Skip to main content
SpringerLink
Log in

Limitations of indirect methods of estimating small bowel transit in man

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Experiments were carried out in healthy volunteers to explore the utility of a new [14C]lactulose breath test for measuring small intestinal transit time in man and to use this procedure to test whether two antidiarrheal agents, codeine and clonidine, alter small intestinal transit time during digestion of a liquid meal. In an initial validation study performed in 12 subjects (three studies in each subject), a liquid test meal containing 10 g [14C]lactulose was administered and the colonic entry time estimated from the time course of14CO2 excretion in breath compared with that of H2 excretion. There was a fair correlation (r=0.77;P<0.001) between results obtained by the two methods; both methods gave similar results, but14CO2 output was delayed when compared to H2 output and was incomplete. The meal also contained xylose and [13C]glycine, permitting the duodenal entry time of the meal to be estimated by the appearance of xylose in blood and13CO2 in breath, respectively. The same liquid meal was then used to examine the effect on small intestinal transit time (colonic entry time minus duodenal entry time) of codeine or clonidine.99Tc-sulphur colloid was also added to the meal to permit a comparison of small intestinal transit estimated by imaging with that estimated by the14CO2-lactulose breath test.99Tc radioactivity appeared in the cecum (as assessed using gamma scintigraphy) about 2 hr before14CO2 radioactivity appeared in breath; the correlation between transit time estimated by the two methods was moderate (r=0.61;P<0.05). Based on the [14C]lactulose data, small intestinal transit time ranged from<1 to 3 hr for a liquid meal containing 10 g lactulose; within-subject variation (coefficient of variation 17%) was considerably less than between-subject variation (coefficient of variation 56%). Codeine increased the small intestinal transit time significantly (from 2.7±0.3 hr to 5.0 ±0.9 hr; mean±SE), whereas clonidine did not alter small intestinal transit time, as estimated by the colonic entry time minus duodenal entry time. Neither drug influenced duodenal entry time. These results suggest that the [14C]lactulose breath test, which has only moderate accuracy, may have occasional utility as a convenient, noninvasive method for estimating small intestinal transit time in man. However, this study also suggests that indirect methods of estimating small bowel transit in man have limitations, variability, and possibly may lack the desired sensitivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schiller LR, Davis GR, Santa Ana CA, Morawski SG, Fordtran JS: Studies of the mechanisms of the antidiarrheal effect of codeine. J Clin Invest 70:999–1008, 1982

    Google Scholar 

  2. Schiller LR, Santa Ana CA, Morawski SG, Fordtran JS: Mechanism of the antidiarrheal effect of loperamide. Gastroenterology 86:1475–1480, 1984

    Google Scholar 

  3. Bond JH Jr, Levitt MD: Investigation of small bowell transit time in man utilizing pulmonary hydrogen (H2) measurements. J Lab Clin Med 85:546–555, 1975

    Google Scholar 

  4. Perman JA, Modler S, Barr RG, Rosenthal P: Fasting breath hydrogen concentration: normal values and clinical application. Gastroenterology 87:1358–1363, 1984

    Google Scholar 

  5. Bond JH, Levitt MD: Effect of dietary fiber on intestinal gas production and small bowel transit time in man. Am J Clin Nutr 31:S169-S174, 1978

    Google Scholar 

  6. Nguyen KN, Welch JD, Manion CV, Ficken VJ: Effect of fiber on breath hydrogen response and symptoms after oral lactose in lactose malabsorbers. Am J Clin Nutr 35:1347–1351, 1982

    Google Scholar 

  7. Korth H, Muller I, Erckenbrecht JF, Wienbeck M: Breath hydrogen as a test for gastrointestinal transit. Hepatogastroenterology 31:282–284, 1984

    Google Scholar 

  8. LaBrooy SJ, Male PJ, Beavis AK, Misiewicz JJ: Assessment of the reproducibility of the lactulose H2 breath test as a measure of mouth to caecum transit time. Gut 24:893–896, 1983

