Assessment of chronic constipation: colon transit time versus defecography

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Abstract

Objective: The aim of this study was to determine the value of radiological colon transit time (CTT) measurements in relation to defecography (DFG) in chronically constipated patients. Materials and methods: In 30 patients with chronic constipation, total and segmental CTT was determined using radiopaque markers. In all of these patients defecography (DFG) was obtained. The patients were divided into three groups: In group I, 11 patients were classified with idiopathic constipation based on low stool frequency, normal DFG, or absence of symptoms of abnormal defecation. In group II, ten patients with rectal intussusception were diagnosed by DFG. In group III, there were nine patients with rectal prolapse or spastic pelvic floor syndrome, based on results of DFG. Results: Group I, idiopathic constipation (n=11), showed increased total CTT (mean, 93 h) and segmental CTT (right colon, 33 h (36%), left colon, 31 h (33%), rectosigmoid, 29 h (31%)). In group II, intussusception (n=10), patients had normal mean total CTT (54 h) and a relative decrease in rectosigmoid CTT (mean, 13 h (24%)). In group III (n=9), rectal prolapse (n=5) or spastic pelvic floor syndrome (n=4), patients showed elevated total (mean, 167 h) and rectosigmoidal CTT (mean, 95 h (57%)). Mean total CTT was significantly different between groups I and II and between groups II and III, and mean rectosigmoidal CTT was significantly different between all three groups (P<0.05). Conclusion: The use of total and rectosigmoidal CTT helps to identify the underlying pathophysiology of chronic constipation. Furthermore CTT helps to identify patients, who may benefit from DFG.

Introduction

The value of total colonic transit time (CTT) has been examined in normal subjects, in patients with idiopathic constipation, and in patients with spastic pelvic floor syndrome [1], [2], [3], [4], [5], [6], [7], but the evaluation of segmental CTT is inconsistent. There is controversy about the value of segmental CTT because it is uncertain whether a distinction can be made between an isolated increase in the right, left, and rectosigmoidal CTT [8], [9], [10], [11]. When comparing total and segmental CTT in spastic pelvic floor syndrome, a literature search determined that total CTT was increased in 70% of patients. Abnormal segmental CTT, indicating spastic pelvic floor syndrome, was present in 92% [4] and in 80% [12].

The aim of our study was to correlate radiological colonic transit time measurements and defecography with chronic constipation disorders. Is it possible to differentiate chronic idiopathic constipation and anorectal disorders by CTT and DFG? Is it possible to determine characteristic segmental CTTs for chronic constipation, intussusception, rectal prolapse, and spastic pelvic floor syndrome? Which of the segmental CTT, right colon, left colon, or rectosigmoid is most significant for this characterisation?

Section snippets

Materials and methods

Radiological evaluation of CTT and DFG was performed on 30 patients with clinical suspected constipation and defecation disorders. Five men and 25 women (20–82 years; mean: 44±16 years) within a 3-year time period were examined. Constipation in these 30 patients was resistant to typical therapies such as laxatives, increased drinking, fibre-enriched diet, or increased exercise. Barium enema and rectoscopy with negative results were performed before CTT and defecography. Informed consent was

Results

In group I, 11 patients with normal DFG had idiopathic constipation. Two patients with chronic therapy-resistant constipation symptoms and low stool frequency but without complaints during defecation were found to have normal total CTTs (<72 h). Nine patients had prolonged total CTT. The mean total CTT was 92.9±22.4 h. In group I, mean total CTT was significantly elevated compared to group II (P<0.01) and elevated but without significant difference compared to group III (Fig. 3).

In group II,

Discussion

The aim of our study was to determine the value of radiological colon transit time versus defecography in patients with chronic constipation. Does the CTT characterise chronic constipation due to anorectal disorders found in DFG? Does segmental CTT help to differentiate chronic constipation, intussusception, rectal prolapse, and spastic pelvic floor syndrome?

The procedure for radiological CTT measurement is simple, economical, and the amount of time and technical devices needed are minimal [1],

Conclusion

In patients with chronic constipation, the radiological investigation of CTT can differentiate between normal and pathological CTT and further quantify total and segmental colonic transit. In addition, CTT offers proof of an increase in segmental CTT, such as in chronic constipation.

Our results demonstrate that, based on rectosigmoidal CTT, a statistically significant differentiation is possible between three groups: chronic constipation, intussusception, and anorectal prolapse and spastic

References (24)

  • B. Krevsky et al.

    Colonic transit scintigraphy

    Gastroenterology

    (1986)
  • A.M. Metcalf et al.

    Simplified assessment of segmental colonic transit

    Gastroenterology

    (1987)
  • Alvarez WC, Freedlander, SO. The rate of progress of food residues through the bowel. J Am Med Assoc...
  • M. Bouchoucha et al.

    What is the meaning of colorectal transit time measurement?

    Dis. Colon Rectum

    (1992)
  • J.H. Cummings et al.

    Measurement of the mean transit time of dietary residue through the human gut

    Gut

    (1976)
  • J.M. Hinton et al.

    A new method for studying gut transit times using radioopaque markers

    Gut

    (1969)
  • M.A. Kamm et al.

    Dynamic scanning defines a colonic defect in severe idiopathic constipation

    Gut

    (1988)
  • B. Krevsky et al.

    Patterns of colonic transit in chronic idiopathic constipation

    Am. J. Gastroenterol.

    (1989)
  • A.G. Klauser et al.

    Behavioral modification of colonic function. Can constipation be learned?

    Dig. Dis. Sci.

    (1990)
  • S.A. Müller-Lissner

    Effect of wheat bran on weight of stool and gastrointestinal transit time: a mete analysis

    Br. Med. J.

    (1988)
  • A.L. Stephen et al.

    The effect of age, sex, and level of intake of dietary fibre from wheat on large-bowel function in thirty healthy subjects

    Br. J. Nutr.

    (1986)
  • J.B. Stubbs et al.

    A noninvasive scintigraphic assessment of the colonic transit of nondigestible solids in man

    J. Nucl. Med.

    (1991)
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