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Simplified assessment of segmental colonic transit
Abstract
Transit times of radiopaque markers through the human gut were measured by published techniques and compared with a simplified method. Three sets of distinctive markers were ingested by 24 healthy persons on 3 successive days. In the first part of the study, daily abdominal x-rays were taken and individual stools were collected for radiography. Mouth-to-anus transits were assessed from the fecal output of markers and mean colonic and segmental colonic transits were calculated from the daily radiographs. These established methods were then compared with estimates of total colonic and segmental transits based on a single abdominal film, taken on the fourth day. The single-film technique correlated well with values obtained from the previous, but more inconvenient, methods. Using the simpler approach, colonic transit was assessed in 49 additional healthy subjects, for a total group of 73. Total colonic transit was 35.0 +/- 2.1 h (mean +/- SE); segmental transits was 11.3 +/- 1.1 h for the right colon, 11.4 +/- 1.4 h for the left colon, and 12.4 +/- 1.1 h for the rectosigmoid. Men had significantly shorter transits for the whole colon than did women (p less than 0.05), and this difference was apparent to some extent in the right (p = 0.06) and left colon (p = 0.07) but not in the rectosigmoid. Age did not influence transit significantly nor did a small dose of supplemental fiber. The technique is simple, convenient for clinical usage, and reduces the exposure to radiation to acce…
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“A useful first step is to distinguish slow-transit constipation from evacuation disorders (e.g., pelvic floor dyssynergia), because confirmatory tests and treatment strategies differ (Manabe et al., 2010; Metcalf et al., 1987).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Metcalf et al., 1987
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“Mean colonic transit time was calculated as the number of markers remaining in the colon on day 4 as previously described (10).”
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“The technique was used to measure total and segmental colonic transit time as had been described byMetcalf et al.(25) Abdominal radiographic films were obtained using a high-kilowatt fast-film technique to reduce radiation exposure (estimated surface exposure 0.”
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“[69] found a regular transit time in different segments of the colon of healthy elderly, while Madsen and Graff [70] reported a significant increase in colon transit time in the same population.”
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“Evidence level : B Agreemnet rate : 74% Comment : The radiopaque marker technique is established as a clinical signi fi cant colonic transit time testing method and is the most widely used technique worldwide [96], with SITZMARKS Ⓡ being the representative marker technique.”
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“One such test is the radiopaque marker transit Metcalf method (24); using this protocol, about onethird of adults with unexplained chronic constipation or chronic diarrhea had demonstrably abnormal transit (25).”
MethodEffect of Aging on the Gastrointestinal Tract and the Pancreas
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“Most studies of segmental colonic transit time only distinguish between right and left colon (28, 29), but in a study of healthy children, the transverse and rectosigmoid colon were identified as relatively slow transit segments (30).”
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“To simulate colon conditions, the residence time in the colon vessels was 20 h and pH was controlled at pH 6.15–6.40 which are both in the range of in vivo observations (Metcalf et al. 1987; Nugent et al. 2001).”
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“Radiopaque marker transit measurements are useful and have been validated for identifying slow transit (Metcalf et al., 1987), but there has not been sufficient validation in diarrheal diseases.”
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“Several procedures have been used to measure colonic transit time (CTT), and different upper limits of normal CTT have been described, varying from 45 [15] to 72 h [17,18].”
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“The pressure-sensitive radio pill can also be used to measure transit, although it has high intersubject variability being a single estimate of transit of one particle rather than a weighted average of many, like scintigraphy or radio-opaque pellets.(28) In a recent study the mean transit time for constipated subjects…”
BackgroundMethodInfluentialThe clinical value of solid marker transit studies in childhood constipation and soiling
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“The error could be corrected by using a second abdominal X-ray on the 7th day [12], but in children this is unjustified because of increased radiation.”
MethodConstipation and Colonic Transit Times in Children With Morbid Obesity
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“These contradictions have been described in studies in adults as well (9,10,28).”
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Ileocecal reservoir reconstruction with physiologic function after total mesorectal cancer excision.