    Google Scholar 

  9. Read NW, Miles CA, Fisher D, Holgate AM, Kine ND, Mitchell MA, Reeve AM, Roche TB, Walker M: Transit of a meal through the stomach, small intestine, and colon in normal subjects and its role in the pathogenesis of diarrhea. Gastroenterology 79:1276–1282, 1980

    Google Scholar 

  10. Read NW, Al-Janabi MN, Edwards CA, Barber DC: Relationship between postprandial motor activity in the human small intestine and the gastrointestinal transit of food. Gastroenterology 86:721–727, 1984

    Google Scholar 

  11. Read NW, Cammack J, Edwards C, Holgate AM, Canan PA, Brown C: Is the transit time of a meal through the small intestine related to the rate at which it leaves the stomach. Gut 23:824–828, 1982

    Google Scholar 

  12. Corbett CL, Thomas S, Read NW, Hobson N, Bergman I, Holdsworth CD: Electrochemical detector for breath hydrogen determination: Measurement of small bowel transit time in normal subjects and patients with the irritable bowel syndrome. Gut 22:836–840, 1981

    Google Scholar 

  13. Malagelada JR, Robertson JS, Brown ML, Remington M, Duenes JA, Thomforde GM, Carryer PW: Intestinal transit of solid and liquid components of a meal in health. Gastroenterology 87:1255–1263, 1984

    Google Scholar 

  14. Fromm H, Thomas PJ, Hofmann AF: Sensitivity and specificity in tests of distal ileal function: Prospective comparison of bile acid and vitamin B12 absorption in ileal resection patients. Gastroenterology 64:1077–1090, 1973

    Google Scholar 

  15. Newcomer AD, McGill DB, Thomas PJ, Hofmann AF: Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med 293:1232–1236, 1975

    Google Scholar 

  16. Trinder P: Micro-determination of xylose in plasma. Analyst 100:12–15, 1975

    Google Scholar 

  17. Schoeller DA, Klein PD: A microprocessor-controlled mass spectrometer for the fully automated purification and isotopic analysis of breath CO2. Biomed Mass Spectrom 6:350–355, 1979

    Google Scholar 

  18. Snedecor GW, Cochran WG: Statistical Methods, 6th ed. Ames, Iowa, Iowa State University Press, 1967

    Google Scholar 

  19. Caride VJ, Prokop EK, Troncale FJ, Buddoura W, Winchenbach K, McCallum RW: Scintigraphic determination of small intestinal transit time: Comparison with the hydrogen breath technique. Gastroenterology 86:714–720, 1984

    Google Scholar 

  20. Bond JH, Currier BE, Buchwald H, Levitt MD: Colonic conservation of malabsorbed carbohydrate. Gastroenterology 78:444–447, 1980

    Google Scholar 

  21. Ruppin H, Bar-Meir S, Soergel KH, Wood CM, Schmitt MG Jr: Absorption of short chain fatty acids by the colon. Gastroenterology 78:1500–1507, 1980

    Google Scholar 

  22. Irving CS, Wong WW, Shulman RJ, O'Brian Smith E, Klein PD:13C Bicarbonate kinetics in humans: Intra-vs interindividual variations. Am J Physiol 245:R190-R202, 1983

    Google Scholar 

  23. Meyer JH: Gastric emptying of ordinary food: Effect of antrum on particle size. Am J Physiol 239:G133-G135, 1980

    Google Scholar 

  24. Lagerlof HO, Johansson C, Ekelund K: Studies on gastrointestinal interactions. VI. Intestinal flow, mean transit time and mixing after composite meals in man. Scand J Gastroenterol 9:261–270, 1974

    Google Scholar 

  25. Nimmo WS, Wilson J, Prescott LF: Narcotic analgesics and delayed gastric emptying during labour. Lancet 1:890–893, 1975

