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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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“The same publication showed that this score correlates well with transit time in hours as measured using the well‐established radio‐opaque marker test.(24) On the day of the visit, subjects fasted before attendance, with the exception of sips of water with essential medicines.”
MethodEstablished and emerging methods for assessment of small and large intestinal motility
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“We also used the segmental method to evaluate the transit time for the right colon, the left colon, and the rectosigmoid colon separately.(26)”
MethodDyssynergic Defecation: A Comprehensive Review on Diagnosis and Management
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“The marker excretion rate (MER)5 (20-NI)/20, whereNI is the sumof themarkers present in the entire x-rayfilm(s) (18,19).”
BackgroundAssessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives
Kornum, D. S., Terkelsen, A. J., Bertoli, D., Klinge, M. W., Høyer, K. L., Kufaishi, H., Borghammer, P., Drewes, A. M., Brock, C., & Krogh, K. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10071392 · Cited by 53
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“This has been witnessed in studies using serial AXRs to assess transit.(6) In this study symptom severity was not shown to correlate with faecal loading (measured either by the formal or casual method) or colonic transit.”
MethodInfluentialChan, A., Cheng, C., Hui, W., Hu, W., Wong, N., Lam, K., Wong, W., Lai, K., Lam, S., & Wong, B. (2005) · World Journal of Gastroenterology · doi:10.3748/wjg.v11.i34.5362 · Cited by 47
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Role of Intestinal Transit in the Pathogenesis of Gallbladder Stones
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“We (30) also used a radio-opaque marker shape technique (39) to study whole gut and large bowel transit times (LBTTs) in the same groups of individuals, that is, control subjects, acromegalic patients untreated with OT and acromegalics on long term OT therapy.”
MethodBlatchford, P. A., Stoklosinski, H. M., Eady, S. L., Wallace, A. J., Butts, C. A., Gearry, R. B., Gibson, G. R., & Ansell, J. (2017) · Journal of Nutritional Science · doi:10.1017/jns.2017.52 · Cited by 45
“Faecal samples originate from the distal bowel, therefore distal rectosigmoid colon pH was determined by taking the last 35 · 4 % of total colonic pH measurements as calculated in a study interpreting segmental colonic transit times (27) .”
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“colon([54]) and the limited free water volume in the transverse colon,([55]) the primary region of interest in regard to drug/ dosage form performance in the lower gut is the ascending colon.”
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“in women (6), which appears to be related to delayed transit”
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“In a subgroup from each center, GI transit time was reported for total and segmental gut using SmartPill (New Zealand and Italy) (29,30), or radio-opaquemarker (Japan) (31).”
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“The reference values from the study of the Spanish Motility Group(25) were used, with an upper limit of 22 hours for the right colon, 37 hours for the left colon, 37 hours for the rectosigmoid, and 71 hours for total colonic transit.(26,27)”
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“2 times the sum of the markers on the entire or a segment of colon.(25,26) 3) Transanal ultrasound”
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“[12], in which a capsule containing 24 radio-opaque markers is given for 3 days, and the markers seen on a plain abdominal X-ray on days 4 and 7 are counted; the presence of more than 68 markers on the second radiogram is suggestive of slow transit constipation (STC).”
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“Colon transit time was measured using Konsyl Phamaceuticals’ SITZMARKS® radio-opaque markers, and the procedure by Metcalf et al.12 was used.”
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“The lower digestibility by rats may relate to the more limited time available for fermentation in the rat caecum (8-10 h for animals fed on high-NSP diets; Goodlad & Mathers, 1990; Mathers et al. 1990) than in the right and transverse colon of man (14-26 h; Metcalf et al. 1987).”
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“All patients had a normal colonoscopy and delay in gastrointestinal transit documented by radiopaque markers (5) .”
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“Normalization of straining 80 (71-87) 39 (24-55) 0.”
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Stamatopoulos, K., O’Farrell, C., Simmons, M. J. H., & Batchelor, H. K. (2021) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2021.113915 · Cited by 41
Constipation screening in people taking clozapine: A diagnostic accuracy study
Every‐Palmer, S., Inns, S. J., & Ellis, P. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.03.032 · Cited by 38
Lever, E., Scott, S. M., Louis, P., Emery, P. W., & Whelan, K. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.01.003 · Cited by 45
“Whole gut transit time Radio-opaque markers followed by abdominal fluoroscopy were used to measure whole gut transit time (WGTT), using the Metcalf method [26] at Queen Mary University of London.”
MethodInfluence of positive family history on clinical characteristics of functional constipation.
