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
ARTICLE HIGHLIGHTS
Research background

Patients with irritable bowel syndrome (IBS) experience abdominal pain and irregularities of stool form and passage frequency. The prevalence ranges from 9%-23%, and IBS imposes profound burdens on patients, physicians, and the healthcare system. The pathophysiology is poorly understood.

Research motivation

Faecal retention is suspected to play a role in IBS symptoms. However, few colonic transit studies exist, and none have included simultaneous determination of colonic faecal content. Such information would likely have implications for choice of therapeutic decisions.

Research objectives

The present case-control study was performed to compare colonic transit time (CTT) and faecal load between IBS-patients and healthy controls. We further aimed to compare these parameters in patients before and after treatment with a prokinetic regime.

Research methods

CTT and faecal load were measured by performing a marker study. IBS-patients swallowed a capsule containing 24 radiopaque markers, and abdominal X-rays were taken after 48 h and 96 h. Control subjects ingested 24 markers at the same time for 6 d, followed by an X-ray on day 7. For both groups, CTT was calculated in hours, and a faecal load score was estimated.

Research results

Compared to 44 healthy controls, 140 IBS-patients exhibited a significantly prolonged mean CTT (45.48 h vs 24.75 h, P < 0.001) and a significantly greater mean faecal loading scores in each colonic segment (P < 0.001). After the intervention, the mean CTT in IBS-patients was reduced from 45.48 h to 34.50 h (P > 0.05), with the post-treatment CTT not significantly differing from the CTT among control subjects (P > 0.05). Moreover, following treatment, half of the patients were relieved from bloating, and the majority no longer experienced abdominal pain and had achieved a consistent daily stool.

Research conclusions

IBS-patients were examined by using a new method comprising the simultaneous determination of CTT and faecal load. Our results showed a significantly prolonged CTT and significantly heavier faecal loading in IBS-patients compared to healthy control persons. These findings may contribute to the IBS symptoms, which were relieved to some degree following treatment with a prokinetic regime. Studies are needed to examine further the association between faecal retention and symptoms.

Research perspectives

Simultaneous measurement of CTT and faecal load may serve as a diagnostic tool for investigating IBS-patients and could also be extended for use in patients with other bowel disorders. This method may also be useful for monitoring the effects of different treatment regimens.