Lower functional gastrointestinal disorders: evidence of abnormal colonic transit in a 287 patient cohort

Abstract

BACKGROUND Abnormalities of colonic motility were reported in relatively small studies of patients with lower functional gastrointestinal disorders (FGID) including irritable bowel syndrome (IBS). The influence of gender and body mass on the observed motor pathophysiology is unclear. We sought to compare colonic transit in patients within different lower FGID subgroups and healthy controls, controlling for gender and BMI, and to determine whether BMI independently influences colonic motility. METHODS We evaluated a scintigraphic gastrointestinal and colonic transit database of 287 lower FGID patients associated with constipation (IBS-C, or functional constipation, n = 118), diarrhoea (IBS-D or functional diarrhoea, n = 139) or mixed bowel function (IBS-M, n = 30) and 170 healthy controls. We measured colon filling at 6 h (CF 6 h), and overall colonic transit at 8, 24 and 48 h. KEY RESULTS Colon filling at 6 h did not differentiate health from FGID. Colonic transit was abnormal at 24 h (GC24 of <1.50 or >3.86) in 29.7% of all lower FGID patients. There was a significant overall association between colonic transit and subject group (healthy controls and FGID subgroups) at 8 (P = 0.01), 24 (P < 0.001) and 48 h (P < 0.001) in particular for those with diarrhoea or constipation at 24 and 48 h (P < 0.05), even after adjusting for age, gender and BMI. In addition, BMI was associated with colonic transit after adjusting for age, gender and subject group. CONCLUSIONS & INFERENCES Abnormal transit is documented non-invasively with scintigraphy in 30% of lower FGID patients; transit measurement may help document pathophysiology and inform selection of therapy in lower FGID.

Figure 1a

Histograms showing distribution of GC24 for healthy controls and for patients with each lower FGID subtype. The 10th and 90th percentile cut off are defined using the distribution of the healthy control sample for GC24.

Figure 1b

Histograms showing distribution of GC48 for healthy controls and for patients with each lower FGID subtype. The 10th and 90th percentile cut off are defined using the distribution of the healthy control sample for GC48.

Figure 2

Comparison of colonic GC at 8, 24 and 48 hours in healthy controls and lower FGID patients with different types of bowel dysfunction. *P <0.05; **P <0.01

Figure 3

Comparison of least square means for colonic GC at 8, 24 and 48 hours among 3 groups according to the BMI values. **P <0.01 versus BMI >30 kg/m²; P=0.018 versus BMI >30 kg/m²