Background-Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown. Aim-To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence. Methods-Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ingested a dual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning was performed until radioisotope left the gut and pressure was recorded for a median of 44 hours. Results-Three of six patients showed abnormal gastric emptying. Patients showed no disturbance of colonic radioisotope transit. Controls had a median of 12, whereas patients had a median of 16, high amplitude propagated waves per 24 hours. In three patients urge incontinence was associated with high amplitude (up to 500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occuring in healthy subjects, the only diVerence 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 left colon and rectum. The urge to defaecate was associated with either propagated waves (45%) or non-propagated contractions (55%). Rectal motor 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 of frequent high pressure propagated waves. Rhythmic activity occurs both proximal to and in the rectum. Defaecation is characterised by high pressure propagated waves associated with coordinated anal sphincter relaxation. Patients with faecal incontinence may have a widespread disturbance of gut function. Urge incontinence, an urge to defaecate, and defaecation can all be associated with identical high amplitude propagated pressure waves.

Gastric emptying of liquid (orange juice containing technetium-99m ('Tc) labelled antimony sulphide colioid) and solid (570 kcal pancake containing O 5 mm resin microspheres labelled with Indiun-ll ("'-In)) was measured in seven patients with jejunum and no colon (jejunal lengths 30-160 cm), six patients with jejunum in continuity with the colon (jejunal length 25-75 cm), and in 12 normal subjects. In patients with no colon early emptying of liquid was rapid (median 25% emptying: 7 v 25 min, no colon v normal, p

Radio-opaque markers have a well established role in distinguishing between patients with normal and those with slow intestinal transit, but in the latter group their accuracy in defining the region of delay has not been established. To study regional colonic transit accurately the transit of a radioisotope labelled meal was determined and findings were compared with those of simultaneously ingested radio-opaque markers. Twelve healthy controls (mean age 33 years) and 12 severely constipated women (mean age 36 years, bowel frequency

Although this last study investigated small bowel motor activity, the final consequence of such an abnormality, and the means by which symptoms are generated, is likely to be an alteration in the transit of intestinal contents. We have therefore investigated gastrointestinal transit in patients with good and poor bowel frequency after pouch creation, the latter group having an apparently good anatomical result and no pouchitis. Methods SUBJECTSTwenty one patients who had undergone restorative proctocolectomy with closure of their temporary ileostomy at least eight months previously were recruited. All patients had been operated on by one surgeon (RJN). Patients were prospectively selected and classified on the basis of their pouch function. Those with good pouch function were defined as having a bowel frequency of less than six times per day and less than or equal to once per night, were fully continent, able to empty their pouch spontaneously, and defer defaecation for more than 15 minutes. Those with poor function had a bowel frequency of more than six times per day and once per night. In this study those with poor function were selected to have full continence and spontaneous emptying, to exclude the effect of analpouch dysfunction as the cause of symptoms.We studied 11 patients (eight males, mean age 43 years, range 27-62) with good function and 10 patients (six males, mean age 43 years, range 27-60) with poor function. No patient had current or previous endoscopic or histological evidence of pouchitis.

This study of radioimmunoscintigraphy (RIS) was primarily undertaken to determine how the imaging results related to surgical findings. Technetium-99m radiolabelled 1A3, a monoclonal antibody against a columnar cell surface antigen, was used. No adverse effects or thyroid uptake was observed in 127 studies. The 85 primary colorectal cancers were all image positive. In the assessment of recurrent tumour in the abdomen or pelvis, the accuracy was 33/35 (94%), including true-positive findings in some whose serum carcinoembryonic antigen was normal. There was a positive predictive value for abdominal or pelvic recurrence of 92% and a negative predictive value of 100%, at a prevalence of 66%. In those patients whose liver was able to be evaluated, the accuracy was 72/79 (91%). There was a positive predictive value for liver metastases of 88% and a negative predictive value of 93%, at a prevalence of 32%. The simple procedure for labelling antibody with 99mTc and its ready availability allow a completed report to be given within 24 h of the request.