Cited by 928Gastrointestinal motility and disordersPelvic floor disorders treatmentsIntestinal Malrotation and Obstruction Disorders

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Simplified assessment of segmental colonic transit

Metcalf, Amanda M., Phillips, Sidney F., Zinsmeister, Alan R., MacCarty, Robert L., Beart, Robert W., Wolff, Bruce G.·1987·Gastroenterology

DOI 10.1016/0016-5085(87)90837-7

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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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Method
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Background
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Method
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Total and segmental colonic transit time in constipated patients with Chagas' disease without megaesophagus or megacolon.
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Method
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Effect of Yogurt Enriched Water-soluble Fiber on Functional Constipation
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Biofeedback therapy in constipated, female patients and caused by radical hysterectomy or vaginal delivery
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Physiology of the Colon and Its Measurement
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Composition and Function of the Gut Microbiome
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Anorectal Disorders
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Colonic Physiology
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“ingest single capsules on three successive days, with only one abdominal radiograph done on day 4 of the study so as to minimize radiation exposure.(57) The number of markers present equals the colonic transit time in hours.”
Abdominal radiograph in the assessment of fecal impaction in children with functional constipation: comparing three scoring systems.
da Cunha, T. B., Tahan, S., Soares, M. F. D. F., Lederman, H., & de Morais, M. D. (2012) · Jornal de Pediatria · doi:10.2223/jped.2199 · Cited by 13
Study on the characteristics of intestinal motility of constipation in patients with Parkinson's disease
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Number of retained radiopaque markers on a colonic transit study does not correlate with symptom severity or quality of life in chronic constipation
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Recent advances in the diagnosis of irritable bowel syndrome
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“Large intestinal transit with radioistotopically marked standard meal showed a substantial interindividual variation of colonic transit time in healthy subjects (6–64 hours) with COV of 46% [228].”
Background
Measurement of oro-caecal transit time by magnetic resonance imaging
Savarino, E., Savarino, V., Fox, M., Leo, G. D., Furnari, M., Marabotto, E., Gemignani, L., Bruzzone, L., Moscatelli, A., de Cassan, C., et al. (2015) · European Radiology · doi:10.1007/s00330-014-3575-1 · Cited by 13
“evaluation of OCTT is controversial due to important problems of the available techniques, such as lactulose hydrogen breath testing (LHBT), sequential scintigraphy with isotope-marked meals, or by magnetic resonance imaging (MRI) (9-17).”
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Advances in motility testing—current and novel approaches
Bredenoord, A., & Smout, A. (2013) · Nature Reviews Gastroenterology &Hepatology · doi:10.1038/nrgastro.2013.80 · Cited by 13
Profiles of faecal output of rare earth elements and stable isotopic tracers of iron and zinc after oral administration
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“The kinetics of digesta can be estimated from retention patterns and mean transit time of nutritional markers as described by Kotb & Luckey (1972), Luckey (1979) and Metcalf et al. (1987).”
Method
Intestinal Transit Time in Children with Intestinal Neuronal Malformations Mimicking Hirschsprung's Disease
Ure, B., Holschneider, A., Schulten, D., & Meier-Ruge, W. (1999) · European journal of pediatric surgery · doi:10.1055/s-2008-1072219 · Cited by 13
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Magnetic tracking of gastrointestinal motility
Brinck, C. E., Mark, E. B., Klinge, M. W., Ejerskov, C., Sutter, N., Schlageter, V., Scott, S. M., Drewes, A. M., & Krogh, K. (2020) · Physiological Measurement · doi:10.1088/1361-6579/abcd1e · Cited by 16
What’s in the pipeline for lower functional gastrointestinal disorders in the next 5 years?
Camilleri, M. (2019) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00205.2019 · Cited by 12
Does caffeine reduce postoperative bowel paralysis after elective laparoscopic colectomy? (CaCo trial): study protocol for a randomized controlled trial
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“4 [11].”
Relevance of Colonic Gas Analysis and Transit Study in Patients With Chronic Constipation
Park, S., Park, H.-B., Lee, J.-M., Lee, H., Park, C., Kim, H., Choi, S.-K., & Rew, J. (2015) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm14109 · Cited by 15
“the mean CTT was 30-40 hours with upper normal limit of 70 hours.(4,11,21) In studies from Asia, the mean CTT was 20-30 hours in normal subjects.”
