Measuring colonic transit time in chronic idiopathic constipation

Introduction and objectives: colonic transit time can define three types of delay: right colon (colonic inertia), left colon and recto sigmoid. The aim of this study is to compare clinic characteristics and manometric results among the different groups with segmental colonic transit disorder. Patients and methods: 61 subjects were included in our study (5 men and 56 women) with an average age of 47.5 years (range: 17-84 years). We carried out a study of segmental and total colonic transit time, with the use of radio-opaque markers and sequential abdominal X-rays. We considered that transit time was prolonged when it was longer than 72 hours, and segmental transit time, when right colon was longer than 22 hours, left colon 37.2 hours and recto-sigmoid 37.2 hours. We included different clinic data: age, sex, place of residence, stool frequency, abdominal pain, painful evacuation, incomplete evacuation, evacuation desire, dietary fibre intake, use of laxatives. We practised anorectal manometry in 20 patients. Results: the average total colonic transit time was 38.2 hours in normal transit and 103 hours with disorder. The frequency in the three colonic segments, when there was a long total colonic transit time, was: 40% in the left colon, 33% in the recto-sigmoid and 27% in the right colon. We analysed the clinical characteristics of these three groups, finding more frequency of painful evacuation and defecation desire and lower dietary fibre intake in recto sigmoid. The most important abnormality in anorectal manometry was the hiposensitivity in the anorectal area, that only appeared in subjects with long segmental transit time in the right colon (colonic inertia), statistically significant. Conclusions: the measurement of colonic transit time with radio-opaque markers is a simple technique that allows for the objective detection of the different groups of patients with chronic idiopathic constipation. The exact typification of the abnormality is important for the individualization of each treatment.