Do Stool Form and Frequency Correlate With Whole-Gut and Colonic Transit? Results From a Multicenter Study in Constipated Individuals and Healthy Controls

Saad, Richard J.; Rao, Satish S.; Koch, Kenneth L.; Kuo, Braden; Parkman, Henry P.; McCallum, Richard W.; Sitrin, Michael D.; Wilding, Gregory E.; Semler, John R.; Chey, William D.

doi:10.1038/ajg.2009.612

Cited by 217 publications

(176 citation statements)

References 24 publications

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“…S5). Accordingly, transit time itself is correlated with the consistency of feces (41,42) which can be quantified by the Bristol stool scale (BSS), a diagnostic measure to formally score fecal consistency on a scale from 1 (separate hard lumps) through 7 (watery without solids; see SI Appendix, section 5.8, for a detailed analysis of the relation between transit time and BSS) (41). In agreement with our predictions (Fig.…”

Section: Significancesupporting

confidence: 76%

Effect of water flow and chemical environment on microbiota growth and composition in the human colon

Cremer

Arnoldini

Hwa

2017

Proc. Natl. Acad. Sci. U.S.A.

143

192

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The human gut harbors a dynamic microbial community whose composition bears great importance for the health of the host. Here, we investigate how colonic physiology impacts bacterial growth, which ultimately dictates microbiota composition. Combining measurements of bacterial physiology with analysis of published data on human physiology into a quantitative, comprehensive modeling framework, we show how water flow in the colon, in concert with other physiological factors, determine the abundances of the major bacterial phyla. Mechanistically, our model shows that local pH values in the lumen, which differentially affect the growth of different bacteria, drive changes in microbiota composition. It identifies key factors influencing the delicate regulation of colonic pH, including epithelial water absorption, nutrient inflow, and luminal buffering capacity, and generates testable predictions on their effects. Our findings show that a predictive and mechanistic understanding of microbial ecology in the gut is possible. Such predictive understanding is needed for the rational design of intervention strategies to actively control the microbiota. T he human gut microbiota is composed of trillions of bacterial cells (1-4) from several hundred species (1-3, 5, 6). Over the last two decades, a multitude of studies have shown a strong impact of human health status on the composition of this microbiota, and in turn a strong effect of microbiota composition on host physiology has also been confirmed (7-9). Various intervention strategies are being investigated to modify the microbiota composition via prebiotics and probiotics (10). Despite this importance for human health, little is known about how the microbiota composition is shaped by the interplay between human and bacterial physiology in the gut.In this study, we present a physiological model that quantitatively describes this host-microbiota interplay. Our model is based on a hydrodynamic perspective, which posits that bacterial densities reached in the colon result from a dynamic balance between bacterial growth, flow through the colon, and peristaltic mixing (11). To build the present model, we extensively analyzed literature data on human gut physiology to obtain quantitative estimates for a range of relevant host parameters. We further characterized the rates of bacterial growth, carbohydrate consumption, and fermentation product excretion for representatives of the two dominant bacteria phyla, Bacteroidetes and Firmicutes, that typically make up more than 90% of the bacterial cells observed in the gut (6).Combining these aspects of human and bacterial physiology into a coarse-grained mathematical model allowed us to study bacterial growth dynamics in the human gut. Without resorting to ad hoc fitting parameters, model results are in quantitative agreement with available data on key observables of human gut physiology. We find that changes in pH values in the colon that are due to the secretion of acidic fermentation products and shaped by human physiology (such a...

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Section: Significancesupporting

confidence: 76%

Effect of water flow and chemical environment on microbiota growth and composition in the human colon

Cremer

Arnoldini

Hwa

2017

Proc. Natl. Acad. Sci. U.S.A.

143

192

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“…Moreover, stool frequency correlates poorly with both measured whole-gut and colonic transit time, and only a modest correlation between GI transit and stool form exists in chronic constipated patients. 41 This strongly accentuates the limitations of studies using number of SBMs as the primary outcome measure, as it may potentially underestimate symptoms regarded more bothersome for the patient. Our study supports these results, as SBM frequency only changed on day 2, but other OIBD symptoms were present throughout the study along with the significant increased transit times in the colon.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Poulsen

Nilsson

Brock

et al. 2016

J Neurogastroenterol Motil

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Background/AimsTo employ an experimental model of opioid-induced bowel dysfunction in healthy human volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility assessed by questionnaires and regional GI transit times using the 3-dimensional (3D)-Transit system. MethodsTwenty-five healthy males were randomly assigned to oxycodone or placebo for 5 days in a double blind, crossover design. Adverse GI effects were measured with the bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptom questionnaire, and Bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system, and segmental transit times in the colon were determined using a custom Matlab ® graphical user interface. ResultsGI symptom scores increased significantly across all applied GI questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 hours (P < 0.001), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 hours (P = 0.012), rectosigmoid colon transit from 2.7 to 9.0 hours (P = 0.044), and colorectal transit time from 18.6 to 38.6 hours (P = 0.001). No associations between questionnaire scores and segmental transit times were detected. ConclusionsSelf-assessed GI adverse effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of constipation.

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“…No correlation has been observed between stool frequency and measured transit in constipated or healthy adults. 38 In constipated adults, stool form correlated well with colon transit, but this correlation was not detected in healthy controls. Thus, history taking pertaining to stool form is a simple and useful way to estimate CTT in constipated patients.…”

Section: Statementmentioning

confidence: 98%

“…37 It uses simple visual illustration that is easily understood by patients, enabling them to recognize stool form and consistency. The BSFS is a reliable indicator of CTT 38 and particularly useful in patients reporting some discrepancy between the frequency of bowel movements and stool hardness. 26 Some patients complain of having constipation with a normal frequency of bowel movement and hard or lumpy stool, but in some cases, patients consider constipation to be having rare bowel movements with normal stool consistency.…”

Section: Statementmentioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

J Neurogastroenterol Motil

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The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

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Do Stool Form and Frequency Correlate With Whole-Gut and Colonic Transit? Results From a Multicenter Study in Constipated Individuals and Healthy Controls

Cited by 217 publications

References 24 publications

Effect of water flow and chemical environment on microbiota growth and composition in the human colon

Effect of water flow and chemical environment on microbiota growth and composition in the human colon

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

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