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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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Regulation of Gastrointestinal and Colonic Transit by CCK Antagonists
Meyer-Wyss, B., Werth, B., & Beglinger, C. (1991) · doi:10.1007/978-3-642-76362-5_19 · Cited by 3
Radiologische Methoden (Defäkographie, Transitmessung)
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Fermentation-driven interactions of gut microbes with their environment
Berretta, A., & Schwab, C. (2025) · Essays in Biochemistry · doi:10.1042/ebc20253057 · Cited by 2
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“The colonic transit time analysis and a colon enema were added if patients complained about constipation 20,21 .”
Knoph, C. S., Hesthaven, A. S., Cook, M., Novovic, S., Hansen, M., Mortensen, M. B., Nielsen, L. B., Høgsberg, I. M., Salomon, C., Thorlacius-Ussing, O., et al. (2025) · Neurogastroenterology and Motility · doi:10.1111/nmo.70027 · Cited by 2
“Transit times were subsequently calculated on the basis of the following equation, adapted from Metcalf et al. [24], considering the number of radiopaque markers ingested on Day 3 ( N ), the number of remaining markers identified on the CT scan ( n ), and the time from ingestion of the marker…”
Overall and Regional Colonic Transit Abnormalities in Elderly Patients with Constipation
Yang, D. Y., Lupianez‐Merly, C., Jencks, K. J., Burton, D. D., Ryks, M. D., & Camilleri, M. (2025) · Digestive Diseases and Sciences · doi:10.1007/s10620-024-08833-8 · Cited by 2
Abdelnaem, N., Camilleri, M., & Bartlett, D. J. (2024) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2024.2434592 · Cited by 2
“This method introduced the ability to evaluate full GI and colonic transit in combination with the 99m Tc sulfur colloid egg gastric emptying test over 48 hours in contrast to the more widely used radiopaque marker method performed with a single radiograph taken on the 4th day [26].”
Rajindrajith, S., Hathagoda, W., Ganewatte, E., Devanarayana, N., Thapar, N., & Benninga, M. (2023) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2023.2288164 · Cited by 2
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Dyssynergic Defecation in Chronically Constipated Children in Korea
Bae, S. (2023) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2023.26.2.127 · Cited by 2
“The CTT test was performed according to the Metcalf protocol [9] with 20 radio-opaque markers per capsule, and FDG was performed as described in a previous study [7].”
Obstruktives Defäkationssyndrom
Dawoud, C., Argeny, S., Harpain, F., & Riss, S. (2022) · Coloproctology · doi:10.1007/s00053-022-00630-z · Cited by 2
Tsai, A. (2022) · Pediatric Radiology · doi:10.1007/s00247-022-05371-1 · Cited by 2
“radiograph taken on the 4th day (and the 7th day if a large number of radiopaque markers remain) [19].”
BackgroundTransanal irrigation bowel routine for people with Cauda Equina Syndrome
Ethans, K., Smith, K., Khandelwal, A., Nankar, M., Shea, J., & Casey, A. R. (2022) · Journal of Spinal Cord Medicine (JSCM) · doi:10.1080/10790268.2021.2022371 · Cited by 2
“Other secondary outcome measures compared at week 10 to baseline included: (1) Cleveland Constipation Score 26 (range, 0 – 30, with 30 representing severe symptoms; a score of 15 or greater indicates significant constipation) for those with constipation, (2) St. Mark ’ s Incontinence Questionnaire 27,28 (range, 0 – 24…”
MethodFernandez, J., Patel, S. J., Hopson, P., & Safder, S. (2022) · Journal of Pediatric Gastroenterology and Nutrition - JPGN · doi:10.1097/mpg.0000000000003383 · Cited by 2
“TAI was shown to have a favorable impact on gut microbiota in pediatric patients with spina bifida (41), and colonic transit time via stimulating colonic peristalsis (29,30,35,42).”
BackgroundJiang, Y., Kong, H., Chang, T.-M., Bai, T., Xiang, X.-L., Zhang, X., Xie, X.-P., Zhang, L., Zhang, C.-X., Hou, X., et al. (2020) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.15209 · Cited by 2
Delayed or not delayed? That is the question in Indian children with constipation
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“Foram contadas as partículas, de acordo com a sua localização, com base na divisão do cólon, proposta por Metcalf et al. (1987)23, no cólon direito (CD), cólon esquerdo (CE) e cólon sigmoide e reto (SR), e o total das partículas no cólon (CT).”
BackgroundEmpty colon: a pitfall in the assessment of colonic transit time
de Meij, T. D., & Kneepkens, C. F. F. (2011) · European Journal of Pediatrics · doi:10.1007/s00431-011-1593-4 · Cited by 2
“Several methods have been published, differing in the number of markers ingested, in the number of days markers are ingested and in the number and intervals of abdominal X-rays [4, 7].”