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Misoprostol is effective treatment for patients with severe chronic constipation
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“Patients age 18 years or older were selected based on a history of constipation, with infrequent bowel movements (every four days or less), and delayed colonic transit as documented by the radiopaque marker technique (8).”
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“Total and segmental CTT were quantified using the radiopaque marker technique described by Metcalf et al.14 Anorectal manometry and surface EMG were performed following the protocols of the American Gastroenterology Association15 and the Spanish Group for the Study of Digestive Motility.16 Patients were evaluated afte…”
MethodWollmer, E., Ungell, A.-L. B., Nicolas, J.-M., & Klein, S. (2021) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2021.114084 · Cited by 64
Marciani, L., Garsed, K. C., Hoad, C., Fields, A., Fordham, I., Pritchard, S., Placidi, E., Murray, K., Chaddock, G., Costigan, C., et al. (2014) · Neurogastroenterology and Motility · doi:10.1111/nmo.12403 · Cited by 56
Dong, K., Jia, B., Yu, C., Dong, W., Du, F., & Hong, L. (2012) · Biosensors and Bioelectronics · doi:10.1016/j.bios.2012.10.028 · Cited by 61
Zarate, N., Knowles, C. H., Newell, M., Garvie, N. W., Gladman, M. A., Lunniss, P. J., & Scott, S. M. (2008) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01675.x · Cited by 44
“While these are a valid screening test for the presence or absence of delayed colonic transit, serial marker studies (with attendant radiation exposure) (12, 13) or isotope scintigraphy may be used to characterize patterns of delayed transit (14).”
BackgroundGeneral geriatrics and gastroenterology: constipation and faecal incontinence
Müller-Lissner, S. A. (2002) · Best Practice & Research Clinical Gastroenterology · doi:10.1053/bega.2002.0269 · Cited by 53
Gastrointestinal transit of small tablets in patients with ulcerative colitis
Hardy, J., Davis, S., Khosla, R., & Robertson, C. (1988) · International Journal of Pharmaceutics · doi:10.1016/0378-5173(88)90249-9 · Cited by 56
The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy
de Lorijn, F., van Rijn, R. R., Heijmans, J., Reitsma, J. B., Voskuijl, W. P., Henneman, O. D. F., Taminiau, J. A. J. M., & Benninga, M. A. (2005) · Pediatric Radiology · doi:10.1007/s00247-005-0031-z · Cited by 47
Measurement of Gastrointestinal and Colonic Motor Functions in Humans and Animals
Camilleri, M., & Linden, D. (2016) · Cellular and Molecular Gastroenterology and Hepatology · doi:10.1016/j.jcmgh.2016.04.003 · Cited by 55
Manning Criteria in Irritable Bowel Syndrome: Its Diagnostic Significance
Jeong, H., Lee, H., Yoo, B. C., & Park, S. (1993) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.1993.8.1.34 · Cited by 55
Ileocolonic transit does not change after right hemicolectomy.
Fich, A., Steadman, C., Phillips, S. F., Camilleri, M., Brown, M. L., Haddad, A. C., & Thomforde, G. (1992) · Gastroenterology · doi:10.1016/0016-5085(92)90008-m · Cited by 55
Self-citationEffect of Lactobacillus casei Shirota on colonic transit time in patients with chronic constipation
Krammer, H.-J., von Seggern, H., Schaumburg, J., & Neumer, F. (2011) · coloproctology · doi:10.1007/s00053-011-0177-0 · Cited by 54
“The transit time was calculated by the following equation [12]: Colonic transit time (h)=sum of retained markers x 1.”
MethodDo Oro-anal Transit Markers Predict Which Children Would Benefit From Colonic Manometry Studies?
