Methods for the Assessment of Small-Bowel and Colonic Transit

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Transit assessment of the small intestine and colon is relevant in the study of physiology, pathophysiology, and pharmacodynamics, and there is increasing use of small-bowel and colonic transit measurements in clinical practice as well. The main methods that are applied in clinical practice are substrate-hydrogen breath tests for small-bowel transit and radiopaque markers for colonic transit. Over the past 2-3 decades, scintigraphy has become the preferred standard in research studies, particularly for studies of pathophysiology and pharmacodynamics. New approaches include experimental stable isotope measurement of orocecal transit and the recently approved method using a wireless motility capsule that is validated as an accurate measurement of small-bowel and colonic transit.

Section snippets

Barium Contrast Studies

The earliest and most readily available method for assessing gastrointestinal transit is contrast radiography. Barium is an imperfect substitute for intestinal chyme because it is inert and, therefore, it does not initiate events induced by the biochemical components of food. Barium also has a greater density than water, and it is hypoosmolar compared with food. Nevertheless, barium contrast studies are immensely helpful in patients with suspected motility disorders to rule out mechanical

Radiopaque Marker

Colonic transit studies are used to evaluate total and segmental colonic transit times. Radiopaque markers can be obtained commercially.

Several different methods to measure colonic transit with radiopaque markers have been described.80, 81, 82 The method that is perhaps the simplest and involves the least amount of radiation exposure is the method reported by Hinton et al.80 This involves the ingestion of a gelatin capsule containing 24 radiopaque 4.5-mm rings and performing a single plain

Acknowledgments

The authors thank Mrs Cindy Stanislav for excellent secretarial support. M.C. is supported in part by grants RO1-DK-1RC1-DK086182, R01-DK-079866, and RO1-DK-67071 from National Institutes of Health.

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