Regional Colonic Transit Pattern Does Not Conclusively Identify Evacuation Disorders in Constipated Patients with Delayed Colonic Transit

Abstract

Background/AimsAfter exclusion of structural diseases, chronic constipation may be associated with normal or slow transit or rectal evacuation disorders. We evaluated: (1) clinical features and anorectal function, (2) difference of regional colonic transit according to the presence or absence of evacuation disorders, and (3) association of colonic transit with gender in patients with objectively slow colonic transit. MethodsWe reviewed electronic medical records of 1553 patients with constipation seen by one gastroenterologist from 1994-2015 at a tertiary medical center. We identified patients with slow colonic transit using scintigraphy. Evacuation disorders were identified on clinical examination or anorectal manometry. Colonic compliance and tone were measured in 29 patients. Statistical analysis was by the Mann-Whitney rank sum test. ResultsOf the 207 patients (155 females, mean age 41.3 ± 15.3 [SD] years), 113 had evacuation disorders (ED+ve) and 94 did not (ED-ve). There were no significant differences in colonic transit or gastric emptying between ED+ve or ED-ve; similarly, colonic compliance, tone and responses to neostigmine were not different in ED+ve and ED-ve. Conversely, there were significant differences by gender in patients with slow colonic transit: colonic transit, small bowel transit, and gastric emptying (all P < 0.005). ConclusionsDelayed colonic transit does not exclude evacuation disorders in chronic constipation. In chronic constipation and objectively slow colonic transit, females had slower gastric, small bowel, and colonic transit than males. (J Neurogastroenterol Motil 2017;23:92-100)

Rectal Gas Volume Measured by Computerized Tomography Identifies Evacuation Disorders in Patients With Constipation

“…In fact, a recent analysis of patients with constipation associated with overall delay in colonic transit showed that scintigraphic evaluation over 48 hours was unable to differentiate slow transit constipation from a rectal evacuation disorder. 13 …”

“…The study population, 13–22 criteria for rectal evacuation disorders, slow or normal transit constipation, 23–26 and conduct of procedures, anorectal manometry and balloon expulsion studies 8 and colonic transit measurements, 15 are detailed in the Supplemental Material.…”

Rectal gas volume: Defining cut‐offs for screening for evacuation disorders in patients with constipation

“…The patients’ mean age was 42.9±16.2 years and BMI was 22.9±3.9 kg/m 2 . These patients are in a cumulated cohort of over 1500 patients that has been fully characterized elsewhere; less than 8% of patients in this cohort had undergone CT scans related to the constipation, and the CTs were performed (usually at the referring centers) for exclusion of organic diseases.…”

Radiopaque marker colonic transit study in the pediatric population BSPGHAN Motility Working Group consensus statement

“…Park et al 59 verified that regional CTT (i.e., the measurement of transit in specific colonic segments) could not be used to exclude evacuation disorders in adults with FC. It was suggested, that further investigations such as the balloon expulsion test or ARM are recommended.…”

“…It was suggested, that further investigations such as the balloon expulsion test or ARM are recommended. Park et al, 59 hypothesized that fecal impaction could delay colonic motility; thus, making it difficult to differentiate between STC and an ROO. 6 Colonic manometry (CM) remains at its infancy, regarding clinical use within pediatrics.…”