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. 1988 Aug;29(8):1085–1092. doi: 10.1136/gut.29.8.1085

Dynamic scanning defines a colonic defect in severe idiopathic constipation.

M A Kamm 1, J E Lennard-Jones 1, D G Thompson 1, R Sobnack 1, N W Garvie 1, M Granowska 1
PMCID: PMC1433900  PMID: 3410334

Abstract

A technique is described in which a chemical stimulus applied to the mucosa of the right colon is used to assess colonic motor function. Peroral intubation of the right colon was achieved using a fine polyvinylchloride (PVC) tube. Bisacodyl was used to initiate colonic motor activity, and colonic transit was monitored using 99mTc-DPTA and a gamma camera. In normal subjects there was rapid movement of the radiopharmaceutical from the right colon to the rectum. In patients with severe idiopathic constipation, a spectrum of colonic abnormality was observed from slow transit involving the rectum and sigmoid only to slow transit involving the whole colon. The hepatic flexure to rectum transit time for the 'head of the isotope column' in normals ranged from 1-10 minutes (mean 5.3 minutes), whereas in patients the transit time was 14-25 minutes in four patients and radioisotope did not reach the rectum by two hours in three other patients (controls v patients, p less than 0.01). Patients also showed relatively impaired transport of the isotope 'mass'. This technique has shown that the normal colon is capable of rapid effective transport in response to a standard stimulus, and that patients with severe idiopathic constipation have a definable colonic motor disorder.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnes P. R., Lennard-Jones J. E. Balloon expulsion from the rectum in constipation of different types. Gut. 1985 Oct;26(10):1049–1052. doi: 10.1136/gut.26.10.1049. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Devroede G., Lamarche J. Functional importance of extrinsic parasympathetic innervation to the distal colon and rectum in man. Gastroenterology. 1974 Feb;66(2):273–280. [PubMed] [Google Scholar]
  3. Hardcastle J. D., Mann C. V. Study of large bowel peristalsis. Gut. 1968 Oct;9(5):512–520. doi: 10.1136/gut.9.5.512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hinton J. M., Lennard-Jones J. E., Young A. C. A ne method for studying gut transit times using radioopaque markers. Gut. 1969 Oct;10(10):842–847. doi: 10.1136/gut.10.10.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kerlin P., Tucker R., Phillips S. F. Rapid intubation of the ileo-colonic region of man. Aust N Z J Med. 1983 Dec;13(6):591–593. doi: 10.1111/j.1445-5994.1983.tb02610.x. [DOI] [PubMed] [Google Scholar]
  6. Krevsky B., Malmud L. S., D'Ercole F., Maurer A. H., Fisher R. S. Colonic transit scintigraphy. A physiologic approach to the quantitative measurement of colonic transit in humans. Gastroenterology. 1986 Nov;91(5):1102–1112. [PubMed] [Google Scholar]
  7. Krishnamurthy S., Schuffler M. D., Rohrmann C. A., Pope C. E., 2nd Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology. 1985 Jan;88(1 Pt 1):26–34. doi: 10.1016/s0016-5085(85)80128-1. [DOI] [PubMed] [Google Scholar]
  8. Preston D. M., Hawley P. R., Lennard-Jones J. E., Todd I. P. Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease). Br J Surg. 1984 Jul;71(7):547–552. doi: 10.1002/bjs.1800710726. [DOI] [PubMed] [Google Scholar]
  9. Preston D. M., Lennard-Jones J. E. Anismus in chronic constipation. Dig Dis Sci. 1985 May;30(5):413–418. doi: 10.1007/BF01318172. [DOI] [PubMed] [Google Scholar]
  10. Preston D. M., Lennard-Jones J. E. Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation. Dig Dis Sci. 1985 Apr;30(4):289–294. doi: 10.1007/BF01403835. [DOI] [PubMed] [Google Scholar]
  11. Read N. W., Timms J. M., Barfield L. J., Donnelly T. C., Bannister J. J. Impairment of defecation in young women with severe constipation. Gastroenterology. 1986 Jan;90(1):53–60. doi: 10.1016/0016-5085(86)90074-0. [DOI] [PubMed] [Google Scholar]
  12. Schang J. C., Hémond M., Hébert M., Pilote M. Changes in colonic myoelectric spiking activity during stimulation by bisacodyl. Can J Physiol Pharmacol. 1986 Jan;64(1):39–43. doi: 10.1139/y86-005. [DOI] [PubMed] [Google Scholar]
  13. Spiller R. C., Brown M. L., Phillips S. F. Decreased fluid tolerance, accelerated transit, and abnormal motility of the human colon induced by oleic acid. Gastroenterology. 1986 Jul;91(1):100–107. doi: 10.1016/0016-5085(86)90445-2. [DOI] [PubMed] [Google Scholar]
  14. Trotman I. F., Price C. C. Bloated irritable bowel syndrome defined by dynamic 99mTc bran scan. Lancet. 1986 Aug 16;2(8503):364–366. doi: 10.1016/s0140-6736(86)90053-x. [DOI] [PubMed] [Google Scholar]
  15. Turnbull G. K., Lennard-Jones J. E., Bartram C. I. Failure of rectal expulsion as a cause of constipation: why fibre and laxatives sometimes fail. Lancet. 1986 Apr 5;1(8484):767–769. doi: 10.1016/s0140-6736(86)91783-6. [DOI] [PubMed] [Google Scholar]
  16. Womack N. R., Williams N. S., Holmfield J. H., Morrison J. F., Simpkins K. C. New method for the dynamic assessment of anorectal function in constipation. Br J Surg. 1985 Dec;72(12):994–998. doi: 10.1002/bjs.1800721221. [DOI] [PubMed] [Google Scholar]

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