No abstract available.
Constipation* ; Diagnosis*

BACKGROUND: There are few reports about the reproducibility of colonic transit studies. Major therapeutic decisions are rendered based upon a single colonic transit study. Therefore, the aim of this study was to access the reproducibility of colonic transit studies in patients with chronic constipation. METHODS: Fifty one (51) patients with chronic constipation underwent two separate colonic transit studies. All clinical conditions, methodologies, and patients' instructions were identical on both occasions. The gamma rate (linear correlation analysis) was taken between the first and the second colonic transit studies. The patients were subdivided into those tested within the same year and those whose tests occurred more than 12 months apart. These two groups were further divided according to the diagnosis of colonic inertia, paradoxical puborectalis contraction, and chronic idiopathic constipation. RESULTS: In 35 of the 51 patients (69%), the results were identical between the two studies; however, in 16 patients (31%), the results were disparate (gamma correlation coefficient=0.53; p<0.01). The correlation coefficient for tests repeated within one year was 0.38 (p<0.05) whereas for periods greater than one year it was 0.72 (p<0.01). The specific correlation coefficients for patients with colonic inertia, paradoxical puborectalis contraction, and chronic idiopathic constipation were 0.12, 0.21, and 0.60 (p<0.05), respectively. CONCLUSIONS: Colonic transit studies are reproducible in patients with chronic constipation, regardless of the duration between tests. The correlation coefficient is best for patients with idiopathic constipation and worst for patients with colonic inertia.
Colon* ; Constipation* ; Diagnosis ; Humans

No abstract available.
Colon* ; Constipation* ; Diagnosis*

PURPOSE: The results of a subtotal colectomy in colonic inertia, even those reported in the most recent literature, vary dramatically. The purpose of this study was to assess the effect of a colonic transit study on the results of a subtotal colectomy in colonic inertia. METHODS: Between 1992 and 1997, 30 patients underwent a subtotal colectomy with ileorectal anastomosis due to colonic inertia. Twenty-one of them underwent a colonic transit study only one time preoperatively, and 9 patients underwent such a study two times. The success rate was calculated using traditional definition with two sets of criteria. We modi fied the criteria of success by including new symptoms, such as abdominal, pelvic, or rectal pain, difficult evacuation, and loose stool or diarrhea. The success rate was recalculated using our more stringent cri teria, and compared between group 1 and group 2. RESULTS: By the traditional definition, the functional success rate was 100% for patients undergoing a colonic transit study two times preoperatively and 90% for patients undergoing only one study (p=0.34). By our more stringent criteria, the success rate was 100% for patients undergoing studies two times and 62% for those undergoing only one study (p=0.03). CONCLUSIONS: The success rate of a colectomy for colonic inertia was significantly higher for patients who underwent a repeat transit study than for those who underwent a single study. Patients who have two or more transit studies to confirm the diagnosis of inertia have a significantly higher probability of postoperative improvement of both bowel frequency and associated symptoms, such as pain and difficult evacuation. The mechanism for this discriminatory effect of repeated colonic transit studies requires elucidation by further study.
Colectomy* ; Colon* ; Constipation* ; Diagnosis ; Diarrhea ; Humans

Clinical diagnosis and treatment of constipation lags behind relatively with unsatisfactory efficacy. Pathogeneses and molecular mechanisms for different types of constipation are waiting to be further clarified. New biomarkers and therapeutic targets for clinical diagnosis of constipation are so urgent. As for current problems in diagnosis and treatment of constipation, it is necessary to use the concept of translational medicine to break existing imprisonment of thinking, and find out new thinking ways of research methods, diagnosis and treatment approaches, thereby improving diagnosis and treatment levels.
Constipation ; diagnosis ; therapy ; Humans ; Translational Medical Research

