Determination of total and segmental colonic transit time in constipated patients

Ninety-one patients with idiopathic constipation had segmental colonic transit studied with radiopaque markers using a new simplified technique to determine frequency and type of colonic transit time (CTT) abnormalities and to determine the utility of this test in planning therapy. Colonic transit studies defined four groups: normal CTT(N=49), right colonic stasis (N=16), outlet obstruction (N=12), and isolated left colonic stasis (N=14). Right colonic stasis and outlet obstruction were associated with frequent use of digital pressure to assist defecation. Right colonic stasis was characterized by a low stool frequency (<3 per week) in 93% of cases and failure to respond to bran therapy. Outlet obstruction also showed a poor response to bran therapy but weekly stool frequency was higher than 3 in 46% of cases. Normal colonic transit time and isolated left colonic stasis were characterized by a normal stool frequency (5.8±0.05 and 4.2±0.1, respectively) and clinical help with the use of bran treatment (72 and 64%, respectively). Our study suggested that patients who complain of idiopathic constipation represent a heterogenous group of disorders. Segmental CTT determination is a simple, useful, and noninvasive test of patients with constipation.     

Small bowel transit time and colonic fermentation in young and elderly women

Small bowel transit time (SBTT) in 15 young and 13 elderly women was assessed by measuring breath hydrogen concentrations after they had consumed a solid test meal. The meal consisted of 200 g cooked rice, 50 mlmiso (made from fermented soy bean curd) soup, a boiled egg, and 95.5 g of cooked soy beans with mixed vegetables. This meal provided 17 g protein, 14.1 g fat, 92.9 g carbohydrate, 7 g dietary fiber, and 565 kcal total energy. The SBTT, calculated by a 3 ppm increase in breath hydrogen, was 19±14.9 (mean±SE) min in the young and 188.1±16.8 min in the elderly group; the difference was not significant. Breath hydrogen levels, however, were higher in the young than in the elderly group (39.1±6.3 ppm, vs 22.2±4.3 ppm,P<0.05). There was an initial peak of hydrogen concentration, reached almost immediately after the ingestion of the meal, and then a decline to baseline within 60 min. This initial peak was not as pronounced in the elderly subjects. A second peak, indicating the entry of the test meal into the cecum, was more pronounced in the young than in the elderly group. SBTT did not differ significantly between the two groups, but colonic fermentation was more pronounced in the young, both in the fasting and the postprandial state.     

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

BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.     

Effects of anatomical position on esophageal transit time： A biomagnetic diagnostic technique

AIM： To study the esophageal transit time （ETT） and compare its mean value among three anatomical inclinations of the body; and to analyze the correlation of ETT to body mass index （BMI）.
METHODS： A biomagnetic technique was implemented to perform this study： （1） The transit time of a magnetic marker （MM） through the esophagus was measured using two fluxgate sensors placed over the chest of 14 healthy subjects; （2） the EIF was assessed in three anatomical positions （at upright, fowler, and supine positions; 90°, 45° and 0°, respectively）.
RESULTS： ANOVA and Tuckey post-hoc tests demonstrated significant differences between E-IT mean of the different positions. The ETT means were 5.2 ± 1.1 s, 6.1 ± 1.5 s, and 23.6 ± 9.2 s for 90°, 45° and 0°, respectively. Pearson correlation results were r = -0.716 and P 〈 0.001 by subjects＇ anatomical position, and r = -0.024 and P 〉 0.05 according the subject＇s BMI. CONCLUSION： We demonstrated that using this biomagnetic technique, it is possible to measure the ETT and the effects of the anatomical position on the ETT.     

Stool characteristics and colonic transit in irritable bowel syndrome: evaluation at two time points

Abstract

Objective. Information on the relationships between stool characteristics and colonic transit time (CTT) in irritable bowel syndrome (IBS) is limited. Our aims were: (i) to relate stool frequency and consistency to total and segmental CTTs, (ii) to correlate changes in these stool characteristics with changes in CTTs between a baseline assessment and a 12-week assessment, and (iii) to examine the confounding effects of mood on these relationships, in patients with IBS. Materials and methods. Twenty-one female patients with IBS underwent, on two occasions 12 weeks apart, a colonic transit study and completed at these times Bristol Stool Form Scale (BSFS) and Bowel Symptoms Severity Rating Scale (BSSRS). All patients also completed the Hospital Anxiety and Depression scale. Results. Between baseline and the 12-week assessment, an increase in the number of days over the past week without a bowel motion correlated with prolonged total CTT (r = 0.54, p = 0.01). An increase in the number of days with more than three bowel motions per day correlated with a shorter right CTT (r = –0.52, p = 0.02). Only after adjusting for anxiety and depression, did an increase in loose or watery bowel motions (for BSSRS but not for BSFS) correlate with a shorter right CTT (r = –0.47, p = 0.03). Conclusions. Stool frequency, as well as stool consistency, correlates with CTT. Correlations between stool consistency and CTT are more robust for BSSRS than for BSFS. An effect of mood appears to be important in the relationship between stool consistency and CTT.     