Background
Gastrointestinal Issues in the Older Female Patient
Zuchelli, T. E., & Myers, S. E. (2011) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2011.03.007 · Cited by 13
Long‐term results of subtotal colectomy for severe slow‐transit constipation in patients with normal rectal function
Aldulaymi, B. H., Rasmussen, O., & Christiansen, J. (2001) · Colorectal Disease · doi:10.1046/j.1463-1318.2001.00283.x · Cited by 12
Constipation: a physiological approach.
Thompson, W. (2000) · Canadian journal of gastroenterology = Journal canadien de gastroenterologie · doi:10.1155/2000/391807 · Cited by 12
Colonic Motor and Sensory Function and Dysfunction
Cook, I. J., Brookes, S. J., & Dinning, P. G. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6189-2.00098-6 · Cited by 10
Colorectal motility patterns and psychiatric traits in functional constipation and constipation-predominant irritable bowel syndrome: A study from China
Lv, C., Song, G., Liu, J., Wang, W., Huang, Y., Wang, B., Tian, J.-S., Yin, M.-Q., & Yu, Y. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i41.5657 · Cited by 12
“The X-ray analysis determined the number and distribution of the markers as per the protocol described by Metcalf et al [14].”
Clinical Features of Severely Constipated Children: Comparison of Infrequent Bowel Movement and Fecal Soiling Groups
Lee, G., Son, J., & Bae, S. (2020) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2020.23.1.26 · Cited by 11
“The CTT test was performed according to the Metcalf protocol [8], with caution for food, medicine, and acute illness.”
Method
Value of Fluoroscopic Defecography in Constipated Children With Abnormal Colon Transit Time Test Results
Kim, K., Jeon, H., & Bae, S. (2019) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm18201 · Cited by 11
Gut microbial transformation of the dietary mutagen MeIQx may reduce exposure levels without altering intestinal transport.
Zhang, J., Empl, M. T., Schneider, M., Schröder, B., Stadnicka-Michalak, J., Breves, G., Steinberg, P., & Sturla, S. (2019) · Toxicology in Vitro · doi:10.1016/j.tiv.2019.04.004 · Cited by 11
Normal colonic transit time predicts the outcome of colonic manometry in patients with chronic constipation—an exploratory study
Vork, L., van Avesaat, M., van Hoboken, E. A., Kruimel, J., Conchillo, J., Keszthelyi, D., & Masclee, A. (2019) · International Journal of Colorectal Disease · doi:10.1007/s00384-019-03376-1 · Cited by 11
Combined exercise improves gastrointestinal motility in psychiatric in patients
Song, B., Kim, Y., Kim, H. S., Oh, J.-W., Lee, O., & Kim, J.-S. (2018) · World Journal of Clinical Cases · doi:10.12998/wjcc.v6.i8.207 · Cited by 11
DA‐9701 improves colonic transit time and symptoms in patients with functional constipation: A prospective study
Kim, S. Y., Woo, H. S., Kim, K. O., Choi, S. H., Kwon, K. A., Chung, J., Kim, Y. J., Kim, J. H., Kim, S. J., & Park, D. K. (2017) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.13807 · Cited by 11
Colon Transit Time Test in Korean Children with Chronic Functional Constipation
Yoo, H., Kim, M. R., Park, H., Son, J., & Bae, S. (2016) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2016.19.1.38 · Cited by 11
“After about 1 month of maintenance medication with Forlax or lactulose syrup, CTT test was performed with capsules which contain 20 radio-opaque markers per capsule according to Metcalf protocol [14].”
Method
Colorectal sensation and motility
Gudsoorkar, V. S., & Quigley, E. M. M. (2013) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000028 · Cited by 14
“Table 1 summarizes two of the more commonly used marker transit protocols [6,7].”
BackgroundMethod
Short-term, daily intake of yogurt containing Bifidobacterium animalis ssp. lactis Bf-6 (LMG 24384) does not affect colonic transit time in women
Merenstein, D. J., D'Amico, F. J., Palese, C., Hahn, A., Sparenborg, J., Tan, T., Scott, H., Polzin, K. M., Kolberg, L. W., & Roberts, R. (2013) · British Journal Of Nutrition · doi:10.1017/s0007114513002237 · Cited by 12
“placebo on regulating CTT by a simplified segmental colonic transit technique((20)).”
Method
The Pathophysiology of Constipation
Milla, P. (2007) · Annales Nestlé (English ed ) · doi:10.1159/000101714 · Cited by 11
The difficult patient with constipation.
Müller-Lissner, S. (2007) · Best practice & research. Clinical gastroenterology · doi:10.1016/j.bpg.2007.01.008 · Cited by 11
Treatment of megacolon and megarectum
Szarka, L. A., & Pembérton, J. H. (2006) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-006-0016-5 · Cited by 10
Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation
El-Tawil, A. (2004) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2003.03309.x · Cited by 11
Slow-transit constipation
Bharucha, A. E., & Philips, S. F. (2001) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-001-0056-9 · Cited by 23
Chronic constipation in adults. How far should evaluation and treatment go?
Marshall, J. B. (1990) · Postgraduate medicine · doi:10.1080/00325481.1990.11704724 · Cited by 11
Reversibility of exocrine pancreatic function.
Devière, J., Urbain, P., & Cremer, M. (1987) · Gastroenterology · doi:10.1016/0016-5085(87)90670-6 · Cited by 11