    Google Scholar 

  26. Nimmo WS, Heading RC, Wilson J, Tothill P, Prescott LF: Inhibition of gastric emptying and drug absorption by narcotic analgesics. Br J Clin Pharmacol 2:509–513, 1975

    Google Scholar 

  27. Ingram DM, Catchpole BN: Effect of opiates on gastroduodenal motility following surgical operation. Dig Dis Sci 26:989–992, 1981

    Google Scholar 

  28. Bitar KN, Makhlouf GM: Opiate receptors are present on circular and selectively absent from longitudinal muscle cells of the intestine. Gastroenterology 84:1107, 1983 (abstract)

    Google Scholar 

  29. Weisbrodt NW: Motility of the small intestine.In Physiology of the Gastrointestinal Tract, Vol 1. LR Johnson (ed) New York, Raven Press, 1981, pp 411–443

    Google Scholar 

  30. Christensen J: Motility of the colon.In Physiology of the Gastrointestinal Tract, Volume 1. LR Johnson (ed) New York, Raven Press, 1981, pp 455–471

    Google Scholar 

  31. Ruwart MJ, Klepper MS, Rush BD: Clonidine delays small intestinal transit in the rat. J Pharmacol Exp Ther 212:487–490, 1980

    Google Scholar 

  32. Schiller LR, Santa Ana CA, Morawski SG, Fordtran JS: Studies of the antidiarrheal action of clonidine: Effects on motility and intestinal absorption. Gastroenterology 89:982–988, 1985

    Google Scholar 

  33. McArthur KE, Anderson DS, Durbin TE, Orloff MJ, Dharmsathaphorn K: Clonidine and lidamidine to inhibit watery diarrhea in a patient with lung cancer. Ann Intern Med 96:323–325, 1982

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of California at San Diego, 225 Dickinson Street, 92103, San Diego, California

    Jeffrey H. Pressman MD, Alan F. Hofmann MD, Kathryn F. Witztum MD, Stanford L. Gertler MD, Joseph H. Steinbach PhD, Kusum Stokes MD, Drew G. Kelts MD, Diane M. Stone BS, Brian R. Jones MD &  Kiertisin Dharmsathaphorn MD

  2. Division of Nuclear Medicine, Department of Radiology, University of California at San Diego, 92103, San Diego, California

    Jeffrey H. Pressman MD, Alan F. Hofmann MD, Kathryn F. Witztum MD, Stanford L. Gertler MD, Joseph H. Steinbach PhD, Kusum Stokes MD, Drew G. Kelts MD, Diane M. Stone BS, Brian R. Jones MD &  Kiertisin Dharmsathaphorn MD

  3. Division of Pediatric Gastroenterology, Department of Pediatrics, University of California at San Diego, 92103, San Diego, California

    Jeffrey H. Pressman MD, Alan F. Hofmann MD, Kathryn F. Witztum MD, Stanford L. Gertler MD, Joseph H. Steinbach PhD, Kusum Stokes MD, Drew G. Kelts MD, Diane M. Stone BS, Brian R. Jones MD &  Kiertisin Dharmsathaphorn MD

Authors
  1. Jeffrey H. Pressman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alan F. Hofmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathryn F. Witztum MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stanford L. Gertler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph H. Steinbach PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kusum Stokes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Drew G. Kelts MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Diane M. Stone BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Brian R. Jones MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kiertisin Dharmsathaphorn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Drs. Pressman, Gertler, and Stokes were supported by NIH Training Grant AM 07202; Dr. Jones was a recipient of an AGA Summer Fellowship Award; and Dr. Dharmsathaphorn was a recipient of an NIH Research Career Development Award, AM 1146, as well as an AGA/Glaxo Research Scholar Award.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pressman, J.H., Hofmann, A.F., Witztum, K.F. et al. Limitations of indirect methods of estimating small bowel transit in man. Digest Dis Sci 32, 689–699 (1987). https://doi.org/10.1007/BF01296133

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01296133

Key Words

Search

Navigation