Constipation is a common symptom affecting 2-27% of general population in Western countries. According to a population-based study on bowel habits in a Korean community, the prevalence was 16.5% for self-reported constipation and 9.2% for functional constipation. There is a broad range of causes for constipation. There are three subtypes in functional constipation, although overlap is not uncommon. Physiologic studies such as colonic transit test, anorectal manometry, balloon expulsion test, and defecography can be helpful in further evaluating and classifying functional constipation. Slow transit constipation is characterized by prolongation of transit time through- out the colon, caused by either myopathy or neuropathy. Functional defecation disorder is characterized as an inability to initiate defecation following the urge to do so, a feeling of incomplete evacuation, tenesmus, excessive straining or manual evacuation. Normal transit constipation is the most common subtype and characterized by constipation occurring in the presence of normal colonic transit time and normal defecatory function. It is important for clinicians to choose appropriate treatment for constipation which are most efficacious for the individual patient. Most patients with functional constipation respond to laxatives, but a small proportion may be resistant to this treatment. In patients with functional defecation disorder, biofeedback is helpful. Sacral nerve stimulation may be helpful in some patients with slow transit constipation. Patients who are resistant to all the conservative modalities may require surgical intervention. Extensive clinical and physiological preoperative assessment of patients with slow colonic transit time is essential before considering surgery, including an assessment of small bowel motility and identification of coexistent defecatory disorder.
Biofeedback (Psychology) ; Constipation/*classification/etiology/*therapy ; Defecation/physiology ; Defecography ; Diagnosis, Differential ; Gastrointestinal Transit/physiology ; Humans

Slow transit constipation(STC)is the common type of chronic idiopathic constipation. Due to failure of routine conservative treatment, laxatives abuse is the most choice for majority of the patients, which could damage the enteric nervous system and result in aggravation of constipation. Resection of the slow transit colon is the ultimate option for some patients. It is hard to prevent and treat STC clinically because of the unknown pathophysiologic mechanism. Abnormalities of enteric neurotransmitters such as VIP, SP, NOS and decreased number of interstitial cells of Cajal have been described in the colon of the patients with STC. However, long term application of stimulant laxatives can also result in the almost same changes in the colon. Exploration of the potential relationship among the above reported abnormalities is the direction of future study.
Constipation ; physiopathology ; Enteric Nervous System ; physiopathology ; Gastrointestinal Transit ; physiology ; Humans ; Interstitial Cells of Cajal ; cytology

A noninvasive measuring system for human GI physiological signals has been designed, and human GI physiological realtime parameters are acquired in the normal physiological state of human. In this paper is mainly discussed the design of "In-vitro data recorder" of a noninvasive measuring system for human GI physiological signals. By experiments, the portable "In-vitro data recorder" works normally and reliably; it can meet the needs of clinical application.
Capsules ; Electronics, Medical ; instrumentation ; methods ; Equipment Design ; Gastrointestinal Transit ; physiology ; Humans ; Monitoring, Physiologic ; instrumentation ; methods ; Signal Processing, Computer-Assisted ; instrumentation

Assessment of transit through the gastrointestinal tract provides useful information regarding gut physiology and pathophysiology. Although several methods are available, each has distinct advantages and limitations. Recently, an ingestible wireless motility capsule (WMC), similar to capsule video endoscopy, has become available that offers a less-invasive, standardized, radiation-free and office-based test. The capsule has 3 sensors for measurement of pH, pressure and temperature, and collectively the information provided by these sensors is used to measure gastric emptying time, small bowel transit time, colonic transit time and whole gut transit time. Current approved indications for the test include the evaluation of gastric emptying in gastroparesis, colonic transit in constipation and evaluation of generalised dysmotility. Rare capsule retention and malfunction are known limitations and some patients may experience difficulty with swallowing the capsule. The use of WMC has been validated for the assessment of gastrointestinal transit. The normal range for transit time includes the following: gastric emptying (2-5 hours), small bowel transit (2-6 hours), colonic transit (10-59 hours) and whole gut transit (10-73 hours). Besides avoiding the use of multiple endoscopic, radiologic and functional gastrointestinal tests, WMC can provide new diagnoses, leads to a change in management decision and help to direct further focused work-ups in patients with suspected disordered motility. In conclusion, WMC represents a significant advance in the assessment of segmental and whole gut transit and motility, and could prove to be an indispensable diagnostic tool for gastrointestinal physicians worldwide.
Colon ; Constipation ; Deglutition ; Diagnosis ; Endoscopy ; Gastric Emptying ; Gastrointestinal Motility ; Gastrointestinal Tract ; Gastrointestinal Transit ; Gastroparesis ; Humans ; Hydrogen-Ion Concentration ; Physiology ; Reference Values

AIMTo investigate the effect of acute exhaustive exercise on gastrointestinal motility and its enteric nervous mechanisms.

METHODS24 rats were randomly divided into control group (C) and acute exhaustive exercise group (AEE). The rate of gastrointestinal transit was measured and histologic changes of nitriergic nerves in ileum myenteric plexus were observed with enzymatic histochemical and image analytic technique.