Investigations of Anorectal Function
Scott, S., & Lunniss, P. (2009) · doi:10.1007/978-1-84628-503-5_9 · Cited by 11
Constipation: an approach to diagnosis, treatment, referral.
Soffer, E. E. (1999) · Cleveland Clinic journal of medicine · doi:10.3949/ccjm.66.1.41 · Cited by 11
“In the other method, markers are ingested on 3 consecutive days and radiographs are obtained on days 4 and 7.(8) This allows both total and segmental colonic transit time to be quantified.”
Method
TBG-136, a Schizophyllum commune-derived β-glucan benefits gut microbiota and intestinal health: A randomized, double-blind, and placebo-controlled clinical trial
Jang, H.-Y., Jung, S., Park, E.-O., Kim, S.-D., Kim, J.-K., Chae, S., Cha, Y., & Lee, S. (2023) · Journal of Functional Foods · doi:10.1016/j.jff.2023.105668 · Cited by 11
Caffeine for intestinal transit after laparoscopic colectomy: randomized clinical trial (CaCo trial)
Abbassi, F., Müller, S., Steffen, T., Schmied, B. M., Warschkow, R., Beutner, U., & Tarantino, I. (2022) · British journal of surgery · doi:10.1093/bjs/znac265 · Cited by 10
Rectosigmoid Localization of Radiopaque Markers for Identifying Defecation Disorders in Patients With Chronic Constipation: A Retrospective Cohort Study
Abe, T., Kunimoto, M., Hachiro, Y., Ohara, K., Inagaki, M., & Murakami, M. (2021) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm20204 · Cited by 10
“The most commonly used techniques include a single ingestion of markers with an abdominal X-ray after 3 days(11-13) or a serial ingestion of markers over 3 days with an X-ray on the fourth day.(14,15) Because a CTS is simple, safe, and inexpensive, clinicians frequently use rectosigmoid (RS) localization of markers or…”
Method
Solid lipid nanoparticles self-assembled from spray dried microparticles
Sanchez-Vazquez, B., Lee, J. B., Štrimaite, M., Buanz, A. B. M., Bailey, R. J., Gershkovich, P., Pasparakis, G., & Williams, G. R. (2019) · International Journal of Pharmaceutics · doi:10.1016/j.ijpharm.2019.118784 · Cited by 14
Can balneotherapy improve the bowel motility in chronically constipated middle-aged and elderly patients?
Dandinoğlu, T., Dandin, O., Ergin, T., Tihan, D., Akpak, Y. K., Aydın, O., & Teomete, U. (2017) · International journal of biometeorology · doi:10.1007/s00484-016-1295-8 · Cited by 10
“It is simple to measure the colonic transit time (CTT) with these markers which are widely available (Chaussade et al. 1986; Metcalf et al. 1987).”
Background
In Vitro and In Vivo Evaluation of Combined Time and pH- Dependent Oral Colonic Targeted Prednisolone Microspheres.
Hashem, F. (2013) · Journal of Pharmaceutical Research International · doi:10.9734/bjpr/2013/3195 · Cited by 10
“The slower and delayed absorption of PR from F1 also indicated that the selected system released a significant amount of the drug at the colon; since colonic transit time was reported to be around 10 hr [31].”
Background
Gender- and Age-Related Differences in Muscular and Nerve-Mediated Responses in Human Colon
Maselli, M. A., Trisolini, P., Demma, I., Pezzolla, F., & Ponti, F. D. (2010) · Digestive Diseases and Sciences · doi:10.1007/s10620-010-1324-0 · Cited by 9
Ingestão de fibra alimentar e tempo de trânsito colônico em pacientes com constipação funcional
Lopes, A. C., & Victória, C. (2008) · Arquivos de Gastroenterologia · doi:10.1590/s0004-28032008000100011 · Cited by 10
“al.((26)) o qual prevê a ingestão de 20 marcadores diários, durante 3 dias consecutivos sempre no mesmo horário, com realização de Rx abdominal simples no 4o dia.”
Background
Pathophysiology of colonic motility disorders.
Mcintyre, P., & Pemberton, J. H. (1993) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)46189-x · Cited by 10
The application of radio-opaque markers prior to ileostomy in an infant with chronic intestinal pseudo-obstruction: Report of a case
Hase, T., Kodama, M., Kishida, A., Naka, N., Shimadera, S., Egawa, T., Ohno, M., & Shimada, M. (2006) · Surgery today (Print) · doi:10.1007/bf02483614 · Cited by 10
Magnetic stimulation: A novel method for the treatment of chronic constipation
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Outcomes of Colonic Resection for Chronic Idiopathic Constipation in Childhood.
Tamura, R., & Jaffray, B. (2019) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2019.10.047 · Cited by 9
Influence of assay conditions on the in vitro hindgut digestibility of dry matter
Coles, L., Moughan, P., Awati, A., & Darragh, A. (2011) · doi:10.1016/j.foodchem.2010.10.004 · Cited by 9
Non‐compliance does not impair qualitative evaluation of colonic transit time
Bouchoucha, M., Prado, J., Chtourou, L., Devroede, G. J., Atanassiu, C., & Benamouzig, R. (2011) · Neurogastroenterology and Motility · doi:10.1111/j.1365-2982.2010.01601.x · Cited by 9
Effects of conventional treatment of chronic functional constipation on total and segmental colonic and orocecal transit times.
Soares, A. C. F., Tahan, S., & de Morais, M. D. (2009) · Jornal de Pediatria · doi:10.2223/jped.1912 · Cited by 9

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)
DOI: 10.1016/0016-5085(87)90837-7
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Simplified assessment of segmental colonic transit

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