Influence of age, gender, hormonal status and smoking habits on colonic transit time.

The factors that influence colonic transit time in healthy humans are not yet clearly defined. The aim of this study was therefore to determine (a) if there are differences in colonic transit time between men and women and (b) if age, female hormonal status or smoking habits are associated with alterations in these parameters. Colonic transit time was measured in 164 asymptomatic subjects (80 males, 84 females) by a radio-opaque marker technique with one single plain abdominal X-ray. Colonic transit time was significantly shorter in men than in women (30 +/- 2 vs. 42 +/- 3 h, P < 0.05). Colonic transit time in non-smoking males was significantly shorter compared with smoking males (26 +/- 2 vs. 40 +/- 5 h, P < 0.05). In females only height and menstrual cycle influenced colonic transit times. We conclude that gender and smoking habits should be considered when studying colonic transit time in health and disease.

[Evaluation of small intestinal motility]. / Abklärung der Dünndarmmotilität.

Disturbances of small bowel motor function are increasingly recognized in clinical practice, either in the setting of an underlying disease that may affect the neuro-hormonal control of gut motility, such as diabetes or scleroderma, or as part of unexplained intestinal dysfunctions such as the irritable bowel syndrome or chronic idiopathic intestinal pseudo-obstruction. In the absence of endoscopic or radiological mucosal disease, it is often clinically helpful to define the motor function of the small bowel to understand the origin of the patient's symptoms. The hydrogen breath test after a lactulose oral load is currently used to measure mouth to caecum transit time. However, the reproducibility of this test is poor, and the range of normal values is wide. Scintigraphic determination of small intestinal transit time overcomes some of the limitations of the hydrogen breath test. This is however a time consuming procedure--up to 10 hrs when the time for acquisition, processing and analysis is included--and the costs prohibit widespread application of the technique. It is further restricted by the exposure to ionising radiation, particularly if repeated evaluations are necessary, for example in drugs trials. Manometry records mechanical activity of the bowel and detects quantitative and qualitative changes of small intestinal motility. As with scintigraphy, high costs and radiation exposure limit its usefulness. The major clinical application of the technique is in the diagnosis of chronic intestinal pseudo-obstruction.

[Evaluation of anorectal motility]. / Abklärung der anorektalen Motilität.

Constipation and incontinence frequently lead to medical consultation. A careful history and a complete physical examination of both anus and rectum are required before performing anorectal motility tests, the most important of which are anorectal manometry coupled with electromyography of the external anal sphincter and defecography. The pathophysiologic origin of these symptoms can then be understood. This has led to the development of new therapies such as bio-feedback or corrective surgery.

Solitary rectal ulcer: an unusual cause of rectal bleeding in children.

The solitary rectal ulcer syndrome (SRUS) is a disease which is commonly diagnosed in adults but only rarely described in children. Rectal prolapse and intussusception are frequently associated with this entity. A relationship between SRUS and chronic constipation due to spastic pelvic floor syndrome (SPFS) is often observed. Thus biofeedback defaecation training is an efficient treatment of both conditions. We describe two paediatric patients suffering from SRUS associated with SPFS who showed complete recovery after biofeedback defaecation training.

[Age- and sex-specific standard values of colonic transit time in healthy subjects]. / Alters- und geschlechtsspezifische Normwerte der Dickdarmtransitzeit bei Gesunden.

Use of radiopaque markers with a plain X-ray of the abdomen is a simple technique to measure mean segmental and total colonic transit time. We evaluated 128 healthy volunteers with a mean age of 40 years (range 20-81 years) from three different parts of Switzerland to assess age and sex specific normal transit times. In men and women colonic transit time was not influenced by age. The mean transit time was significantly shorter in men than in women (30 +/- 2 hours versus 41 +/- 3 hours: p less than 0.05). In men the transit time was also influenced by smoking. Non-smoking men had a significantly shorter transit time than smokers (26 +/- 2 hours versus 40 +/- 5 hours: p less than 0.05). In women, neither smoking nor the menstrual cycle influenced transit time. For normal colonic transit time we recommend up to 66 hours for smoking men, up to 44 hours for non-smoking men and up to 70 hours in general for women.

Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome.

Sensory and pressure responses to gastric distension were evaluated in 24 consecutive patients suffering from chronic idiopathic dyspepsia and 20 healthy subjects. A latex balloon was placed in the proximal stomach and inflated by increments of 100 ml of air up to a maximal volume of 800 ml. Symptom response and intragastric pressure-volume curve were recorded during the gradual balloon distension. Thirteen of the 24 patients experienced pain at a distension volume less than or equal to 400 ml of air, but only one of the 20 controls (P less than 0.001). Intragastric pressure-volume curves were similar in patients and controls, and in patients with and without abnormal pain threshold, suggesting that a compliance defect was not the cause of the sensory anomaly. Gastric emptying of solids and liquids was measured in 20 of the 24 patients using a dual isotopic technique; psychological status was also evaluated in 18 patients using the Mini-Mult test. The frequency of the sensory anomaly was not different in patients with (7/14) or without (4/6) gastric stasis, but was lower in patients with (5/13) than in those without psychological disturbances (5/5, P less than 0.01). Thus, a primary visceral sensory anomaly, either alone or in conjunction with motility disturbances, can play an important role in chronic idiopathic dyspepsia and must be taken in account for further therapeutic research.

[Ischemic colitis. Results of conservative treatment]. / La colite ischémique. Résultats du traitement conservateur.

34 consecutive patients were admitted for ischemic colitis confirmed by colonoscopy, contrast enema, laparotomy, and/or post-mortem between 1984 and 1988. 13 underwent excisional surgery, usually at an early stage, because of acute abdomen. This study is devoted to the remaining 21 patients (62%), i.e. nearly two thirds of the whole series, who were treated conservatively (intravenous hydration and antibiotics). Our results suggest that (1) ischemic colitis usually affects elderly patients in whom an underlying cardiovascular disease is seldom found; (2) the right colon is infrequently involved, and (3) outcome is generally favorable in the absence of superimposed major pathology or of peritoneal signs which would require surgical exploration.

[Terminal constipation: priority for anorectal manometry]. / Constipation terminale: priorité à la manométrie ano-rectale.

Terminal constipation is a common ailment which may be readily suspected by appropriate questioning of the patient. Investigation is by function tests such as anorectal manometry and measurement of colonic transit time. The goal of this investigation was to explore the relative merits of these two methods in terminal constipation. Measurement of colonic transit time did not make it possible to distinguish terminal from other forms of constipation, whereas anorectal manometry allowed this distinction and, in cases of terminal constipation, provided information on the physiopathological mechanisms, thereby permitting appropriate anorectal reeducation by biofeedback. We conclude that, once an organic cause has been excluded by coloscopy, anorectal manometry is the investigation of choice in terminal constipation.

[Conservative treatment of esophageal perforations following pneumatic dilatation]. / Traitement conservateur des perforations oesophagiennes après dilatation pneumatique.

Over a 15-year period we have treated 50 patients with achalasia by pneumatic dilatation (61 dilatations). Perforation occurred in 5 patients, 2 of whom required surgery while the other 3 were successfully managed by conservative means. These 3 patients are reported on with reference to the indications and modalities of the medical treatment.

[Constipation and incontinence: significance of colonic transit time, anorectal manometry and defecography]. / Constipation et incontinence: intérêt du temps de transit colique, de la manométrie ano-rectale et de la défécographie.

