A Novel Noninvasive Method for Quantitative Detection of Colonic Dysmotility Using Real-Time Ultrasonography

<b><i>Introduction:</i></b> Colonic motility disorders are a frequent clinical problem caused by various drugs and diseases. However, the etiology of colonic dysmotility is often unclear due to the lack of in vivo methods, including rapid dynamic assessment. <b><i>Objectives:</i></b> The aim of this study was to establish a novel quantitative method to objectively assess colonic motility using ultrasonography. <b><i>Methods:</i></b> We applied echocardiographic speckle tracking-based strain imaging to analyze murine colonic motility. A trace line was placed on the boundary between the proximal wall of the colon and the inner cavity to analyze colonic wall displacement and strain rate. Locomotion activities of the colonic wall were used to quantify colonic motility via ultrasonography. <b><i>Results:</i></b> We found that ultrasonography can quantitatively detect a decrease in colonic motility induced by loperamide, an antidiarrheal drug. These quantitative data were consistent with the imaging findings of colonic peristalsis and colon transit time. Additionally, ultrasonography also revealed changes in colonic motility over short intervals. Furthermore, we have shown that ultrasonography can quantitatively and noninvasively detect colonic dysmotility and hypervascularity of the colonic wall in colitis mice. <b><i>Conclusions:</i></b> These findings suggest that ultrasonography is a useful in vivo method for objectively monitoring changes in colonic motility caused by drugs and diseases.

Dyssynergic patterns of defecation in constipated adolescents and young adults with anorectal malformations

We aimed to evaluate the etiologies of constipation in patients with anorectal malformations having a good prognosis for bowel control but a high risk of constipation. We included twenty-five patients from the Odense university hospital in Denmark. Patients were subjected to colon transit time examination and high resolution anorectal manometry (HRAM). The median age was 18 (14–24) and 48% (12/25) were females. Fifty-two % (13/25) of patients were diagnosed with constipation. Types of anorectal malformation were perineal fistula (9/25), rectovestibular fistula (8/25), rectourethral bulbar fistula (5/25) and no fistula (3/25). No difference in neither total colon transit time nor segmental colon transit times were found based on the presence of constipation. Only four of the constipated patients fulfilled criteria for dyssynergic defecation with a dyssynergic pattern at HRAM and prolonged colon transit time. A Type I dyssynergic pattern was dominant in constipated patients (7/13). A Dyssynergic defecation pattern was due to isolated contraction of puborectalis muscle in 9 out of 13constipated patients. We found a dyssynergic pattern during attempted defecation in patients with anorectal malformations disregarded the presence of constipation. In the majority of constipated patients an isolated contraction of the puborectalis muscle was visualized with HRAM.

Effects of rice-based and wheat-based diets on bowel movements in young Korean women with functional constipation

Background Although several studies have reported the effects that dietary fiber intake from different types of grains and fiber components have on bowel movements, insufficient attention has been paid to comparing and evaluating the effects of rice-based and wheat-based diets. This study compared and evaluated the effects of ingesting rice-based (brown rice-based diet: BRD; white rice-based diet: WRD) and wheat-based diet (WD) on the bowel movements of young women with functional constipation. Method Based on an open, randomized, controlled, and parallel design, 39 subjects were assigned to BRD, WRD, and WD groups (13 in each group). Each participant had received three types of experimental diets over the course of 4 weeks and we recommended that the subjects eat only the test diet provided during the study. Primary outcomes (total colon transit time TCTT) and secondary outcomes (bowel movements, short-chain fatty acid content, and fecal enzyme activity) were compared before and after the 4-week intervention period. Results After the 4-week study, the rice-based diet (BRD and WRD) groups and the WD group had a statistically significant difference in TCTT (p = 0.028). The TCTT of the BRD group was significantly reduced (p = 0.028) compared with the WRD group (−16.5 ± 8.1 vs +6.8 ± 2.1), and the TCTT of the WD group was also significantly reduced (p = 0.022) compared with that of the WRD group (−17.1 ± 11.9 vs +6.8 ± 2.1). Conclusion Among women with functional constipation, the BRD and WD both improved bowel function by reducing TCTT and increasing the number of bowel movements compared with the WRD group.