Physiopathologie de la constipation
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Relevance of Abdominal Gas Analysis and Transit Study after Colorectal Cancer Surgery
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Measurement of whole-gut transit: a new test comes of age?
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Nuclear Medicine in Pediatric Gastrointestinal Diseases
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Idiopathic Constipation and Other Motility Disorders
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Electrogastrography, Breath Tests, Ultrasonography, Transit Tests, and SmartPill
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Imaging Techniques (Technique and Normal Parameters)
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Age-Related Physiologic Changes in the Gastrointestinal Tract
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Mechanisms and Management of Chronic Constipation
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Signed, sealed, delivered: a generalizable model for living biotherapeutic dosing and metabolism
DeVito, V. L., & Karamched, B. R. (2026) · npj Systems Biology and Applications · doi:10.1038/s41540-026-00685-4 · Cited by 1
Okawa, Y. (2025) · Gastrointestinal Disorders · doi:10.3390/gidisord7010012 · Cited by 1
Lupianez‐Merly, C., Dilmaghani, S., Jencks, K. J., Eckert, D. J., Ryks, M. D., Burton, D. B., & Camilleri, M. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14917 · Cited by 1
Ammann, Y., Warschkow, R., Bischofberger, S., Ukegjini, K., Tarantino, I., & Steffen, T. (2023) · BJS Open · doi:10.1093/bjsopen/zrad111 · Cited by 1
“11 .”
MethodInfluentialCommon Tests for the Pelvic Floor
Sands, D., & Thorsen, A. J. (2021) · The ASCRS Textbook of Colon and Rectal Surgery · doi:10.1007/978-3-319-25970-3_57 · Cited by 1
Trastornos funcionales de la evacuación. Una revisión
Solé, L. (2020) · NeuroGastroLATAM Reviews · doi:10.24875/ngl.m18000006 · Cited by 1
“El criterio manométrico más relevante para el diagnóstico de intususcepción rectoanal fue la asociación de un área de alta presión adicional anterior y un descenso perineal excesivo; encontrándose un valor predictivo positivo del 100% (81,5-100), un valor predictivo negativo del 61,9% (38.”
BackgroundIntractable Constipation in the Elderly
Baffy, N. J., Foxx–Orenstein, A. E., Harris, L. A., & Sterler, S. M. (2017) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-017-0142-2 · Cited by 25
Infante, J., Rayo, J., Serrano, J., García, L., Moreno, M., Martínez, A., & Huertas, J. (2017) · doi:10.1016/j.remnie.2017.02.010 · Cited by 1
Surgical management of severe constipation due to slow transit and obstructed defecation syndrome
Giannakaki, V., & Bordeianou, L. (2016) · doi:10.1053/j.scrs.2015.12.002 · Cited by 1
Ultrasonic measurement of rectal diameter and area in neurogenic bowel with spinal cord injury
Kim, G.-W., Won, Y., Ko, M.-H., Park, S.-H., & Seo, J.-H. (2016) · Journal of Spinal Cord Medicine (JSCM) · doi:10.1179/2045772314y.0000000282 · Cited by 1
Comparison of Segmental Colon Transit Time With Total Energy Expenditure in Psychiatry Unit Patients
Kim, Y., Song, B., Lee, O., & Kwon, H. (2015) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000061 · Cited by 1
“Several researchers showed that PA or exercise did not make a difference in CTT ( Metcalf et al., 1987 ).”
BackgroundMethodInfluentialConstipation and Constipation Syndromes
Bharucha, A. E., & Grover, M. (2012) · Wiley eBooks · doi:10.1002/9781118321386.ch61 · Cited by 2
直腸肛門機能障害の位置づけ : 新しいROME IIIとの関連について
Takano, M. (2007) · doi:10.3862/jcoloproctology.60.889 · Cited by 1
Is the constipated Asian male more common than we think?
Gwee, K., & Wong, R. (2007) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2007.05017.x · Cited by 1
Endoscopic Placement of Radiopaque Markers for Focused Evaluation of Intestinal Motility
Turner, P. L., Kavic, S., & Park, A. (2006) · Surgical Innovation · doi:10.1177/1553350606294246 · Cited by 1
“, internal rectal prolapse, anismus.(3)”
Approche du malade avec une diarrhée fonctionnelle
Delvaux, M., & Gay, G. (2006) · Gastroentérologie Clinique et Biologique · doi:10.1016/s0399-8320(06)73196-7 · Cited by 1
“Plusieurs études ont montré de fait que la consistance des selles et leur forme étaient des paramètres plus fiables que la fréquence des selles pour définir la diarrhée [2-6].”
BackgroundInvestigation and management of constipation.
Lamparelli, M., & Kumar, D. (2002) · Clinical medicine (London) · doi:10.7861/clinmedicine.2-5-415 · Cited by 1
Birrer, R. (2002) · Disease-a-month : DM · doi:10.1067/mda.2002.122480 · Cited by 1
Radionuclide Colon Transit Study in Normal Chinese
Wang, S.-J., Lin, W., Ko, C.-Y., & Chen, G.-H. (2001) · doi:10.6332/anms.1402.003 · Cited by 1
“There are several methods by which colon transit can be quantified in humans, of which radiological are the most commonly used [2-4].”
MethodHennigs, S., Jäger, H., Gissler, M., Roggenkamp, K., Löhlein, D., Albrecht, M., & Mathias, K. (2000) · doi:10.1055/s-2000-9216 · Cited by 1
Investigation of colonic disease.
Wan, A., & Darzi, A. (2000) · Hospital Medicine · doi:10.12968/hosp.2000.61.10.1438 · Cited by 1
Chedid, V. G., & Camilleri, M. (2019) · Encyclopedia of Gastroenterology · doi:10.1016/b978-0-12-801238-3.66006-3
Colonic Transit Study by Radio-Opaque Markers
Min, Y., & Rhee, P. (2016) · doi:10.1007/978-81-322-0822-8_3 · Cited by 1
A Study on the Use of Stimulant Laxatives Using Large Bowel Transit Time as an Index
Okazaki, K. (2011) · doi:10.3862/jcoloproctology.64.408 · Cited by 1
Disorders of Defecation in Women
Gearhart, S. (2010) · doi:10.1016/b978-0-12-374271-1.00029-0 · Cited by 1
Methods to Measure Small-Bowel and Colonic Transit
Kim, H. J., & Camilleri, M. (2006) · Springer eBooks · doi:10.1007/978-1-84628-275-1_7 · Cited by 1
Lee, Y.-J., & Chung, K. (2005) · Korean Journal of Pediatric Gastroenterology and Nutrition · doi:10.5223/kjpgn.2005.8.2.130 · Cited by 1
Chapter 32 Autonomic nervous system evaluation: diagnosis of rectal and lower gut dysfunction
Bittinger, M., & WIENBECK, M. (2000) · Supplements to Clinical neurophysiology · doi:10.1016/s1567-424x(09)70163-1 · Cited by 1
Konzept und funktionelle Analyse der ileozäkalen Interposition als neues Verfahren zum Rektumersatz
von Flüe, M., & Harder, F. (1997) · doi:10.1007/978-3-642-60527-7_8 · Cited by 1
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Clinical Investigations in Gastroenterology
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Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction
Shouman, K., Camilleri, M., & Singer, W. (2026) · Autonomic Neuroscience · doi:10.1016/j.autneu.2026.103474
Zhang, X., Tian, H., Gu, L., Nie, Y., Ding, C., Ge, X., Yang, B. K., Gong, J., & Li, N. (2018) · Science China Life Sciences · doi:10.1007/s11427-017-9229-1 · Cited by 65
“Transit time was calculated using the formula mentioned by Metcalf and coworkers (Metcalf et al., 1987).”
MethodColon Capsule Endoscopy-Measured Colonic Transit Time Is Associated with Frailty in Older Adults
Nakaji, K., Kumamoto, M., & Nakae, Y. (2026) · Medicina · doi:10.3390/medicina62071362
“CTT has traditionally been measured using radiopaque marker methods [20], but colon capsule endoscopy (CCE) has more recently enabled a non-invasive assessment of CTT [21–25].”
Chronische Obstipation und obstruktives Defäkationssyndrom
Tatu, A. M. (2026) · Die Gastroenterologie · doi:10.1007/s11377-026-00997-1
Colonic transit study in patients with chronic constipation using Japanese-made radiopaque markers
Kamiya, T., Kubota, E., Ozeki, K., Tanaka, M., Shime, A., Tada, M., Fukuta, H., & Kataoka, H. (2026) · Journal of smooth muscle research = Nihon Heikatsukin Gakkai kikanshi · doi:10.1540/jsmr.62.17
Neri, M. C., Battaglia, E., Galeazzi, F., d'Alba, L., Lambiase, C., Usai-Satta, P., Bellini, M., & Bassotti, G. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15072571
“Diffuse retention of markers throughout the colon supports the diagnosis of slow-transit constipation, whereas accumulation of markers in the pelvic https://doi.org/10.3390/jcm15072571 region supports the diagnostic hypothesis of an obstructed defecation syndrome [17,18].”
