GASTRIC-EMPTYING IN PATIENTS WITH CONSTIPATION FOLLOWING CHILDBIRTH AND DUE TO IDIOPATHIC SLOW TRANSIT

Background Idiopathic slow transit constipation (ISTC) is considered t o be a heterogeneous condition in which patients have varying sites an d degrees of delayed gastrointestinal transit. The majority of patient s have pancolonic disease, and colectomy with ileocolorectal anastomos is has been the mainstay of surgical treatment. Severe constipation fo llowing traumatic childbirth is now being recognized and this subgroup of patients may have delayed transit confined to the rectosigmoid col on. In theory, proximal transit in these patients should be normal. Me thods Gastric emptying was studied in patients with constipation follo wing childbirth or ISTC and in controls. After an overnight fast, both patients and controls received breakfast, which consisted of cornflak es, sugar and milk. The liquid marker In-111-labelled di-ethylene tri- amine penta-acetic acid (DTPA) was added to the milk. A solid marker, Tc-99m-labelled colloid, was impregnated on to paper and sealed with c ellulose. The t(1/2) for gastric emptying was calculated. Results Liqu id phase emptying was normal in both constipation following childbirth and ISTC. Solid phase emptying was delayed significantly in ISTC comp ared with that in patients with constipation following childbirth and controls. In addition, half the patients with ISTC had delayed transit through the small bowel and proximal colon. Small bowel and colonic t ransit were normal in patients with constipation following childbirth. Conclusion Patients with constipation following childbirth represent a distinct subgroup with normal proximal gastrointestinal function. Ga stric emptying studies may be helpful in selecting patients for surgic al management of severe constipation.