术中即时桥血管流量测定在不停跳冠状动脉旁路移植术中的应用研究

目的:探讨术中即时血流测定(transit time flow measurement,TTFM)在不停跳冠状动脉旁路移植术中的应用价值。方法:2009年12月至2010年12月,对在北京安贞医院心外科行不停跳冠状动脉旁路移植术的427例患者,共计1 123支桥血管行术中即时血流测定,根据测定结果,定义满足以下3点标准中的2点者为桥血管失功能:1.搏动指数(PI)>5,2.左侧冠状动脉平均流量(mean graft flow,MGF)<10mL/min,右侧冠状动脉桥血管MGF<15mL/min,3.舒张期血流比例(diastolic flow,DF):左侧冠状动脉桥血管<50%,右侧冠状动脉桥血管<40%。对失功能的桥血管进行修正后再次测定血流量。结果:41例患者(41/427,9.6%)的47支桥血管(47/1 123,4.2%)诊断为失功能桥血管,修正的桥血管中13支为前降支桥血管,7支为对角支桥血管,15支为回旋支桥血管,11支为右侧冠状动脉桥血管。45支桥血管修正后流量满意,成功率为95.7%;2支桥血管修正后无明显改善。但术后6个月冠状动脉CTA检查示桥血管均通畅。结论:术中TTFM能便捷、有效地检测出由于吻合口狭窄导致的桥血管失功能,提高手术疗效,减少围术期不良心脏事件发生率。但对于冠状动脉远端血管床阻力较高的患者,其应用价值有待进一步观察。     

慢传输型便秘结肠肌间神经丛超微结构改变

目的　慢传输型便秘（ＳＴＣ） 病因不清、症状顽固、临床处理较困难． 进一步探讨其发生和发展的病理学基础．方法　应用电镜技术对１４ 例ＳＴＣ 患者和１１ 例非梗阻性直肠癌患者经手术切除的乙状结肠标本进行了对照研究．结果　与对照组相比，ＳＴＣ 患者结肠肌间神经丛的超微病理改变表现为：神经元及其突起有十分明显的退行性变，轴突及树突空化呈网格状结构，胞质内出现空泡及脂褐素等；轴突末端膨体及突触前区内突触小泡含量明显减少，大部分突触小泡出现空化．结论　ＳＴＣ 患者结肠肌间神经丛有明显的神经病理学改变，存在递质耗竭或递质合成、传输障碍等现象，它是ＳＴＣ 患者肠道传输减慢的超微病理基础． 这种改变可能与ＳＴＣ 患者长期滥用接触性泻剂有关．     

Colonic transit time of radiopaque markers and rectoanal manometry in patients complaining of constipation

Transit time, rectoanal manometry, and symptoms were studied in 61 patients complaining of constipation. A slow transit, in the colonic area of most of the patients, was found in 49. Rectoanal manometry was abnormal in 40. Both examinations were abnormal in 32 patients, colonic transit only in 17, and manometry only in eight. Finally, both examinations were normal in only four subjects. A transit delay was always associated with less than three stools per week, and straining at stool was constant when rectoanal manometric disturbances were shown. Objective abnormalities appear common in patients complaining of constipation and, correlated with symptoms, suggest that clinical study in constipation could be of more value than usually is believed.     

Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence

Background—Colonic motor function has not beenstudied in the ambulatory setting over a prolonged period in theunprepared state. Furthermore, the disturbance of this function inpatients with faecal incontinence is unknown.
Aim—To study colonic function over two to threedays in the ambulatory, unprepared state in health and in patientswith idiopathic faecal incontinence.
Methods—Six healthy women and six women withfaecal incontinence and a structurally intact anal sphincter ingested adual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning wasperformed until radioisotope left the gut and pressure was recorded fora median of 44hours.
Results—Three of six patients showed abnormalgastric emptying. Patients showed no disturbance of colonicradioisotope transit. Controls had a median of 12, whereas patients hada median of 16, high amplitude propagated waves per 24 hours. In threepatients urge incontinence was associated with high amplitude (up to500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occuring in healthy subjects, the only difference being the lack of adequate sphincter response. Passive incontinence was not associated with colonic motor activity. Defaecation in all subjects was associated with identical propagated waves, and distal movement of 13%(median) of right colonic content and excretion of 32% from the leftcolon and rectum. The urge to defaecate was associated with eitherpropagated waves (45%) or non-propagated contractions (55%). Rectalmotor complexes were recorded in both groups of subjects, but similar rhythmic activity was also recorded in the sigmoid and descending colon.
Conclusions—Normal colonic function consists offrequent high pressure propagated waves. Rhythmic activity occurs bothproximal to and in the rectum. Defaecation is characterised by highpressure propagated waves associated with coordinated anal sphincterrelaxation. Patients with faecal incontinence may have a widespreaddisturbance of gut function. Urge incontinence, an urge to defaecate,and defaecation can all be associated with identical high amplitude propagated pressure waves.

