Assessment of chronic constipation: colon transit time versus defecography
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
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2013, Gastroenterology Clinics of North AmericaCitation Excerpt :Transit studies are an important element in the work-up for chronic constipation, but they have limited usefulness in the specific evaluation of rectal prolapse. Although 1 small study showed a slightly prolonged colonic transit time in full-thickness prolapse compared with internal intussusception, there was no significant difference from idiopathic constipation.48 In another study addressing transit times before and after Ripstein rectopexy, the investigators showed that prolonged preoperative transit times correlated with evacuation difficulties after surgery.49
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