P = 0.04), in methane and nonmethane producers. Segmental colonic transit times were 17.5 and 10.5 hours, respectively (P = 0.580), in right colon, 29.5 and 10.5 hours (P = 0.001), respectively, in left colon, and 31.5 and 27.0 hours (P = 0.202), respectively, in the rectosigmoid. By the sixth week of treatment, the reduction in the total colonic transit time was greater in patients who had become nonmethane producers. The presence of breath methane in children with chronic constipation may suggest the possibility of prolonged colonic transit time.

A Pilot Study of the Effects of Sildenafil on Stool Characteristics, Colon Transit, Anal Sphincter Function, and Rectal Sensation in Healthy Men

Nitric oxide is an important mediator of gut smooth muscle relaxation and visceral sensation. Sildenafil results in stimulation of the nitric oxide-cyclic GMP pathway. We sought to determine the effects of daily sildenafil administration on colorectal function. Over a 4-week period, sildenafil was administered during weeks 2 and 3. Stool frequency and consistency were assessed daily. Anorectal manometry, rectal sensation, and colon transit testing were performed at the end of weeks 1 and 3. Ten healthy men were studied. No significant differences in segmental or total colon transit time were noted; however, significant changes in stool frequency and trends toward decreased stool consistency were noted during sildenafil use. A trend toward reduced resting anal sphincter pressure was seen after sildenafil. Rectal volumes to first sensation and desire to defecate were significantly increased after sildenafil on test day 2 only. Additionally, volumes to desire to defecate and maximal tolerable volume were significantly increased before sildenafil on test day 2 compared to before sildenafil on test day 1. We conclude that daily administration of sildenafil is well tolerated and results in alterations in colorectal function.