Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Slow Transit Constipation: Aspects of Diagnosis and Treatment
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (P<0.05–0.001). Two individual patients had a delay in the right colon.

Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (P<0.001). The number of patients with bloating, excessive straining and painful defecation decreased (P<0.05). The laxative use decreased (P<0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome.

Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (P<0.05), and squeeze pressure tended to be lower (P=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95th percentile of controls. The rectal compliance was increased in patients (P<0.05–0.01).

Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (P<0.05). However, the results varied considerably for individual patients.

In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2005. , p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 31
Keyword [en]
Surgery, colectomy, constipation, radio-opaque markers, rectal compliance, rectal sensation, scintigraphy, segmental colonic resection, segmental colonic transit, sphincter pressure
Keyword [sv]
Kirurgi
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-5770ISBN: 91-554-6230-8 (print)OAI: oai:DiVA.org:uu-5770DiVA, id: diva2:166302
Public defence
2005-05-24, Grönwallsalen, Akademiska sjukhuset, Ingång 70, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-05-03 Created: 2005-05-03Bibliographically approved
List of papers
1. Scintigraphic assessment of slow transit constipation with special reference to right- or left-sided colonic delay
Open this publication in new window or tab >>Scintigraphic assessment of slow transit constipation with special reference to right- or left-sided colonic delay
Show others...
2004 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 6, no 6, p. 499-505Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Subtotal colectomy and ileorectal anastomosis for slow transit constipation has several side-effects. The motor abnormality in some patients may be segmental which could motivate a limited resection of the colon. Therefore a diagnostic tool to identify a segmental colonic motor dysfunction is needed. The aim of this study was to evaluate a scintigraphic method to assess colonic transit with special reference to right- or left-sided delay. METHODS: Twenty-three constipated patients (19 women, mean age 50 years) with slow colonic transit on radio-opaque marker studies and 13 healthy individuals (11 women, mean age 46 years) were studied. All subjects were examined with oral (111)Indium-DTPA scintigraphy. The scintigraphic results for patients and controls were presented as geometric centre of radioactivity and percent activity over time in the right, the left and the recto-sigmoid colon. The inter-observer variation in the interpretation of the scans was also evaluated. RESULTS: There was no difference in transit time between the groups of patients and controls in the right colon whereas the patients had a significant delay in the left colon (P < 0.05). Two patients had a marked delay in the right colon followed by relatively rapid transit in the left colon. The inter-observer correlation was good comparing the right, the left and the recto-sigmoid colon (r = 0.58-0.98, P < 0.01-0.001). CONCLUSION: The results indicate that colonic scintigraphy with oral (111)Indium-DTPA may help to select patients for a left or, in a few cases, a right hemicolectomy for slow transit constipation.

Keyword
Adult, Aged, Case-Control Studies, Colon/physiology, Comparative Study, Constipation/physiopathology/*radionuclide imaging/surgery, Female, Gastrointestinal Transit/*physiology, History; Medieval, Humans, Indium Radioisotopes/*diagnostic use, Male, Manometry, Middle Aged, Observer Variation, Probability, Prospective Studies, Reference Values, Sensitivity and Specificity, Severity of Illness Index, Statistics; Nonparametric, Time Factors
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-92963 (URN)10.1111/j.1463-1318.2004.00694.x (DOI)15521943 (PubMedID)
Available from: 2005-05-03 Created: 2005-05-03 Last updated: 2017-12-14Bibliographically approved
2. Outcome of segmental colonic resection for slow-transit constipation
Open this publication in new window or tab >>Outcome of segmental colonic resection for slow-transit constipation
2002 In: British Journal of Surgery, ISSN 0007-1323, Vol. 89, no 10, p. 1270-1274Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-92964 (URN)
Available from: 2005-05-03 Created: 2005-05-03Bibliographically approved
3. Anorectal physiology in the decision making before surgery for slow transit constipation
Open this publication in new window or tab >>Anorectal physiology in the decision making before surgery for slow transit constipation
(English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92965 (URN)
Available from: 2005-05-03 Created: 2005-05-03 Last updated: 2013-08-15Bibliographically approved
4. Segmental colonic transit studies: Comparison of a radiological and a scintigraphic method
Open this publication in new window or tab >>Segmental colonic transit studies: Comparison of a radiological and a scintigraphic method
Show others...
2007 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 9, no 4, p. 344-351Article in journal (Refereed) Published
Abstract [en]

Objective: Colonic transit studies are used to diagnose slow transit constipation (STC) and to evaluate segmental colonic transit before segmental or subtotal colectomy. The aim of the study was to compare a single X-ray radio-opaque marker method with a scintigraphic technique to assess total and segmental colonic transit in patients with STC. Methods: Thirty-one female patients (median age 46 years) with severe constipation and a prolonged or borderline prolonged colonic transit time on radio-opaque marker study were included in the study. They were subsequently investigated with 111 Indium-DTPA colonic transit scintigraphy, with a median time between the investigations of 4(range 1-27) months. Normal values of healthy female controls were used for comparison. Results: There was no difference between the two methods interms of prolonged or normal total colonic transit time. Twenty-nine of 31 female patients had a prolonged transit time only in one or two segments on the marker study. On scintigraphy, the transit time was prolonged for patients in the left (P < 0.05 to P < 0.001), but not in the right colon. With respect to prolonged or normal segmental transit time, there was a significant difference between the two methods only in the descending colon (P = 0.02). However, the results varied considerably for individual patients. Conclusion: Segmental colonic delay was a common finding. The two methods gave similar results for groups of patients, except in the descending colon. The variation of the results for individuals suggests that a repeated transit test may improve the assessment of total and segmental transit.

Keyword
Colonic transit, colectomy, constipation, radio-opaque markers, scintigraphy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92966 (URN)10.1111/j.1463-1318.2006.01153.x (DOI)000245505100011 ()17432988 (PubMedID)
Available from: 2005-05-03 Created: 2005-05-03 Last updated: 2017-12-14Bibliographically approved

Open Access in DiVA

fulltext(451 kB)3727 downloads
File information
File name FULLTEXT01.pdfFile size 451 kBChecksum SHA-1
9e263eb41b9e6f101e0cd3d7c8c0d1ed7f024c4bf74769c364b96060a50bd01e80b54542
Type fulltextMimetype application/pdf
Buy this publication >>

By organisation
Department of Surgical Sciences
Surgery

Search outside of DiVA

GoogleGoogle Scholar
Total: 3727 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 2063 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf