Prognosis of constipation: clinical factors and colonic transit time

Abstract

Background: Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation. Aim: To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome. Methods: Between 1995 and 2000, 169 consecutive patients (median age 8.4 years, 65% boys) fulfilling the criteria for constipation were enrolled. During the intervention and follow up period, all kept a diary to record symptoms. CTT was measured at entry to the study. Results: At entry, defecation frequency was lower in girls than in boys, while the frequency of encopresis episodes was higher in boys. CTT values were significantly higher in those with a low defecation frequency ((1/week) and a high frequency of encopresis (>2/day). However, 50% had CTT values within the normal range. Successful outcome occurred more often in those with a rectal impaction. CTT results ,100 hours were not predictive of outcome. However, those with CTT .100 hours were less likely to have had a successful outcome. Conclusion: The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT .100 hours is associated with a poor outcome at one year.

Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar

“…We also observed changes in the patterns of colonic dysmotility toward normal patterns or exclusive involvement of distal colonic portions (Table 3) and fecaloma emptying, neutralizing the phrenocolonic reductive effect on the proximal motility of the digestive tube. 8,11,12 Only one study analyzed orocecal transit time during treatment and did not show its reduction, 24 in opposition to our data, which showed a decrease in this parameter using both lactulose and bean test meal. It is worth mentioning that dysmotility of the proximal digestive tube may be associated with symptoms in the upper abdomen, such as early saciety, which may disappear after fecaloma emptying.…”

“…Another aspect refers to patient severity, that is, the results from the present study cannot be extrapolated to all functionally constipated children, especially to those with less severe functional constipation who do not attend specialized clinics. 12,[26][27][28] Of the patients followed for up to 1 year after treatment, half of them still needed mineral oil to maintain an adequate bowel habit, which is consistent with the scarce information found in the literature concerning improvement of clinical symptoms of constipated patients followed for at least 1 year in specialized clinics.…”

“…In Dutch children with functional constipation treated with a therapy regimen similar to that used in the present study, the authors observed that a negative evolution after 1 year of treatment was associated with a total colonic transit time higher than 100 hours. 12 In our study, we observed that, at admission, nine (28.4%) of the 34 patients showed total colonic transit time higher than 100 hours (data not shown). After a 12-month follow-up period, six of these nine patients remained on mineral oil, confirming that a total colonic transit time higher than 100 hours at baseline assessment may be an indicator of a worse prognosis.…”

“…It is worth mentioning that dysmotility of the proximal digestive tube may be associated with symptoms in the upper abdomen, such as early saciety, which may disappear after fecaloma emptying. 6,8,10,12 Regarding total and segmental colonic transit times, it is difficult to compare our results with the few studies found in the literature, considering that distinct therapy regimens 14,16,24,25 or patients with constipation associated with neurological involvement were analyzed. 15 Regarding our patients with clinical symptoms improved upon Our data also show a higher probability of laxative need after 1 year of treatment in patients with persistence of delayed total colonic transit time at the sixth week of treatment, underscoring the importance of the initial phase of treatment.…”

“…Only a few articles have analyzed the evolution of the colonic transit time during conventional treatment of chronic constipation, some of them focusing on the effect of dietary fibers or prokinetic drugs on transit time. [12][13][14][15][16] Therefore, the objective of the present study is to analyze the effects of conventional treatment of chronic functional constipation in patients attending a referral outpatient clinic on clinical symptoms, total and segmental colonic transit times, and lactulose and bean test meal orocecal transit times. Chronic constipation was characterized by hard stools that were painful or difficult to pass, associated or not with longer intervals between evacuations, blood mixed with stools, fecal retention, and soiling for over a 3-month period.…”