서행성 만성 변비증 환자에서 위 배출능 평가

Abstract

OBJECTIVES: Slow transit type of chronic constipation can be divided into two types, colonic constipation, and generalized gastrointestinal dysmotility. However, it is debatable whether generalized GI dysmotility should be considered as upper gastrointestinal dysmotility secondary to colonic constipation or independent type of chronic constipation. In this study, we compared gastric emptying time(T1/2) of patients of chronic constipation with that of normal controls, and tried to find out any relationship between segmental colonic transit time and gastric emptying time. METHODS Twenty three patients with chronic slow transit constipation who either visited or admitted to Youngdong Severance Hospital between september 1995 to lune 1997, and 27 normal controls were recruited. Both the patients and normal controls were fed with radioopaque material and colonic transit time and gastric emptying time were measured. RESULTS 1) Seventy four percent of patients with chronic slow transit constipation showed a delayed gastric emptying time. Patients group showed a significantly delayed gastric emptying time compared with that of normal controls(110.9+/-32.3 min vs. 72.1+/-11.4 min, p<0.05). Gastric emptying time in respect to gender showed significant differences in normal controls(M=65.5+/-9.6 min, F=78.7+/-10.4 min). However, no significant difference was found in patient group(M=97.8+/-11.8 min, F=114.5+/-35.4 min). 2) In chronic slow transit constipation, colonic transit time was 48.8+/-11.7 hr. Each segments of colon showed a different transit time: Right colon 19.3+/-7.3 hr, left colon 21.2+/-12.3 hr, and rectosigmoid 8.3+/-9.2 hr. All of which were significantly delayed, compared with those of normal controls. 3) In patients group, colonic transit time of the whole colon had no significant correlation with gastric emptying time. 4) Seventy five percent of patients with chronic slow transit constipation whose right colonic transit time was delayed showed a delayed gastric emptying time. On the other hands, 63% of patients with delayed left colonic transit time had a delayed gastic emptying time. Patients with delayed gastric emptying time and those with normal gastric emptying time had no significantly different colonic transit time(49.1+/-13.2 hr vs 48.0+/-6.5 hr). CONCLUSIONS Large number of patients with chronic slow transit constipation had a delayed gastric emptying time. When surgical treatment is considered in patients with chronic slow transit constipation, it seems to be beneficial to estimate such parameters as manometry or gastric emptying time in order to evaluate functional derangement of UGI tract. These parameters may provide a guideline in treatment of chronic idiopathic constipation.