Chan, A., Lam, K., Hui, W.-M., Leung, G., Wong, N., Lam, S., & Wong, B. (2007) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2006.10.009 · Cited by 36
The Association Between Cigarette Smoking and Colorectal Polyp Recurrence (United States)
Paskett, E., Reeves, K. W., Pineau, B., Albert, P., Caan, B., Hasson, M., Iber, F., Kikendall, J., Lance, P., Shike, M., et al. (2005) · Cancer Causes and Control · doi:10.1007/s10552-005-0298-2 · Cited by 36
“The rectosigmoid area of the colon has a longer transit time than the proximal or distal colon, and the transit time in the combined distal and rectosigmoid sections is significantly longer than that of the proximal colon [67].”
BackgroundDelvaux, M. M. (2004) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2004.06.004 · Cited by 34
Horikawa, Y., Mieno, H., Inoue, M., & Kajiyama, G. (1999) · Scandinavian Journal of Gastroenterology · doi:10.1080/003655299750024698 · Cited by 36
Opioid-induced bowel dysfunction in healthy volunteers assessed with questionnaires and MRI
Nilsson, M., Poulsen, J. L., Brock, C., Sandberg, T. H., Gram, M., Frøkjær, J. B., Krogh, K., & Drewes, A. M. (2016) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000574 · Cited by 34
Assessment of colonic transit time using MRI: a feasibility study
Buhmann, S., Kirchhoff, C., Ladurner, R., Mussack, T., Reiser, M. F., & Lienemann, A. (2007) · European Radiology · doi:10.1007/s00330-006-0414-z · Cited by 31
Long-term response to subtotal colectomy in colonic inertia
Verne, G., Hocking, M., Davis, R. H., Howard, R., Sabetai, M., Mathias, J. R., Schuffler, M., & Sninsky, C. (2002) · Journal of Gastrointestinal Surgery · doi:10.1016/s1091-255x(02)00022-7 · Cited by 35
Etherson, K., Minty, I., Bain, I., Cundall, J., & Yiannakou, Y. (2017) · Gastroenterology Research and Practice · doi:10.1155/2017/3826087 · Cited by 34
“Transit time was calculated according to the day 4 time on the Metcalf protocol [15], and PACSYM mean item score as a validated outcome measure of symptom severity in CIC [14].”
MethodHow to use a plain abdominal radiograph in children with functional defecation disorders
Benninga, M. A., Tabbers, M., & van Rijn, R. (2016) · Archives of Disease in Childhood - Education and Practice · doi:10.1136/archdischild-2015-309140 · Cited by 34
Familial Aggregation in Constipated Subjects in a Tertiary Referral Center
Chan, A., Hui, W., Lam, K., Leung, G., Yuen, M.-F., Lam, S., & Wong, B. (2007) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2006.00886.x · Cited by 34
“Slow total colonic transit was defined as >67 h, the mean transit + 2 SD averaged from published studies (14, 15).”
MethodWhitehead, W. (1999) · American Journal of Medicine · doi:10.1016/s0002-9343(99)00078-9 · Cited by 34
Anorectal dysfunction and delayed colonic transit in patients with progressive systemic sclerosis
Basilisco, G., Barbera, R., Vanoli, M., & Bianchi, P. (1993) · Digestive Diseases and Sciences · doi:10.1007/bf01308615 · Cited by 34
“The median total duration of the disease in PSS patients with normal bowel habits was 16 years (2-30) and in those with constipation it was 11 years (6-33).”
BackgroundMethodResultInfluentialOral colon transit scintigraphy using indium-111 DTPA: variability in healthy subjects
Mclean, R., Smart, R., Lubowski, D., King, D., Barbagallo, S., & Talley, N. (1992) · International Journal of Colorectal Disease · doi:10.1007/bf00341215 · Cited by 34
“jects) [1-8], but tests using radionuclide techniques all report small normal populations (4-13 subjects) [9-12, 15-20].”
BackgroundMethodPartial colectomy and coloanal anastomosis for idiopathic megarectum and megacolon
Stabile, G., Kamm, M., Phillips, R., Hawley, P., & Lennard-jones, J. (1992) · Diseases of the Colon & Rectum · doi:10.1007/bf02050671 · Cited by 34
Gut Metagenome as a Potential Diagnostic and Predictive Biomarker in Slow Transit Constipation
Tian, H., Ye, C., Yang, B. K., Cui, J., Zheng, Z., Wu, C., Zhou, S., Lv, X., Qin, N., Qin, H., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2021.777961 · Cited by 35
Andromanakos, N., Pinis, S. I., & Kostakis, A. (2015) · European Journal of Gastroenterology and Hepathology · doi:10.1097/meg.0000000000000288 · Cited by 33
Fujita, T., Yokota, S., Sawada, M., Majima, M., Ohtani, Y., & Kumagai, Y. (2005) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2005.00695.x · Cited by 33
Zimmermann, T., Laufen, H., Yeates, R., Scharpf, F., Riedel, K., & Schumacher, T. (1999) · Journal of clinical pharmacology · doi:10.1177/00912709922011782 · Cited by 33
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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