Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jan 5, 2021; 12(1): 13-20
Published online Jan 5, 2021. doi: 10.4292/wjgpt.v12.i1.13
Increased colon transit time and faecal load in irritable bowel syndrome
Dennis Raahave, Andreas K Jensen
Dennis Raahave, Department of Gastroenterology and Surgery, Copenhagen University North Sealand Hospital, Hilleroed 3400, Denmark
Andreas K Jensen, Faculty of Health Sciences, Section of Biostatistics, University of Copenhagen, Hilleroed 3400, Denmark
Author contributions: Raahave D and Jensen AK designed and performed the study and wrote and approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Scientific Committee, Department of Gastroenterology and Surgery, Copenhagen University North Sealand Hospital Institutional Review Board.
Informed consent statement: All patients and control persons provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dennis Raahave, DSc, MD, PhD, Consultant Physician-Scientist, Senior Researcher, Department of Gastroenterology and Surgery, Copenhagen University North Sealand Hospital, Dyrehavevej 29, Hilleroed 3400, Denmark. dr.dr@dadlnet.dk
Received: October 20, 2020
Peer-review started: October 20, 2020
First decision: October 27, 2020
Revised: November 26, 2020
Accepted: December 4, 2020
Article in press: December 4, 2020
Published online: January 5, 2021
Abstract
BACKGROUND

Irritable bowel syndrome (IBS) is a bowel disorder involving abdominal pain or discomfort along with irregularity of stool form and passage frequency. The pathophysiology is poorly understood and seems to be multifactorial. Investigations of possible causes of IBS have included only a few colonic transit studies and no simultaneous determination of the colonic faecal content.

AIM

To compare colon transit time and faecal load between IBS-patients and healthy control subjects.

METHODS

The study included 140 patients with IBS, with a mean age of 50.0 years. The control group comprised 44 healthy persons with a mean age of 43.4 years, who were selected at random from the National Civil Register. Both the patient group and the control group underwent a marker study to measure colon transit time (CTT) and to calculate a faecal loading score. The patient group underwent treatment with a combined prokinetic regime, after which their CTT and faecal loading were reassessed. Analyses were performed to compare measurements between the control group and the patient group before and after treatment.

RESULTS

Compared to healthy controls, IBS-patients exhibited a significantly prolonged mean CTT (45.48 h vs 24.75 h, P = 0.0002) and significantly greater mean faecal loading scores in all colonic segments (P < 0.001). Among IBS patients, we found no significant differences between the 48 h and 96 h radiographs. Among patients exhibiting increased CTT and faecal loading, approximately half exhibited a palpable mass in the right iliac fossa. After intervention with a prokinetic treatment, the mean CTT among IBS patients was reduced from 45.48 h to 34.50 h (P = 0.091), with the post-treatment CTT not significantly differing from the CTT among control subjects (P = 0.095). The faecal loading score among IBS patients did not significantly differ before and after treatment (P = 0.442). The post-treatment faecal loading score in IBS patients remained significantly higher compared to that in controls (5.3 vs 4.3, P = 0.014). After treatment, half of the IBS-patients were relieved of bloating, while the majority no longer experienced abdominal pain and achieved a daily consistent stool.

CONCLUSION

IBS-patients exhibited prolonged CTT and heavier faecal loading. These assessments may aid in diagnosis. Faecal retention may contribute to IBS symptoms, which can be treated using a prokinetic regime.

Keywords: Irritable bowel syndrome, Functional bowel disease, Faecal retention, Colon transit time, Faecal load

Core Tip: Patients with irritable bowel syndrome (IBS) exhibit a significant prolonged colon transit time (CTT) and greater faecal loading compared to healthy people. This finding adds to our understanding of IBS since faecal retention may lead to major symptoms like abdominal bloating and pain and defaecation disturbances. The targeted therapy was a prokinetic regime. All the more, CTT/faecal load may serve as a diagnostic procedure.