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. 1997 Nov;41(5):658–663. doi: 10.1136/gut.41.5.658

The distal colon provides reserve storage capacity during colonic fluid overload

J Hammer 1, M Pruckmayer 1, H Bergmann 1, K Kletter 1, A Gangl 1
PMCID: PMC1891583  PMID: 9414974

Abstract

Background—In addition to its absorptive function the capacity of the colon to retain fluid might be relevant in compensating for increased fluid loads and prevention of diarrhoea. The distal colon is considered to be mainly a conduit without extensive storage function. 
Aims—To evaluate colonic volume capacity in a model of pure osmotic diarrhoea. 
Methods—A non-absorbable, iso-osmotic solution (OS) containing polyethylene glycol (500 ml) was infused into the caecum of nine healthy volunteers; the control group (n=5) received an equal amount of an easily absorbable electrolyte solution (ES). Fluids were radiolabelled with technetium-99m and gamma camera images were obtained for 48 hours. Counts in the proximal and distal colon were measured and regional and overall colonic transit and stool output were quantified. 
Results—After OS, in contrast to ES, faecal output was increased significantly (p<0.05), but colonic transit after OS was not different from transit after ES (p>0.05). This indicates storage of OS in the colon: after OS infusion, counts in the proximal colon decreased linearly while the distal colon stored approximately 30% of radioactivity for the whole 48 hour study period. After OS, stool output correlated with distal (p<0.01), but not with proximal (p>0.05), colonic transit. In constrast, after ES, stool output was determined by proximal colonic transit (p<0.05) but not by transit through the distal colon (p>0.05). 
Conclusion—The distal colon retains non-absorbable fluid volumes extensively. In our model transit through the distal colon—but not the proximal colon—determined the time at which diarrhoea occurred. 



Keywords: osmotic diarrhoea; colonic transit; storage capacity; colonic scintigraphy

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Figure 1 .

Figure 1

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: Percentage of total counts (mean (SEM)) that remained in the proximal and distal colon 1, 4, 12, 24, and 48 hours after start of fluid infusion. Counts were decay corrected to time zero. 


Figure 2 .

Figure 2

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: Relation between mean residence times in the distal colon, determined at 48 hours, and 48 hour stool weight after caecal infusion of poorly absorbable osmotic solution and easily absorbable electrolyte solution. The filled diamonds identify the three subjects with delayed diarrhoea (subjects 2, 3, and 6 in table 2). 


