Normative Values for Colonic Transit Time and Patient Assessment of Constipation in Adults With Functional Constipation: Systematic Review With Meta-Analysis

Abstract

Availability of normative patient outcome data may assist in designing experiments and estimating sample sizes. The purpose of this review was to determine normative ranges for colonic transit time (CTT), Patient Assessment of Constipation-Symptoms (PAC-SYM), and Patient Assessment of Constipation-Quality of Life (PAC-QOL) in adults diagnosed with functional constipation per Rome III guidelines. Pooled estimates were derived from random-effects meta-analysis. Meta-regression was used to explore sources of heterogeneity among studies. A total of 24 studies (3786 patients) were included in the review. In 10 studies with 1119 patients, pooled CTT was 58 hours (95% confidence interval [CI]: 50-65 hours). Publication bias was not evident (Egger P = .51); heterogeneity was high (I2 = 92%, P < .001). In meta-regression, geographical location explained 57% of the between-study variance, with CTT significantly longer in studies conducted in Europe (71 hours) compared with Asia (49 hours) or the Americas (44 hours). In 9 studies with 2061 patients, pooled PAC-SYM was 1.70 (95% CI: 1.58-1.83). Publication bias was not evident (Egger P = .44). Heterogeneity was high (I2 = 90%, P < .001); however, no study or patient factor influenced PAC-SYM in meta-regression. In 12 studies with 1805 patients, pooled PAC-QOL was 1.97 (95% CI: 1.70-2.24). Publication bias was not evident (Egger P = .28); heterogeneity was high (I2 = 98%, P < .001). In meta-regression, age explained 52% of the between-study variance, with older age associated with lower PAC-QOL scores. Overall, in adults diagnosed with functional constipation per Rome III criteria, significant heterogeneity in CTT, PAC-SYM, and PAC-QOL exists among studies. Variability among studies may be explained by geography and patient factors.

Comparative efficacy and safety of lactulose plus paraffin vs polyethylene glycol in functional constipation: a randomised clinical study

“…The aim of this study was to demonstrate the noninferiority of lactulose plus paraffin vs PEG in the treatment of adult functional constipation. Baseline PAC-SYM scores were similar to those reported in the meta-analysis by Miller and colleagues 22 and those reported in an observational study (mean score 1.6). 23 The non-inferiority of lactulose plus paraffin to PEG was established and the change in the PAC-SYM score from baseline was greater than 1.2 points, which is markedly higher than the minimal clinically important difference of 0.5 determined by Yiannakou and colleagues.…”

“…PAC-SYM has been validated 15,24,26 and used in more than 30 clinical studies and several meta-analyses. 22,27 Although the analysis of correlation between the PAC-SYM score and stool frequency was not planned in the protocol, the pattern of change in both parameters over time was remarkably similar. This is consistent with the finding of the meta-analysis of 13 comparative studies, conducted by Shin and colleagues 27 in which both the PAC-SYM score and the proportion of patients with three or more SBMs per week were significantly improved after treatment with 5-HT agonists relative to control, with a relative risk of 1.85 and 1.47, respectively.…”

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

“…The number of markers counted on the films was interpreted as the number of hours of transit for the whole and segment of the colon. Total colon transit time (TCTT) was calculated as the total number of markers in the colon, and segmental CTT was calculated as the number of markers in the three colonic segments, referred to as the right colon CTT (RTT), left colon CTT (LTT), and rectal sigmoid CTT (RSTT), as previously described by Miller and some authors and colleagues [12]. A mean TCTT of 30 h was chosen as the standard colon transit time, in accordance with previous studies [3, 13, 14].…”

Electro‐acupuncture at ST37 and ST25 induce different effects on colonic motility via the enteric nervous system by affecting excitatory and inhibitory neurons

“…Constipation is a common clinical symptom of a wide range of diseases. Chronic constipation can reduce a patient's quality of life and cause other complications such as headaches, insomnia and anal sinusitis . The current therapeutic interventions for constipation target the strengthening of intestinal contractions.…”