Isolated puborectalis muscle contraction is a common cause of dyssynergic defecation in constipated adolescents and adults with anorectal malformations

Background We aimed to evaluate the etiologies of constipation in adolescents and adult patients with anorectal malformations with colon transit time and high resolution anorectal manometry Methods We included twenty-five patients from the Odense university hospital in Denmark. Written and verbal informed consent was obtained. Patients were subjected to colon transit time examination and high resolution anorectal manometry. Presence of constipation was diagnosed based on the Rome IV criteria. Questionnaires regarding functional bowel outcome and severity of constipation were filled in. Results The median age was 18(14-24) and 48% (12/25) were females. Fifty-two % (13/25) of patients were diagnosed with constipation. Most frequent type of anorectal malformation was anocutaneous fistula (9/25), vestibular fistula (8/25) and urethral bulbar fistula (4/25). No difference in neither total colon transit time nor segmental colon transit times were found based on the presence of constipation. Constipated patients and patients without constipation were equal on manometric parameters. Only four of the constipated patients fulfilled criteria for dyssynergic defecation with dyssynergic defecation pattern and prolonged colon transit time. A Type I dyssynergic pattern was dominant in constipated patients as it was detected in 54% (7/13). Dyssynergic defecation pattern was due to isolated contraction of puborectalis muscle in 69% (9/13) of constipated patients. Conclusions We found a dyssynergic defecation pattern during attempted defecation in patients with anorectal malformations disregarded the presence of constipation. In the majority of constipated patients an isolated contraction of the puborectalis muscle was visualized with high resolution anorectal manometry. Trial registration: Clinical.Trials.gov. (NCT02624232).

Prediction of Inadequate Bowel Preparation Using Total and Segmental Colon Transit Time in Patients with Chronic Constipation: Some Different Outcomes

Aims. Radio-opaque markers have been widely used in the study of colon motility in patients with chronic functional constipation (FC). Here, we evaluate the relationship between the colon transit time (CTT) and the Boston Bowel Preparation Scale (BBPS) to determine whether CTT is a sufficient predictor of bowel preparation in patients with chronic functional constipation. Methods. A total of fifty-six patients with constipation and fifty-two healthy controls (HC) were enrolled in this study. All subjects underwent the colonic transit study using radio-opaque markers and were given a follow-up colonoscopy examination on day 3 to 7 to determine BBPS. The correlation between total and segmental CTT and BBPS was evaluated, and risk factors for predicting inadequate bowel preparation were determined. Results. In our study, we found some distinct outcomes compared with previous studies. The mean total CTT (TCTT) was determined to be 43.37±18.82 h in the FC group and 23.08±10.18 h in the HC group. This difference was found to be significant for both the total and segmental CTTs between the two groups (P<0.05). Further, TCTT was negatively correlated with BBPS both in the FC (r=−0.899, 95% CI -0.748 to -0.925, P<0.001) and the HC (r=−0.978, 95% CI -0.854 to -1.003, P=0.004) groups, as was segmental CTTs and segmental BBPS (P<0.05). In the case of patients with slow transit constipation, multivariate logistic regression analysis indicated that prolonged TCTT (OR 0.722, 95% CI 0.589-0.885, P=0.002) was independently associated with poor bowel preparation. The total and right to left CTTs were found to predict inadequate bowel preparation and exhibited the best sensitivity and specificity at 48.0 h, 15.5 h, 17.5 h, and 19.0 h, based on ROC curve analysis. Conclusions. The CTT test represents a valuable method for predicting the level of bowel preparation prior to a colonoscopy examination. That is, both total and segmental CTTs can be considered an objective predictor of bowel preparation prior to colonoscopy. The present study demonstrates some distinct results relative to previous studies, including STC subtype proportion in FC, the proportion of inadequate bowel preparation in the STC subtype, and the cut-off value of TCTT for predicting inadequate bowel preparation.