Effect of subtotal colectomy on gastric emptying of a solid meal in slow-transit constipation

BACKGROUND: Idiopathic slow-transit constipation is considered a panenteral disease in which patients may have delayed gastric emptying. The effects o f total abdominal colectomy and ileorectal anastomosis on upper gut motilit y are unknown. The aim of this study was to evaluate gastric emptying in pa tients with idiopathic slow-transit constipation before and after subtotal colectomy. METHODS: Gastric emptying of a solid meal was studied by scintig raphic technique in 11 patients with idiopathic slow-transit constipation. The total colonic transit time was more than 72 hours in all patients studi ed, with delay in transit in all segments of the colon. The gastric emptyin g test was repeated 3 to 6 months after total abdominal colectomy and ileor ectal anastomosis in ten of these patients. Before and after surgery, patie nts filled out a questionnaire to record upper gut symptoms. RESULTS: Solid gastric emptying was delayed (T1/2 > upper limit of normal) in 7 of 11 pat ients with idiopathic slow-transit constipation. Gastric emptying T1/2 was almost similar before and after surgery. Mean +/- standard deviation was 14 2 +/- 91 minutes before surgery and 146 +/- 67 minutes after surgery. Sympt oms of vomiting and belching improved significantly after surgery. Symptoms of nausea, bloating, and pyrosis also decreased, but these changes failed to reach statistical significance. CONCLUSION: Despite a reduction in upper gut symptoms, total abdominal colectomy and ileorectal anastomosis does no t improve delayed gastric emptying in patients with idiopathic slow-transit constipation.