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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Research works printed but not linked: 16

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“After each scan, the mini-capsules remaining in the gut were located and counted on the derived in-phase minus out-of-phase images and the WGTT calculated following the Sitzmarks ROM method (21).”
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“Among these methods, the CTT described by Metcalf [2] is considered to be the gold-standard.”
Method
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“Normal findings include 1-2 mm of mucosal intussusception as a result of rectal emptying, excess perineal descent, or an anterior rectocele [6, 7].”
Background
Differential Responsiveness to Contractile Agents of Isolated Smooth Muscle Cells from Human Colons as a Function of Age and Inflammation
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“The in¯ uence of sex on the mechanical properties of colon was studied by Metcalf et al (18) ; they showed that men had signi® cantly shorte r transit times for the whole colon than did women and the difference was appare nt to some extent in the right and left colon.”
Method
Physiology of the Gastrointestinal System
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Influential
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“In contrast, Metcalf et al.[6] documented that the colonic transit times of healthy participants are longer in women than in men, but there was no difference between age groups.”
Background
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“Some patients underwent a CTT test based on the Metcalf protocol [11], and based on the results obtained, they were divided into two groups; normal transit type if the total number of remaining markers was not more than 35 (42 hours as a CTT), and an abnormal transit type if the remaining markers were ≥36 (43 hours) […”
Method
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“The interval time from food entering and leaving the stomach is estimated as approximately 90 minutes, and efficient probiotic bacteria are those able to actively survive in the digestive tract for at least a few hours (17).”
Background
Clinical Characteristics of Constipation with Hypothyroidism
Kim, J.-I., Myung, S., Yang, D.-H., Yoon, I., Seo, S., Ku, H. S., Yoon, S., Kim, K.-J., Ye, B., Byeon, J., et al. (2010) · Intestinal Research · doi:10.5217/ir.2010.8.1.48 · Cited by 6
Dysmotility of the Small Intestine and Colon
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Comparison of fluoroscopy and radiography in the assessment of colonic transit time using radio-opaque markers.
Pomerri, F., Zandonà, M., Barusco, A., Razzoli, M., & Muzzio, P. (2008) · Clinical Radiology · doi:10.1016/j.crad.2008.05.002 · Cited by 6
Preclinical assessment of the feasibility of applying controlled release oral drug delivery to a lead series of atypical antipsychotics.
Eichenbaum, G. E., Pollock-Dove, C., Nguyen, J., Li, S.-L., Evans, J., Borghys, H., Kennis, L., Dong, L.-C., van Osdol, W., Dai, W.-G., et al. (2006) · Journal of Pharmacy and Science · doi:10.1002/jps.20550 · Cited by 6
Evaluation of colonic transit time with radiopaque markers: a study in asymptomatic volunteers
Sobrado, C., Pires, C., Habr-Gama, A., & Kiss, D. (2005) · doi:10.1590/s0100-69912005000300002 · Cited by 6
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“Idiopathic constipation is proposed to comprise patients with colonic inertia, either total or rectal, as evident from intestinal transit studies [3-9].”
Background
A simplified way to assess colorectal transit time
Devroede, G. J., Bouchoucha, M., & Steiber, W. (1999) · Techniques in Coloproctology · doi:10.1007/s101510050018 · Cited by 6
“Thus, the number of days of ingestion have been arbitrarily restricted to as few as 3 [4] or 6 [7] days.”
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Physiologic evaluation of the pelvic floor.
Coates, K. W. (1998) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/s0889-8545(05)70044-9 · Cited by 6
Bowel motility after enterocystoplasty.
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Effect of menstrual cycle on esophageal emptying of liquid and solid boluses.
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Total and Segmental Colonic Transit Times in Patients After Anterior Resection of Sigmoid Colon and Rectal Cancer
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Transit Time Measurement
Kuijpers, J. (1993) · doi:10.1007/978-3-642-77402-7_13 · Cited by 6
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“With intake of ROM on several days (3 or 6) [34,35], regional colonic transit can be defined.”
Testing in functional constipation—What's new and what works
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Vorländer, D., Schultz, G., Hoffmann, K., Rasch, D., & Dohnt, K. (2023) · Biotechnology and Bioengineering · doi:10.1002/bit.28636 · Cited by 5
“The (1) is close to typical colonic transit times, which are reported to be, for example, 35 ± 2.1 h (Metcalf et al., 1987) or 35.74 h (Southwell et al., 2009).”