Keywords:colonic motility; gastric emptying; faecalincontinence

     

西沙必利对慢性功能性便秘患者结肠转运时间的作用

目的 了解另人结肠转运时间的正常值,并探讨西沙必利对慢性功能性便秘患者的结肠转运时间（ＣＴＴ）的作用。方法 通过连续３ｄ各服一粒含不透Ｘ线标志物的胶囊后于第４、第７天拍摄腹部平片的简化方法,测定２５例正常人及２５例慢性功能性便秘患者的全结肠节段结肠转运时间。对全结肠转运时间延长的便秘患者,给予西沙必利１０ｍｇ每日３次口服治疗,疗程４周。在最后１周复查ＣＴＴ,比较服药前后ＣＴＴ的变化。结果 全结肠转     

Functional magnetic stimulation of the vagus nerve enhances colonic transit time in healthy volunteers

Sacral magnetic stimulation (MS) of the full and empty rectum increases rectal and decreases anal pressures. Rectal evacuation was produced by intermittent MS. MS activates not only the muscles but also the nervous tissue. In the present study I investigated the effect of MS of the vagus nerve on the colonic transit to evaluate the possibility of using this method in the treatment of constipation due to colonic inertia. Forty healthy volunteers were divided into 2 equal groups: study (mean age 46.6 years; 13 men, 7 women) and control (mean age 43.9 years; 13 men, 7 women). MS was produced by a magnetic stimulator and a 2-cm coil placed in the middle of the ventral surface of the neck. MS parameters were set at 70% of maximal intensity, 40 Hz frequency, 10 seconds on, 10 seconds off for 20 minutes and followed by 60 minutes rest. This sequence was performed for 5 cycles. Colonic transit was determined by ingesting 20 radiopaque markers and by radiographing the subject. In the control group, 6 subjects had passed all the markers on the sixth day post-ingestion and all the remaining subjects except two on the seventh day; the last two subjects passed all the markers on the eighth day. In the study group, more than 50% of the subjects had passed all the markers already by the fifth post-ingestion day; the others completed passage of the markers by the sixth day. In the study group 100% of the markers had passed by the sixth post-ingestion day against 30% in the control group. These findings suggest that MS of the vagus nerve enhances colonic transit by augmenting the peristaltic activity of the gut. The procedure might thus be used for the treatment of constipation resulting from delayed colonic transit. Received: 17 May 1999 / Accepted in revised form: 30 July 1999     

Large-bowel transit in paraplegic patients

Severe constipation often follows spinal cord injury. The aim of this study was to evaluate transit of contents through the large bowel in patients with paraplegia after a complete transverse lesion of the spinal cord. Transit through the right colon, left colon, and rectum was evaluated in 11 patients (eight males, 3 females; 17 to 63 years old) and data were compared with that of 37 healthy control subjects. In all patients there was either no, or abnormally low, transit at the level of the left colon and rectum. A minor degree of transit delay at the level of the right colon was also present in eight patients. These data indicate that constipation in patients with paraplegia is due to abnormal transit, mainly at the level of the left colon and rectum, and transection of the spine between the C-4 and T-12 vertebral levels causes alteration of large-bowel motor activity mainly at the level of the segments innervated by the parasympathetic fibers of the sacral outflow Presented in part at the European Society for Gastrointestinal Motility, Oxford, England, 1984.     

Anorectal dysfunction and delayed colonic transit in patients with progressive systemic sclerosis

We studied 14 unselected patients with progressive systemic sclerosis (PSS), six with constipation, and eight with normal bowel habits. A control group, matched for age and sex, comprised six patients with idiopathic constipation and seven healthy subjects. Anorectal manometry was performed with perfused catheters and segmental colonic transit was measured by a radiopaque marker technique. The resting pressure of the anal canal was significantly reduced in PSS with constipation (P<0.05). The rectoanal inhibitory reflex was detected in only one PSS patient with constipation, but was present in seven of eight PSS patients with normal bowel habits and in all controls (P<0.01). Total and right colonic transit times were significantly delayed in PSS with constipation and in patients with idiopathic constipation (P<0.05). In patients with PSS, colonic transit was delayed and anal sphincter function was impaired in constipated patients, suggesting involvement of both the colon and the anorectum by the disease.     