RESULTSIn the rats of AEE group, the rate of gastrointestinal transit was delayed comparing with C group (P < 0.05), the numbers of nitrergic neurons and expression levels of nitric oxide synthase (NOS) in the ileum myenteric plexus significantly increased comparing with C group (P < 0.01).

CONCLUSIONIt is possible that increase of nitrergic neurons and expression levels of NOS in the myenteric plexus of small intestine are one of the mechanisms of delay of gastrointestinal transit rate in acute exhaustive exercise rats.

Animals ; Gastrointestinal Motility ; physiology ; Gastrointestinal Transit ; physiology ; Ileum ; innervation ; Male ; Motor Activity ; Myenteric Plexus ; metabolism ; Nitrergic Neurons ; cytology ; Nitric Oxide Synthase ; metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the effects of ghrelin on small intestinal transit and intergigestive gastrointestinal migrating myoelectric complex (MMC) in rats.

METHODSAfter a 24-hour fasting, the rats with or without pretreatment with receptor antagonist (D-Lys3)GHRP-6 were given intravenous injections of ghrelin at different doses to observe the changes in small intestinal transit. The MMCs of the fasting rats were recorded using a multilead physiological recording system, and their changes observed in response to intravenous ghrelin injections, or to ghrelin injection following pretreatment with atropine, phentolamine, propranolol, L-arginine or (D-Lys3)GHRP-6, respectively.

RESULTSGhrelin enhanced the small intestinal transit dose-dependently, and this effect was inhibited by application of ghrelin receptor antagonist. Ghrelin also showed excitatory effect on the MMCs, which was inhibited by atropine, L-arginine or (D-Lys3)GHRP-6, but not by propranolol and phentolamine.

CONCLUSIONGhrelin can promote gastrointestinal motilities, and its excitatory effects rely on the cholinergic pathway in close relation to nitric oxide pathway. Ghrelin receptor is involved in its action in promoting the gastrointestinal motilities.

Animals ; Dose-Response Relationship, Drug ; Female ; Gastrointestinal Motility ; drug effects ; physiology ; Gastrointestinal Transit ; drug effects ; physiology ; Ghrelin ; administration & dosage ; pharmacology ; Injections, Intravenous ; Intestine, Small ; drug effects ; physiology ; Male ; Myoelectric Complex, Migrating ; drug effects ; physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVESlow transit constipation (STC) is a colonic motor disorder whose etiology remains unclear. Recent studies have demonstrated a crucial role for interstitial cells of Cajal (ICC) in regulation of intestinal motility. The aim of this study was to examine the distribution of ICC within the normal sigmoid colon and STC patients.

METHODSTwelve patients with STC and eight age-matched controls were studied. ICC were identified with a monoclonal antibody to c-kit by an indirect immunofluorescence method. Immunostained tissues were examined with a laser scanning confocal microscope and the area occupied by ICC was calculated with image analysis software.

RESULTSICC were located in the external muscle layers including longitudinal muscle (LM), myenteric plexus (MP), circular muscle (CM) and submucosal border (SMB). Two types of Kit-positive ICC were observed: bipolar cells characterized by one or two long processes, and multipolar cells with long stellate processes extending in various directions. A higher percentage of ICC was present in the MP regions and CM layers compared with the SMB and LM layers. Tissues from STC patients showed considerably decreased in number of ICC located in the four regions (ICC-LM, ICC-MP, ICC-CM, ICC-SMP), especially for ICC-SMP, almost completely disappeared.

CONCLUSIONDecreased c-kit + ICC in number may play an important role in the pathophysiology of STC. It remains to be determined whether loss of ICC is primary or secondary to another lesion.

Adult ; Aged ; Case-Control Studies ; Colon, Sigmoid ; pathology ; Constipation ; pathology ; physiopathology ; Female ; Fluorescent Antibody Technique, Indirect ; Gastrointestinal Transit ; physiology ; Humans ; Male ; Middle Aged

BACKGROUND: Measuring colonic transit time (CTT) by the radio-opaque marker method is simple, widely available and important for the diagnosis of slow transit constipation. Moreover, the effects of gender and menstrual cycle on CTT remain controversial. Thus, in this study, we examined the effects of gender and menstrual cycle on CTT in healthy subjects. METHODS: We measured CTT in 42 healthy subjects (21M, 21F) by using a radio-opaque marker, Kolomark (TM). Two simple abdominal radiographs were taken on the 4th and 7th days. Average daily intake of dietary fiber and menstrual history were surveyed. RESULTS: The mean CTT of the 42 healthy subjects was 26.5 +/- 19.4 hours. The mean CTT was not significantly different between the male and female subjects (22.3 +/- 16.1 h vs. 30.1 +/- 21.4 h, p> 0.05). However, the mean CTT of 11 female subjects in the luteal phase was significantly longer than that of 10 female subjects in the follicular phase (40.9 +/- 19.0 h vs. 20.6 +/- 19.2 h, p< 0.05). Serum progesterone level, age, BMI, and the average daily intake of dietary fiber did not correlate with CTT. CONCLUSION: The effects of the menstrual cycle should be considered in interpreting CTT in young women.
Adult ; Colon/*physiopathology/radiography ; Comparative Study ; Constipation/physiopathology/radiography ; Contrast Media ; Female ; Gastrointestinal Transit/*physiology ; Human ; Male ; Menstrual Cycle/*physiology ; Middle Aged ; Radiography, Abdominal ; Sex Factors ; Support, Non-U.S. Gov't