Constipation and fecal incontinence are frequent motives of gastroenterological consultation. An etiological diagnosis can often be suspected from the history and can be confirmed by functional testing. We here report our experience with the measurement of colonic transit time (TTC), anorectal manometry (MAR) and defecography (D). Whilst TTC was unhelpful, MAR revealed abdomino-pelvic asynchrony (anismus) in 60 constipated patients and 7 (47%) of 15 incontinent patients. Perineal descent was suspected in 25 constipated patients and confirmed by defecography, which also revealed associated static pelvic disorders. Our experience confirms the role of functional exploration in the investigation of constipation and fecal incontinence and permits a more precise therapeutic approach.

[Treatment of achalasia using balloon dilatation]. / Traitement de l'achalasie par dilatation pneumatique.

40 patients with achalasia underwent pneumatic dilatation. 25 were followed up for a mean duration of 3.96 years. Digestive symptoms disappeared in 32% of cases, were diminished in 40% and remained unchanged in 28%. In 8 patients oesophageal manometry after dilatation showed a significant reduction in lower oesophageal sphincter pressure. The patients showing improvement had a more marked drop in lower oesophageal sphincter pressure, lower residual pressure in the lower oesophageal sphincter measured by wet swallows, and negative pressure in the oesophagus. As complications 3 patients developed oesophageal perforation with one subsequent death, and 3 symptomatic gastro-oesophageal reflux. In view of these results, we regard pneumatic dilatation as the treatment of choice in achalasia.

[Questionable usefulness of the edrophonium test in the diagnosis of non-cardiac retrosternal pain]. / Utilité discutable du test à l'édrophonium dans le diagnostic d'une douleur rétrosternale non cardiaque.

Of 69 patients with non-cardiac chest pain, one third had abnormal esophageal motility as evidenced by basal esophageal manometry. 8 patients (12%) reported chest pain during a provocation test (edrophonium). While this pain seemed similar to the spontaneous chest pain described by 7 patients, it was not associated with manometric changes in 30% of these cases. The causal relationship between disorders of esophageal motility and non-cardiac chest pain has still to be confirmed, and caution must be exercised in interpreting edrophonium tests.

[Endoscopic sclerotherapy and esophageal varices]. / Sclérose endoscopique et varices oesophagiennes.

60 consecutive patients underwent sclerotherapy for hemorrhage from ruptured esophageal varices. Sclerosis was always started within the first 48 hours. 12 patients (20%) died during initial hospitalization, but only 5 from recurrent bleeding. Of 48 survivors, 22 (46%) did not rebleed during a mean 18-month follow-up, whereas 26 (54%) had recurrences, 27 of these bleeding episodes occurred early (within 4 months) and 17 late (mean 16.5 months). Eradication of the varices was achieved in 29 patients (60%) with a mean of 6.2 sessions and within a mean of 6 months. Of these 48 patients 2 have been lost to follow-up, 25 (52%) are alive after a mean follow-up of 29 months, and 21 (44%) died (though only 2 from variceal bleeding). The survival curve (Kaplan-Meier) of these 60 bleeders is 45% and 37% at 2 and 4 years respectively. Sclerotherapy caused no death and only minor adverse effects. These results confirm those in the literature. We advocate endoscopic sclerosis as first choice in the treatment of ruptured esophageal varices.

[Influence of chronic renal failure on the D-xylose test in man]. / Influence de l'insuffisance rénale chronique sur le test au D-xylose chez l'homme.

The aim of this study was to investigate the effect of chronic renal insufficiency on absorption, distribution and elimination of D-xylose which was chosen as a "test substance". Pharmacokinetic analysis was based on eighteen D-xylose tests carried out either by the enteral or parenteral route in a randomized fashion on nine patients suffering from chronic renal insufficiency. These results were compared with those obtained in healthy volunteers. The renal clearance was simultaneously measured with the 51Cr-EDTA test. In the experimental conditions the intestinal absorption of D-xylose was not modified qualitatively (absorption rate) nor quantitatively (systemic availability). Inspite of this, the maximal concentration of the D-xylose was higher in these patients and was reached later than in healthy volunteers. This fact should be taken into consideration when interpreting the results of a D-xylose test in patients suffering from chronic renal insufficiency.