Tipnis, N., El-Chammas, K. I., Rudolph, C., Werlin, S., & Sood, M. (2012) · Journal of Pediatric Gastroenterology and Nutrition - JPGN · doi:10.1097/mpg.0b013e31822bbcd8 · Cited by 54
Koh, H., Lee, M.-J., Kim, M.-J., Shin, J., & Chung, K. (2010) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2009.06015.x · Cited by 54
Systematic assessment of constipation on plain abdominal radiographs in children
van den Bosch, M. A., Graafmans, D., Nievelstein, R., & Beek, E. (2006) · Pediatric Radiology · doi:10.1007/s00247-005-0065-2 · Cited by 54
Thomas, L., Veysey, M., Murphy, G., Russell-Jones, D., French, G., Wass, J., & Dowling, R. (2005) · Gut · doi:10.1136/gut.2003.028431 · Cited by 54
Oral or intravenous erythromycin has no effect on human distal colonic motility
Jameson, J., Rogers, J., Misiewicz, J., Raimundo, A., & Henry, M. (1992) · Alimentary Pharmacology and Therapeutics · doi:10.1111/j.1365-2036.1992.tb00573.x · Cited by 54
Hawley, C., Wall, D., Johnson, D. W., Campbell, S. B., Griffin, A., Rigby, R., & Petrie, J. (1995) · American Journal of Kidney Diseases · doi:10.1016/0272-6386(95)90605-3 · Cited by 53
Idiopathic slow‐transit constipation
Macdonald, A., Baxter, J., & Finlay, I. (1993) · British Journal of Surgery · doi:10.1002/bjs.1800800909 · Cited by 53
Preparation and Characterization of Cyclodextrin Nanosponges for Organic Toxic Molecule Removal.
Varan, C., Anceschi, A., Sevli, S., Bruni, N., Giraudo, L., Bilgiç, E., Korkusuz, P., Iskit, A., Trotta, F., & Bilensoy, E. (2020) · International journal of pharmaceutics · doi:10.1016/j.ijpharm.2020.119485 · Cited by 52
Behavioural and new pharmacological treatments for constipation: getting the balance right
Camilleri, M., & Bharucha, A. E. (2010) · Gut · doi:10.1136/gut.2009.199653 · Cited by 52
Vallès, M., & Mearin, F. (2009) · Diseases of the Colon & Rectum · doi:10.1007/dcr.0b013e3181a873f3 · Cited by 76
“and Metcalf et al.(22) Reference intervals used for total and segmental CTT interpretation were those obtained in healthy volunteers by the Spanish Group for the Study of Digestive Motility.”
MethodInfluentialAltomare, D. F., Portincasa, P., Rinaldi, M., Ciaula, A. D., Martinelli, E., Amoruso, A., Palasciano, G., & Memeo, V. (1999) · Diseases of the Colon & Rectum · doi:10.1007/bf02237134 · Cited by 88
Which physiologic tests are useful in patients with constipation?
Halverson, A., & Orkin, B. (1998) · Diseases of the Colon & Rectum · doi:10.1007/bf02236261 · Cited by 52
“Ten of the 19 patients with an abnormal transit time had additional pathology, which included a rectocele (5) or pelvic floor dysfunction (5).”
Background
Metadata
- Authors
- Metcalf, A. M., Phillips, S. F., Zinsmeister, A. R., MacCarty, R. L., Beart, R. W., & Wolff, B. G.
- Affiliations
- Mayo Clinic (US)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 1987-01
- Volume
- 92
- Issue
- 1
- Pages
- 40-47
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W1567581279
- Cited by
- 928
- References
- 0
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 14 · 2023: 23 · 2022: 16 · 2021: 24 · 2020: 28 · 2019: 33 · 2018: 23 · 2017: 29 · 2016: 38 · 2015: 28 · 2014: 15 · 2013: 30 · 2012: 30
- FWCI
- 14.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01am032121-03, 3p30am034988-01s1)
- National Center for Research Resources (RR-585)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Intestinal Malrotation and Obstruction Disorders
- Keywords
- colonic transit, radiopaque markers, proximal colon, left colon, rectosigmoid, dietary fiber, radiation dose reduction
- MeSH terms
- Adult, Aged, Colon, Dietary Fiber, Digestive System, Female, Gastrointestinal Motility, Humans, Male, Middle Aged, Radiography
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