Slow Transit Constipation : Aspects of Diagnosis and Treatment

Abstract: Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (P<0.05–0.001). Two individual patients had a delay in the right colon.Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (P<0.001). The number of patients with bloating, excessive straining and painful defecation decreased (P<0.05). The laxative use decreased (P<0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome.Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (P<0.05), and squeeze pressure tended to be lower (P=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95th percentile of controls. The rectal compliance was increased in patients (P<0.05–0.01).Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (P<0.05). However, the results varied considerably for individual patients.In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.