Annals of Coloproctology

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Evaluation of Gastric Emptying in Patients with Chronic Slow Transit.: Moon, Yoon Jae , Park, Hyo Jin , Lee, Kwi Soon , Park, In Suh; J Korean Soc Coloproctol. 1997;13(4):603-610.

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Abstract PDF: OBJECTIVES
Slow transit type of chronic constipation can be divided into two types, colonic constipation, and generalized gastrointestinal dysmotility. However, it is debatable whether generalized GI dysmotility should be considered as upper gastrointestinal dysmotility secondary to colonic constipation or independent type of chronic constipation. In this study, we compared gastric emptying time(T1/2) of patients of chronic constipation with that of normal controls, and tried to find out any relationship between segmental colonic transit time and gastric emptying time.
METHODS
Twenty three patients with chronic slow transit constipation who either visited or admitted to Youngdong Severance Hospital between september 1995 to lune 1997, and 27 normal controls were recruited. Both the patients and normal controls were fed with radioopaque material and colonic transit time and gastric emptying time were measured.
RESULTS
1) Seventy four percent of patients with chronic slow transit constipation showed a delayed gastric emptying time. Patients group showed a significantly delayed gastric emptying time compared with that of normal controls(110.9+/-32.3 min vs. 72.1+/-11.4 min, p<0.05). Gastric emptying time in respect to gender showed significant differences in normal controls(M=65.5+/-9.6 min, F=78.7+/-10.4 min). However, no significant difference was found in patient group(M=97.8+/-11.8 min, F=114.5+/-35.4 min). 2) In chronic slow transit constipation, colonic transit time was 48.8+/-11.7 hr. Each segments of colon showed a different transit time: Right colon 19.3+/-7.3 hr, left colon 21.2+/-12.3 hr, and rectosigmoid 8.3+/-9.2 hr. All of which were significantly delayed, compared with those of normal controls. 3) In patients group, colonic transit time of the whole colon had no significant correlation with gastric emptying time. 4) Seventy five percent of patients with chronic slow transit constipation whose right colonic transit time was delayed showed a delayed gastric emptying time. On the other hands, 63% of patients with delayed left colonic transit time had a delayed gastic emptying time. Patients with delayed gastric emptying time and those with normal gastric emptying time had no significantly different colonic transit time(49.1+/-13.2 hr vs 48.0+/-6.5 hr).
CONCLUSIONS
Large number of patients with chronic slow transit constipation had a delayed gastric emptying time. When surgical treatment is considered in patients with chronic slow transit constipation, it seems to be beneficial to estimate such parameters as manometry or gastric emptying time in order to evaluate functional derangement of UGI tract. These parameters may provide a guideline in treatment of chronic idiopathic constipation.

Clinical Significance of Defecography in Patients with Constipation.: Kwon, Ho Young , Kim, Kwang Ho , Shim, Kang Sub; J Korean Soc Coloproctol. 1999;15(3):195-202.

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Abstract PDF: PURPOSE
To evaluate the clinical usefulness of defecogrophy in diagnosing the etiology and pathophysiology of constipation. A retrospective study of 56 constipated patients who had no abnormalities in colonoscopy, barium enema and rectal exam were done.
METHODS
Fifty-six patients (12 men, 44 women) with constipation underwent defecography and 37 of the patients underwent colonic transit studies. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum.
RESULTS
Normal defecography finding was observed in thirteen of the 56 patients. Rectocele, spastic levator syndrome (nonrelaxing puborectalis syndrome), sigmoidocele, rectal prolapse, rectal intussusception were observed in 67% (38/56), 30% (20/56), 7% (4/56), 5% (3/56) and 2% (1/56) of the patients, respectively. More than one pathological finding was found in 23 (53%) patients. Of the 38 rectoceles, 17 cases were found to be associated with spastic levator syndrome. In solitary rectocele, the anorectal angles at rest, during straining were 92.65 9.08o, 108.09 14.35o, while 99.85 11.85o, 95.90 17.84o, in spastic levator syndrome. In 36 difficult bowel movements, 66% (24/36), 30% (11/36), 3% (1/36) were found to have rectocele, spastic levator syndrome, and sigmoidocele, respectively. Normal colonic transit time was observed in twenty six of the 37 patients. Abnormal findings included colonic inertia in 3 (8%) patients, hindgut dysfunction in 4 (11%) patients, and, outlet obstruction in 4 (11%) patients. Of the normal colonic transit time in 26, rectocele in sixteen, rectal prolapse in 1, spastic levator in 2 were observed. Rectoceles were observed in 2 out of 3 colonic inertia, in all 4 hindgut dysfunction, in 1 out of 4 outlet obstruction.
CONCLUSIONS
Our findings suggest that constipation is often a disorder of defecation rather than a impairment of colonic motility. Defecography should be considered first of all in evaluating the pathophysiology of constipation, especially for whom complaining of difficult bowel.

Clinical Review of Melanosis Coli.: Park, Weon Kap , Cho, Kyung A , Hwang, Do Yean; J Korean Soc Coloproctol. 1999;15(3):187-193.

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Abstract PDF: PURPOSE
Melanosis coli, which is a relatively common disease encountered during colonoscopy, is a brownish or blackish pigmentation of the colon and is associated with the ingestion of anthraquinone compounds. Its histopathological pathogenesis is recognized as colonic epithelial apoptosis. This study was designed to identify the relation between melanosis coli and the colonic transit time, as well as the relation between melanosis coli and other clinical characteristics.
METHODS
We reviewed the clinical records of 80 patients with melanosis coli who had been diagnosed by colonoscopy between Jan. 1997 and Sep. 1998. The colonic transit time was checked in 26 cases of patients with melanosis coli and in 28 cases of patients with constipation without melanosis coli by using the multiple marker bolus technique.
RESULTS
1) The frequency of melanosis coli in patients undergoing a total colonoscopy was 1.25% (80/6422). 2) The age distribution was 20 to 76 years old (mean: 49). The grade of melanosis coli seemed to be related with age. 3) The four causative agents related with melanosis coli were anthraquinone compounds (69.2%), tea (12.3%), herbs (12.3%) and health foods in that order. 4) The duration of medication was from 2 months to 20 years (mean: 48 months). The grade of melanosis coli seemed to be related with the duration of medication. 5) The colonic transit time was normal in 11 cases (42.3%) and delayed in 15 cases (57.5%) of melanosis coli and normal in 10 cases (35.7%) and delayed in 18 cases (64.3%) of patients with constipation without melanosicoli. 6) Colon polyps were detected in 12 cases (15%). However, no relation between the incidence of colon polyps and either the grade of melanosis coli or the duration of medication was noted.
CONCLUSIONS
Melanosis coli is a marker of ingestion of some drugs, such as anthraquinone compounds, and/or some kinds of acidic polysaccharides. Melanosis coli is not an indicator of colonic motility disorder or a danger signal for colon polyps or cancer.

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