Increase of mitotic activity in the colonic mucosa of patients with colorectal cancer

A histologic and histochemical study of the colonic mucosa, including a study of the mitotic index, was performed in routinely processed specimens from control and tumor-bearing patients. A significant increase in the mitotic index (number of mitosis×1000 gland cells), without concomitant modifications in the distribution of mitotic figures along the crypt depth, in mucosal thickness, or in mucin secretion, was demonstrated in the colonic mucosa of patients with colonic or rectal cancer compared with controls. The results point to an accelerated cell renewal in the colonic mucosa of tumor-bearing patients compared with the controls, without concomitant dysplasia. Results are discussed in the light of the possibility that an increased cell proliferation may have preceded the onset of tumor and played a role in the second step of carcinogenesis,i.e., tumor promotion, independently of dysplasia.     

Prolonged survival of a patient with advanced colonic cancer

A 39-year-old man who survived 14 years following the diagnosis of advanced colonic carcinoma is reported. The presence of metastatic lesions had been well documented at the time of abdominal surgery on three different occasions and at autopsy. The possible mechanism for his unusually prolonged survival time is discussed.     

Study on functional constipation and constipation‐predominant irritable bowel syndrome by using the colonic transit test and anorectal manometry

OBJECTIVE: To investigate the visceral perception, anorectal pressure and colonic transit time (CTT) in patients with functional constipation and constipation‐predominant irritable bowel syndrome (C‐IBS), and to study the manometric abnormalities of these two conditions. METHODS: The CTT in patients with functional constipation and C‐IBS was studied by using radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal pressure were examined by electric barostat. RESULTS: The CTT in both groups of constipated patients was abnormal. A lot of radiopaque markers remained in the right colon in C‐IBS patients, whereas in patients with functional constipation, the radiopaque markers remained in each segment of the colon. The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. Rectal compliance and defecation thresholds were much higher compared with controls, and the rectal visceral perception of functional constipation was also abnormal. CONCLUSIONS: The motility abnormalities of functional constipation and C‐IBS occurred in different colonic segments. Results suggest that CTT measure­ment and anorectal manometry could be helpful in the differential diagnosis of these two conditions.     

功能性便秘和便秘型肠易激综合征的结肠运输试验及直肠感觉阈值比较

目的 对功能性便秘和便秘型肠易激综合征（IBS）患者进行肠道转运时间及其肛门直肠运动和直肠容量感觉研究，探讨两类疾病的结肠运动方式有何不同。方法 用不透X线标志物测定全结肠通过时间和结肠分段通过时间并计算转动指数。用电子气压泵研究肛门直肠压力、直肠对容量刺激的感觉和直肠顺应性。结果 便秘型IBS的结肠转动时间延长主要在右半结肠。功能性便秘的各个节段结肠均有延长，结合转动指数研究，发现直肠乙状结肠部位的延长更显著。两种疾病的肛门直肠括约肌静息压、收缩压和松弛压均无明显异常，但两者的顺应性和排便阈值均明显增高，其中功能性便秘的感觉阈值有增加。结论 IBS便秘型结肠运动紊乱主要在右半结肠，功能性便秘的结肠动力改变主要在直肠乙状结肠部为多。说明两者的结肠运动方式改变是不同的，对两者的鉴别诊断有帮助。     

Morphogenesis of human colonic cancer

A total of 155 early carcinomas, collected from colonoscopic polypectomy cases, surgically removed specimens, and resected colon from patients with adenomatosis coli, were histologically investigated in order to find their characteristic morphologic features. The commonest types of early carcinomas examined had a short stalk or were broad-based, and carcinomas 1 to 2 cm in diameter were the largest in acutal number, although the malignancy rate increased with increasing size. The malignancy rate of small adenomas, under 1 cm in diameter, is higher than previously estimated. The clinical importance of the shape and size of such polyps is stressed for earlier detection of carcinomas of the colon, and an improved concept of the morphogenesis of colonic carcinoma is proposed. This paper was presented at the Conference on Gastrointestinal Cancer in Brisbane, Australia, in 1981 with financial support from the Australian-Japan Foundation. This study was financially supported by the Ministry of Education (501005) and the Ministry of Health and Welfare (52-2).