BackgroundInfluential
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Yoon, J., Jung, K. W., Ham, N. S., Kim, J., Do, Y. S., Kim, S., Choi, S. H., Kim, D. W., Hwang, S. W., Park, S. H., et al. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14630 · Cited by 4
Botulinum toxin type-A infiltration of the external anal sphincter to treat outlet constipation in motor incomplete spinal cord injury: pilot cohort study
Vallès, M., Albu, S., Kumru, H., & Mearin, F. (2021) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2021.1921255 · Cited by 5
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Subtype classification of functional constipation in children: polyethylene glycol versus lactulose
Bae, S., & Kim, M. (2020) · Pediatrics International · doi:10.1111/ped.14235 · Cited by 5
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Gupta, D., Gupta, S. V., & Yang, N. (2018) · Handbook of Space Pharmaceuticals · doi:10.1007/978-3-319-50909-9_12-1 · Cited by 5
Value of 24-hour Delayed Film of Barium Enema for Evaluation of Colon Transit Function in Young Children with Constipation
Yoo, H., Son, J., Park, H., Kwak, B., Kim, H. S., & Bae, S. (2016) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm15128 · Cited by 5
“Total CTT was performed according to a method by Metcalf et al.12 A Kolomark (MI Tech, Seoul, Korea) capsule, containing 20 radio-opaque markers per capsule, was taken at the same time each day for 3 consecutive days.”
MethodInfluential
Methanogenic Flora and Constipation: Many Doubts for a Pathogenetic Link
Stefano, M. D., & Corazza, G. (2010) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.282 · Cited by 5
Measurement of colonic transit using a delayed-release capsule containing radio-opaque markers
Park, J. M., Choi, M.-G., Choi, H., Cho, Y. K., Oh, J. H., Lee, I. S., Kim, S. W., Choi, K. Y., & Chung, I. (2008) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520701850204 · Cited by 5
“Several ROM methods have been established and are well defined [4,5].”
Method
Gut transit time after ileal pouch-anal anastomosis using a radiopaque marker
Takesue, Y., Sakashita, Y., Akagi, S., Murakami, Y., Ohge, H., Imamura, Y., Horikawa, Y., & Yokoyama, T. (2001) · Diseases of the Colon & Rectum · doi:10.1007/bf02234459 · Cited by 5
“Number 11 21 Gender Male 4 11 Female 7 10 Median age (range), years 33 (17-59) 37 (21-63) Median follow-up (range), 49 (6-129) 41 (6-123) months GM = 1/20 × (Ni x Vi)”
Olestra, a nondigestible, nonabsorbable fat
Aggarwal, A., Camilleri, M., Phillips, S., Schlagheck, T., Brown, M. L., & Thomfode, G. M. (1993) · Digestive Diseases and Sciences · doi:10.1007/bf01295714 · Cited by 5
“The number of radiopaque markers in the colon on the day 4 radiograph was used to calculate the mean colonic transit time in the five groups (17).”
MethodSelf-citation
Simultaneous noninvasive evaluation of gastric emptying and orocaecal transit times
Bergmann, J., Chassany, O., Guillausseau, P., Bayle, M., Chagnon, S., Caulin, C., & Sallenave, J. (1992) · European Journal of Clinical Pharmacology · doi:10.1007/bf01740656 · Cited by 5
The surgical treatment of severe idiopathic constipation
Kamm, M. (1987) · International Journal of Colorectal Disease · doi:10.1007/bf01649511 · Cited by 5
Initial Evaluation of Constipation
Jorge, J. (2006) · Springer eBooks · doi:10.1007/978-1-84628-275-1_5 · Cited by 5
Idiopathic constipation: any movement?
Kamm, M. (1992) · Scandinavian Journal of Gastroenterology, Supplement · doi:10.3109/00365529209095989 · Cited by 5
[The effect of cisapride on intestinal transit].