OBJECTIVE: The purpose of this study was to establish a minimally invasive and reproducible protocol for estimating the gastrointestinal (GI) transit time in mice using barium and radiopaque markers. MATERIALS AND METHODS: Twenty 5- to 6-week-old Balb/C female mice weighing 19-21 g were used. The animals were divided into three groups: two groups that received loperamide and a control group. The control group (n = 10) animals were administered physiological saline (1.5 mL/kg) orally. The loperamide group I (n = 10) and group II (n = 10) animals were administered 5 mg/kg and 10 mg/kg loperamide orally, respectively. Thirty minutes after receiving the saline or loperamide, the mice was administered 80 microL of barium solution and six iron balls (0.5 mm) via the mouth and the upper esophagus by gavage, respectively. Afterwards, the mice were continuously monitored with fluoroscopic imaging in order to evaluate the swallowing of the barium solution and markers. Serial fluoroscopic images were obtained at 5- or 10-min intervals until all markers had been excreted from the anal canal. For analysis, the GI transit times were subdivided into intestinal transit times (ITTs) and colon transit times (CTTs). RESULTS: The mean ITT was significantly longer in the loperamide groups than in the control group (p < 0.05). The mean ITT in loperamide group II (174.5 +/- 32.3) was significantly longer than in loperamide group I (133.2 +/- 24.2 minute) (p < 0.05). The mean CTT was significantly longer in loperamide group II than in the control group (p < 0.05). Also, no animal succumbed to death after the experimental procedure. CONCLUSION: The protocol for our study using radiopaque markers and barium is reproducible and minimally invasive in determining the GI transit time of the mouse model.
Analysis of Variance ; Animals ; Barium Sulfate/pharmacology ; Contrast Media/administration & dosage ; Female ; Fluoroscopy ; Gastrointestinal Transit/*physiology ; Iron ; Loperamide/administration & dosage ; Mice ; Mice, Inbred BALB C ; Microscopy, Electron, Scanning ; Prostheses and Implants ; Reproducibility of Results ; Sodium Chloride/administration & dosage ; Surface Properties

OBJECTIVETo investigate the application value of colonic transit test (CTT) combined with anorectal manometry (ARM), barium enema (BE) and defecography (DFG) in accurately evaluating colonic lesions of slow transit constipation complicated with adult megacolon.

METHODSClinical data of 47 above patients admitted between October 2007 and February 2015 in the People's Hospital of Hunan Province were analyzed retrospectively. All the patients were examined with≥2 times of CTT combined with ARM and BE, and 42 cases received additional DFG at the same time, to evaluate colonic lesions before operation. Operative biopsy pathology was used as the standard. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of positioning in the ascending colon and caecum, transverse colon and descending colon were calculated, and the consistency was represented by Kappa test(Kappa value≥0.75 indicates good consistency, meanwhile higher Kappa value indicates better consistency). The Heikkinen score was used to evaluate defecation function at postoperative 6 months.

RESULTSThe age of 47 patients was from 18 to 56 years old. Compared with intraoperative findings and biopsy pathology, the diagnostic coincidence rate was 89.4% by CTT combined with BE and DFG positioning, which suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=12), transverse colon (n=26) and descending colon (n=9), while intraoperative findings and biopsy pathology suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=11), transverse colon (n=23) and descending colon (n=13). The sensitivity was 88.3%, specificity 93.5%, PPV 92.1%, NPV 94.9% and Kappa value was 0.827(P<0.001). Procedures performed included segmental colectomy (n=8), subtotal colectomy (n=29), total colectomy (n=10). There was no serious complication during and after operation. Defecatory function was excellent in 24 cases (60.0%), good in 10 (25.0%), and moderate in 6 (15.0%) evaluated by Heikkinen score at postoperative 6 months. A total of 40 patients were followed up from 1 to 7 years (median 3 years) and there was no long-term diarrhea and recurrence of constipation or giant colon after operation.

CONCLUSIONPreoperative detection of CTT combined with ARM, BE and DFG in patients with slow transit constipation complicated with adult megacolon can make a more precise assessment of the extent of colonic lesions in advance, which has a good clinical predictive value.

Adolescent ; Adult ; Barium Enema ; Cecum ; pathology ; physiopathology ; surgery ; Colectomy ; methods ; Colon ; pathology ; physiopathology ; surgery ; Constipation ; complications ; diagnosis ; pathology ; surgery ; Defecography ; Female ; Gastrointestinal Transit ; physiology ; Humans ; Male ; Manometry ; Megacolon ; complications ; pathology ; surgery ; Middle Aged ; Predictive Value of Tests ; Preoperative Period ; Prognosis ; Recovery of Function ; physiology ; Retrospective Studies ; Sensitivity and Specificity