PURPOSE: To evaluate therapeutic effect of biofeedback therapy according to methods of diagnosis in patients with norelaxing puborectalis syndrome. METHODS: From September, 1, 1998 to February, 30, 1999, the patients who were diagnosed with norelaxing puborectalis syndrome on anal electromyography (EMG) and/or cinedefecography (CD) underwent biofeedback therapy. The patients were divided into 3 groups according to the diagnostic method; CD group - only diagnosed on cinedefecography, EMG group - only diagnosed on anal electromyography, CD EMG group - diagnosed on both tests. RESULTS: Nineteen patients were diagnosed nonrelaxing puborectalis syndrome on CD and/or EMG. There were 14 females and 5 males with a mean age of 40.8+/-18.4 years. The patients were classified into CD group; five patients (26.3%); EMG group, eight patients (42.1%); CD EMG group, six patients (31.6%). The patients had 5.4 3.7 sessions of outpatient EMG-based biofeedback sessions. Subjective symptoms after biofeedback therapy improved in 4 (80.0%), 6 (75%), 5 (83%) patients in CD, EMG, CD EMG groups, respectively. There was a statistically significant increase in spontaneous bowel movements, and a reduction in assisted bowel movements after biofeedback therapy in patients in all three groups (p<0.05). However, no significant difference was found among the three groups. CONCLUSION: This study demonstrated that biofeedback therapy had a high therapeutic effect regardless to the diagnostic method. Therefore, biofeedbck therapy can be performed if one test results in the diagnosis of norelaxing puborectalis syndrome in patients with constipation.
Biofeedback, Psychology* ; Constipation ; Diagnosis* ; Electromyography ; Female ; Humans ; Male ; Outpatients

PURPOSE: The role of plain, abdominal radiography in childhood constipation has not been fully evaluated. The aim of this study was to determine the accuracy and reliability of scoring systems assessing a fecal load on plain, abdominal radiographs in children with functional constipation. METHODS: Plain, abdominal radiographs from 38 constipated children and 39 control children were examined by four independent inspectors, pediatric residents. Four inspectors independently scored the radiographs according to three different scoring systems Barr, Blethyn, and Leech. No clinical information about the patients was available to the inspectors. Each abdominal radiograph was evaluated on two separate occasions, one week apart. Kappa coefficients were calculated as indicators of inter-and intra-inspector variability, coefficients < 0.20, 0.21~0.40, 0.40~0.60, 0.60, 0.61~0.80 and 0.81~1.00 were considered to indicate poor, fair, moderate, good, and very good agreement, respectively. RESULTS: The Leech score showed the highest reproducibility: the inter-inspector agreement was uniformly very good on two separate occasions (kappa values of 0.88, 0.91, 0.92, 0.86 in the first time and 0.81, 0.88, 0.89, 0.84 in the second time). Agreement using the Barr score was good (kappa values of 0.66, 0.67, 0.69, 0.66 in the first time and 0.68, 0.65, 0.71, 0.68 in the second time). However, agreement for the Blethyn score was the lowest of the three scoring systems. The Leech scoring system had the highest sensitivity and specificity compared to the Barr scoring system for the diagnosis of functional constipation by plain, abdominal radiographs. CONCLUSION: The Leech score appeared to be a more accurate and reliable method because of its high sensitivity and specificity for evaluating the fecal load on plain, abdominal radiographs in children with functional constipation. Therefore, the Leech scoring system was found to be the most useful for assessment for the degree of constipation on plain, abdominal radiographs in children.
Child ; Constipation* ; Diagnosis ; Humans ; Radiography ; Radiography, Abdominal ; Sensitivity and Specificity

Chronic Disease ; therapy ; Constipation ; diagnosis ; therapy ; Gastrointestinal Transit ; Humans

The Currarino triad is a unique complex of congenital anomalies including anorectal malformation, scral bonyabnormality, and presacral mass. The usual symptomatology is constipation due to anorectal stenosis. Threepatients with this triad confirmed by surgical operation during recent two yeas in Seoul National Universitychildren's Hospital were presented with a brief review of clinical features, unique radiologic appearance andpostulated pathophysiology. The presacral mass was a mature teratoma in the first patient, alipomyelomeningocele-epidermoid inclusion cyst in the second patient, and myelomeningocele in the third patient. Acorrect diagnosis of the Currarino triad by radiologists is important, and may help the phsicians to investigatedetailed family history and associated anomalies and to establish adequate surgical plans.
Constipation ; Constriction, Pathologic ; Diagnosis ; Humans ; Meningomyelocele ; Seoul ; Teratoma

OBJECTIVE: To explore the application value of rectal prolapse constipation balloon in single auxiliary defecation. METHODS: Forty-one patients with moderate or severe rectocele were treated with a rectocele constipation balloon through the vagina. The defecography and VAS scores were compared before and after implantation. RESULTS: There was a significant difference between the anorectal angle, rectocele, and VAS scores before and after intervention in defecography (<0.01). CONCLUSIONS A single assisted defecation of the rectocelicular constipation balloon is feasible.
Constipation ; diagnosis ; Defecation ; Defecography ; instrumentation ; Female ; Humans ; Rectal Prolapse ; Rectocele