InfluentialYi, T., Guo, X., Fang, Y., Liang, H., Lu, Y., Zhang, X., Cao, H., Liu, J.-Z., Wang, Q., Qu, Y., et al. (2025) · Neuromodulation (Malden, Mass.) · doi:10.1016/j.neurom.2025.10.065
Park, J.-B., Jung, K., Bae, J. H., Kim, K., Lee, M.-H., Bae, G., Hong, S. W., Hwang, S., Park, S. H., Yang, D.-H., et al. (2025) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm24179
“23,24 The clinical outcomes, including the disease-related emergency department visits or hospitalizations, the necessity for reoperation, and the nutritional status (eg, oral diet and parenteral nutrition), were examined.”
Tamai, H., Uehara, A., Sankai, Y., Hara, H., & Kawamoto, H. (2025) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc58623.2025.11254929
“Since it typically takes one to two days for digested contents to pass through the large intestine to rectum [43], it is likely that the participant firstly just expelled the hardened stool that had accumulated in the distal colon before the intervention.”
Ren, X.-Y., Yan, X., Zhu, J., He, S., & Yin, Y. (2024) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2024.2434637
“In comparison to the classical method established by Metcalf et al. [6], the simplified CTT is presently more widely utilized.”
Remalayam, B., & Thomas, V. (2023) · Dentistry and Medical Research · doi:10.4103/dmr.dmr_37_23
The Value of a Modified Colonic Transit Test in the Diagnosis of Chronic Constipation
Chen, Y., Zhao, B., Liao, Y., Wei, C., Ma, Y.-C., Wang, F., Wang, D.-R., & Tang, D. (2022) · doi:10.34175/jno202203005
“This method can accurately assess the transit time by counting markers in both the stool and those remaining in the abdomen [8].”
MethodDiagnostics of functional disorders of the gastrointestinal tract in patients with constipation
Kazyulin, A., Samsonov, A., Kucheryavyy, Y., Cheremushkin, S. V., & Gilyuk, A. V. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-12-210-219
Dane, B., & Hindman, N. (2021) · Journal of computer assisted tomography · doi:10.1097/rct.0000000000001233
Wehrmann, T., & Schmitt, T. (2019) · Funktionsdiagnostik in der Gastroenterologie · doi:10.1007/978-3-662-07355-1_6
R., A., & Reddy, V. (2018) · Journal of Gastrointestinal and Abdominal Radiology · doi:10.1055/s-0038-1673317
Diagnosis of gastrointestinal motility disorders.
Koželuhová, J., Balihar, K., & Zdrhova, L. (2018) · Vnitrni lekarstvi · doi:10.36290/vnl.2018.085
“První variantou je požití radiokontrastních značek po dobu 3 dnů, po kterých následuje řada RTG kont rol do vyloučení posledního markeru [21,22].”
The Mexican consensus on chronic constipation
Remes-Troche, J. M., Coss‐Adame, E., López‐Colombo, A., Amieva‐Balmori, M., Sánchez, R. C., Guindic, L. C., Rendón, R. F., Escudero, O. G., Martínez, M. G., Chávez, M. E. I., et al. (2018) · Revista de Gastroenterología de México (English Edition) · doi:10.1016/j.rgmxen.2018.05.012 · Cited by 31
“If the markers observed in the two x-rays add up to ≥ 68, slow colonic transit is diagnosed.(89) The wireless motility capsule is a technology that incorporates a pH sensor, a temperature sensor, and a pressure sensor.”
BackgroundReply to multiregional dysmotility in diabetes mellitus assessed using the wireless motility capsule
Rouphael, C., Thota, P., & Cline, M. (2017) · Neurogastroenterology and Motility · doi:10.1111/nmo.13147
Infante, J. R., Rayo, J., Serrano, J., García, L., Moreno, M., Martínez, A., & Huertas, J. (2017) · Revista Española de Medicina Nuclear e Imagen Molecular · doi:10.1016/j.remn.2016.10.011
Apport de l’ostéopathie dans la prise en charge des troubles fonctionnels intestinaux de l’adulte
Létard, L., Létard, J.-F., Beustes, L., Scribans, C., & Meslé, R. (2017) · La Revue de l'Ostéopathie · doi:10.65071/rev.osteo2017.01.17.5
Diagnosis of Chronic Constipation Using Measurement of Colon Transit Time
Shin, J., Kim, S.-E., Lee, T., Hong, K., Ryu, H., Lee, Y., & Kim, J.-W. (2017) · doi:10.3904/kjm.2017.92.1.41
“Tech, Pyeongtaek, Korea)와 Sitzmarks (24개 표지자; Konsyl Pharmaceuticals, Texas, TX, USA)가 주로 사용되고 있다[8,9].”
Lembcke, B. (2015) · Gastroenterologie up2date · doi:10.1055/s-0041-106639
Malagelada, J., & Malagelada, C. (2013) · doi:10.1002/9781118444689.ch11
Gastrointestinal Motility Testing
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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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