The indications for small-bowel and colon transit measurements are summarized in Table 7.1. Symptoms such as nausea, vomiting, pain, and alterations in bowel movements occur in both functional gastrointestinal diseases and organic motility disorders.9 Moreover, the severity of symptoms is subjective, often unrelated to the degree of altered function. The diagnosis of regional or generalized motor disturbances cannot be based solely on the assessment of symptoms. The severity of motor dysfunction is quantifiable by transit measurements and may be an important variable; it affects the choice of therapy and long-term prognosis. In clinical practice, an objective and reliable means to identify impaired motility10 is useful; it may facilitate the selection of patients for further invasive testing, treatment with prokinetic agents, or a change in the method chosen for supplementation of nutrients. Rarely, surgery is a viable option for localized motility disorders such as megaduodenum or colonic inertia. In the latter patients, transit tests are also useful to exclude more generalized motor disturbances that might preclude a surgical approach.
Manometric evaluation has contributed to a better understanding of gastroduodenal motor dysfunctions.10 However, this requires intubation, which may be difficult in ill patients. Moreover, manometry does not really assess the result of the pressure profile, that is, the transit of chyme. Measurement of transit represents a summary of the overall propagation of chyme over time and thus reflects the net result of gastrointestinal motor activity.
In patients with prolonged orocecal transit, differentiation between delayed gastric emptying and slow small-bowel transit is important since it identifies those in whom enteral nutrition via a jejunal tube may bypass a dysfunctional stomach and thereby avoid total parenteral nutrition. Colonic transit data can be used to assess the severity of constipation or colonic inertia; in the past, prolonged whole-gut (oroanal) transit time had been assumed to
Table 7.1. Indications for measurement of small-bowel and colonic transit
Initial evaluation of suspected small-intestine dysmotility, such as pseudo-obstruction or postvagotomy diarrhea Differentiation of gastric emptying delay from small-bowel transit delay in patients with prolonged orocecal transit Differentiation of neuropathic and myopathic small-bowel dysmotility
Assessment of severity of constipation or colonic inertia Assessment of therapeutic response
From von der Ohe M, Camilleri M. Measurement of small bowel and colonic transit: indications and methods. Mayo Clin Proc 1992;67:1169-1172.
reflect predominantly colonic transit. However, many patients with colonic inertia have a generalized disturbance of gut motility with considerable retardation in small-bowel transit. Thus, oroanal transit times do not merely reflect colonic transit; selective assessment of colonic transit is important, as it may lead to appropriate treatments to correct this disturbance. The results of the transit study may be pivotal in the decision to perform a colectomy for constipation. Finally, transit measurements remain a useful tool for physiologic studies and help provide objective information on the responses to treatment in clinical practice and research.
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