Satake, K., Hongo, M., Ujiie, H., Okuno, Y., & Gotō, Y. (1988) · Nihon Heikatsukin Gakkai zasshi · doi:10.1540/jsmr1965.24.55 · Cited by 5
Assessment of Small Bowel Motility Using Cine-magnetic Resonance Imaging in Patients Suspected With Chronic Intestinal Pseudo-obstruction
Bae, J. H., Jung, K., Park, J.-B., Kim, K., Hong, S. W., Hwang, S., Park, S. H., Yang, D.-H., Ye, B., Byeon, J., et al. (2025) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm24130 · Cited by 4
“18,19”
The Functional Implications of Transanal Irrigation: Insights from Pathophysiology and Clinical Studies of Neurogenic Bowel Dysfunction
Rodriguez, G. M., Kirshblum, S., Thao, M., Mcarthur, M., & Camilleri, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13061527 · Cited by 4
Gut environmental factors explain variations in the gut microbiome composition and metabolism within and between healthy adultsPreprint
Procházková, N., Laursen, M. F., Barbera, G. L., Tsekitsidi, E., Jørgensen, M. S., Rasmussen, M. A., Raes, J., Licht, T. R., Dragsted, L. O., & Roager, H. M. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.01.23.574598 · Cited by 5
Predictors of abdominal pain severity in patients with constipation-prevalent irritable bowel syndrome
Rurgo, S., Vaino, V., Andreozzi, M., Pagliaro, M., Senneca, P., Giorgio, G. D., Efficie, E., Sarnelli, G., & Pesce, M. (2022) · Journal of Basic and Clinical Physiology and Pharmacology · doi:10.1515/jbcpp-2022-0081 · Cited by 4
Assessment of the Potential for Veverimer Drug-Drug Interactions
Parsell, D., Shao, J., Guttendorf, R., Mathur, V., Li, E., Wu, Y. S., Tsao, L., Tabakman, S., Stasiv, Y., Lee, A., et al. (2021) · Drug Metabolism And Disposition · doi:10.1124/dmd.121.000366 · Cited by 4
“A volume of 1 liter was used for dispersion of an orally administered drug in the upper GI tract (Read et al., 1980; Metcalf et al., 1987; Thelen et al., 2011).”
Method
Correlation between Colon Transit Time Test Value and Initial Maintenance Dose of Laxative in Children with Chronic Functional Constipation
Kim, M. R., Park, H., Son, J., Lee, R., & Bae, S. (2016) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2016.19.3.186 · Cited by 4
“CTT test was performed according to a method by Metcalf et al. [19].”
Diagnosis and Treatment of Constipation
Jeon, H. H., & Park, H. (2012) · Korean Journal of Medicine · doi:10.3904/kjm.2012.83.5.568 · Cited by 4
“표지자의 수를 세어서 전체 대장통과시간 및 구획별 통과 시간을 측정하는 방법이다[19].”
Recovery of upper gastrointestinal bowel movement after rectosigmoid cancer surgery: a pilot transit analysis.
Matsuoka, H., Maeda, K., Katsuno, H., Tsunoda, A., Koda, K., Ohge, H., Oya, M., Yoshioka, K., Imazu, Y., & Masaki, T. (2011) · International surgery · doi:10.9738/cc51.1 · Cited by 4
Colonic total and segmental transit times in healthy Italian adults
Pomerri, F., Dodi, G., Nardin, M., & Muzzio, P. (2009) · La radiologia medica · doi:10.1007/s11547-009-0409-3 · Cited by 4
“Metcalf AM, Phillips SF, Zinsmeister AR et al (1987) Simplified assessment of segmental colonic transit.”
MethodResultInfluential
[Surgical treatment of severe constipation].
Christiansen, J. R. (1989) · Ugeskrift for læger · doi:10.3109/00365529109025035 · Cited by 4
Assessment and Investigation of Fecal Incontinence and Constipation
Mitchell, P., & Kiff, E. (2012) · doi:10.1007/978-0-85729-889-8_25 · Cited by 4
Crohn's Disease Involving the Gallbladder: Case Report and Review of the Literature
Rettally, C. A., Trevino, H., Molina, K., & Kane, S. (2003) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2003.07250.x · Cited by 4
Investigation of Anorectal Functional Disorders
Buchmann, P., & Brühlmann, W. (1993) · Springer Berlin Heidelberg · doi:10.1007/978-3-642-77402-7 · Cited by 4
“[6], 8% of the healthy subjects (without complaints of faecal incontinence) had either an op~n or a partly open anal canal at rest.”