Selected References

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

  1. Ameen V. Z., Powell G. K., Jones L. A. Quantitation of fecal carbohydrate excretion in patients with short bowel syndrome. Gastroenterology. 1987 Feb;92(2):493–500. doi: 10.1016/0016-5085(87)90147-8. [DOI] [PubMed] [Google Scholar]
  2. Anderson J. W., Bridges S. R. Dietary fiber content of selected foods. Am J Clin Nutr. 1988 Mar;47(3):440–447. doi: 10.1093/ajcn/47.3.440. [DOI] [PubMed] [Google Scholar]
  3. Banwell J. G., Pierce N. F., Mitra R. C., Brigham K. L., Caranasos G. J., Keimowitz R. I., Fedson D. S., Thomas J., Gorbach S. L., Sack R. B. Intestinal fluid and electrolyte transport in human cholera. J Clin Invest. 1970 Jan;49(1):183–195. doi: 10.1172/JCI106217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barrow L., Steed K. P., Spiller R. C., Watts P. J., Melia C. D., Davies M. C., Wilson C. G. Scintigraphic demonstration of lactulose-induced accelerated proximal colon transit. Gastroenterology. 1992 Oct;103(4):1167–1173. doi: 10.1016/0016-5085(92)91500-4. [DOI] [PubMed] [Google Scholar]
  5. Bazzocchi G., Ellis J., Villanueva-Meyer J., Reddy S. N., Mena I., Snape W. J., Jr Effect of eating on colonic motility and transit in patients with functional diarrhea. Simultaneous scintigraphic and manometric evaluations. Gastroenterology. 1991 Nov;101(5):1298–1306. doi: 10.1016/0016-5085(91)90080-5. [DOI] [PubMed] [Google Scholar]
  6. CONNELL A. M. The motility of the pelvic colon. II. Paradoxical motility in diarrhoea and constipation. Gut. 1962 Dec;3:342–348. doi: 10.1136/gut.3.4.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Davis G. R., Santa Ana C. A., Morawski S. G., Fordtran J. S. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology. 1980 May;78(5 Pt 1):991–995. [PubMed] [Google Scholar]
  8. Debongnie J. C., Phillips S. F. Capacity of the human colon to absorb fluid. Gastroenterology. 1978 Apr;74(4):698–703. [PubMed] [Google Scholar]
  9. Fine K. D., Santa Ana C. A., Fordtran J. S. Diagnosis of magnesium-induced diarrhea. N Engl J Med. 1991 Apr 11;324(15):1012–1017. doi: 10.1056/NEJM199104113241502. [DOI] [PubMed] [Google Scholar]
  10. Flourié B., Briet F., Florent C., Pellier P., Maurel M., Rambaud J. C. Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose? Am J Clin Nutr. 1993 Sep;58(3):369–375. doi: 10.1093/ajcn/58.3.369. [DOI] [PubMed] [Google Scholar]
  11. Frexinos J., Fioramonti J., Bueno L. Colonic myoelectrical activity in IBS painless diarrhoea. Gut. 1987 Dec;28(12):1613–1618. doi: 10.1136/gut.28.12.1613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hammer H. F., Fine K. D., Santa Ana C. A., Porter J. L., Schiller L. R., Fordtran J. S. Carbohydrate malabsorption. Its measurement and its contribution to diarrhea. J Clin Invest. 1990 Dec;86(6):1936–1944. doi: 10.1172/JCI114927. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hammer H. F., Santa Ana C. A., Schiller L. R., Fordtran J. S. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest. 1989 Oct;84(4):1056–1062. doi: 10.1172/JCI114267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hammer J., Phillips S. F. Fluid loading of the human colon: effects on segmental transit and stool composition. Gastroenterology. 1993 Oct;105(4):988–998. doi: 10.1016/0016-5085(93)90941-5. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. 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]
  17. Miller M. S., Galligan J. J., Burks T. F. Accurate measurement of intestinal transit in the rat. J Pharmacol Methods. 1981 Nov;6(3):211–217. doi: 10.1016/0160-5402(81)90110-8. [DOI] [PubMed] [Google Scholar]
  18. Phillips S. F., Giller J. The contribution of the colon to electrolyte and water conservation in man. J Lab Clin Med. 1973 May;81(5):733–746. [PubMed] [Google Scholar]
  19. Proano M., Camilleri M., Phillips S. F., Brown M. L., Thomforde G. M. Transit of solids through the human colon: regional quantification in the unprepared bowel. Am J Physiol. 1990 Jun;258(6 Pt 1):G856–G862. doi: 10.1152/ajpgi.1990.258.6.G856. [DOI] [PubMed] [Google Scholar]
  20. Read N. W. Diarrhoea: the failure of colonic salvage. Lancet. 1982 Aug 28;2(8296):481–483. doi: 10.1016/s0140-6736(82)90504-9. [DOI] [PubMed] [Google Scholar]
  21. Read N. W., Haynes W. G., Bartolo D. C., Hall J., Read M. G., Donnelly T. C., Johnson A. G. Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients. Gastroenterology. 1983 Jul;85(1):105–113. [PubMed] [Google Scholar]
  22. Reddy S. N., Bazzocchi G., Chan S., Akashi K., Villanueva-Meyer J., Yanni G., Mena I., Snape W. J., Jr Colonic motility and transit in health and ulcerative colitis. Gastroenterology. 1991 Nov;101(5):1289–1297. doi: 10.1016/0016-5085(91)90079-z. [DOI] [PubMed] [Google Scholar]
  23. Ruppin H., Bar-Meir S., Soergel K. H., Wood C. M., Schmitt M. G., Jr Absorption of short-chain fatty acids by the colon. Gastroenterology. 1980 Jun;78(6):1500–1507. [PubMed] [Google Scholar]
  24. Vassallo M., Camilleri M., Phillips S. F., Brown M. L., Chapman N. J., Thomforde G. M. Transit through the proximal colon influences stool weight in the irritable bowel syndrome. Gastroenterology. 1992 Jan;102(1):102–108. doi: 10.1016/0016-5085(92)91789-7. [DOI] [PubMed] [Google Scholar]

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