BackgroundInfluential
Association between Disturbances in Gastrointestinal Transit and Functional Bowel Disease
Lind, C. D., & McCallum, R. W. (1989) · Springer eBooks · doi:10.1007/978-1-4684-5694-3_12 · Cited by 6
The Emerging Short Chain Fatty Acid Enriched Metabotype in Irritable Bowel Syndrome and Its Potential Clinical Relevance
Conley, T., Duncan, A., Modasia, A., Ford, A., Pritchard, D. M., Hildebrand, F., Warren, F. J., Spiller, R., & Probert, C. (2026) · Alimentary Pharmacology and Therapeutics · doi:10.1111/apt.70677 · Cited by 3
“The mechanistic metric, WGTT, was measured using radio-opaque markers, modified from Metcalf et al. [32] as previously described [31].”
Design, Construction and Solid-Liquid Separation Performance of a Human Colon Inspired Soft-Elastic Reactor (CSER): breakage, emptying, and solid-liquid separation of the agar gel particles
Cui, X., Huang, Y.-Q., Hu, Z., Wu, P., & Chen, X.-D. (2024) · Chemical Engineering and Processing · doi:10.1016/j.cep.2024.109763 · Cited by 3
Constipation in Children: A guide to Prompt Diagnosis and Effective Treatment
Yacob, D., & Lorenzo, C. D. (2020) · Current Treatment Options in Pediatrics · doi:10.1007/s40746-020-00193-5 · Cited by 3
New large bowel segmentation on plain abdominal radiography in comparison with the conventional method.
Sawa, K., Mizushima, T., Matsushita, K., Shirahige, A., Ochi, K., & Koide, N. (2012) · Acta Medica Okayama · doi:10.18926/amo/48563 · Cited by 3
“Their method is widely used for diagnosing the causes of constipation and irritable bowel syndrome [1-3].”
Method
Motility disorders of the colon and rectum
Wald, A. (2012) · Current Opinion in Gastroenterology · doi:10.1097/mog.0b013e32834d4f61 · Cited by 3
“The traditional approach is to follow the progression of ingested radiopaque markers by obtaining abdominal films at specified times [1].”
Background
CLASSIFICATION OF LEFT COLONIC TRANSIT PATTERNS AFTER LOW ANTERIOR RESECTION AND IT'S RELATION TO DEFECATORY SYMPTOMS
Yagyu, T., Yamamoto, T., Ishikawa, K., Obuchi, Y., Ueno, H., Ozawa, K., Hashiguchi, Y., & Mochizuki, H. (2001) · doi:10.3919/jjsa.62.1824 · Cited by 3
New Experimental Coating Material for Colon-Specific Drug Delivery
Bauer, K. (2001) · doi:10.1201/9780203908563.ch2 · Cited by 3
5 Current applicability of scintigraphic methods in gastroenterology
Maurer, A., & Fisher, R. (1995) · Baillière s Clinical Gastroenterology · doi:10.1016/0950-3528(95)90071-3 · Cited by 3
Klinische und funktionelle Ergebnisse der abdominalen Rektopexie unter Verwendung verschiedener Fixierungsgrundlagen
Winde, G., Reers, B., Holzgreve, A., Fischer, R., Bohlmann, A., & Bünte, H. (1993) · Archiv fuer Klinische Chirurgie · doi:10.1007/bf00202115 · Cited by 3
Intestinal Microbiome in Health and Disease: Introduction
Haller, D. (2018) · Springer eBooks · doi:10.1007/978-3-319-90545-7_1 · Cited by 6
Objective Measurement and Monitoring of Nonmotor Symptoms in Parkinson's Disease
Klingelhoefer, L., Jitkritsadakul, O., & Bhidayasiri, R. (2017) · International review of neurobiology · doi:10.1016/bs.irn.2017.04.004 · Cited by 7
Constipation and Functional Bowel Disorders
Varma, M., & Gurland, B. (2011) · Springer eBooks · doi:10.1007/978-1-4419-1584-9_32 · Cited by 3
Measurement of Colonic Transit Time Using Radiopaque Markers for a Qualitative Diagnosis of Constipation
Okazaki, K. (2010) · doi:10.3862/jcoloproctology.63.339 · Cited by 3
Measurement of Colonic Transit Time Using a Triple Ingestion of Radiopaque Markers in Patients with Chronic Constipation
Oya, M., Ishikawa, H., Kawano, N., Sawada, T., & Muto, T. (1994) · doi:10.3862/jcoloproctology.47.393 · Cited by 3
Measurement of Colonic Motor Function
Steadman, C. J., & Phillips, S. F. (1991) · Springer eBooks · doi:10.1007/978-1-4471-1822-0_2 · Cited by 3
Self-citation

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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