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Am J Gastroenterol. 1995 Aug;90(8):1295-300.
Delayed colonic transit in spinal cord-injured patients measured by indium-111 Amberlite scintigraphy.

Keshavarzian A, Barnes WE, Bruninga K, Nemchausky B, Mermall H, Bushnell D.

Department of Medicine, Loyola University Medical School, Maywood, Illinois, USA.

OBJECTIVE: Constipation is a major problem for patients with chronic spinal cord injury (SCI). However, it is not clear whether abnormal colonic transit is restricted to the rectosigmoid region or involves the entire colon. We assessed regional colonic transit with emphasis on the ascending and transverse segments in patients with chronic SCI and compared the results with those of controls using scintigraphic techniques. METHODS: Seven patients with SCI below T1 and 10 control subjects were studied after oral ingestion of a capsule containing indium-111-labeled Amberlite (Sigma Chemical, St. Louis, MO) pellets. The capsule was coated with a pH-sensitive polymer that prevents disintegration until it reaches the ileocecal region. Assessments of the half-time of emptying and residence time of contents in ascending and transverse segments were made, as well as an assessment of the velocity of contents throughout the entire colon, including the descending colon. RESULTS: A significantly slower half-time of emptying was found in SCI patients (ascending: 29 +/- 27 hr in SCI, 6.81 +/- 3.03 hr in controls, p < 0.01; ascending + transverse: 42 +/- 12 hr in SCI, 15.3 +/- 7.16 hr in controls, p < 0.01). The residence time of the median position of the contents was significantly prolonged in SCI patients (ascending: 31 +/- 23 hr in SCI, 8.75 +/- 4.68 hr in controls, p < 0.05; transverse: 26 +/- 3 hr in SCI, 5.0 +/- 4.4 hr in controls, p < 0.05). Overall, the velocity of the median position of contents throughout the entire colon was significantly lower in SCI (0.63 +/- 0.33 cm/hr in SCI, 2.58 +/- 1.20 cm/hr in controls, p < 0.001). CONCLUSIONS: Patients with chronic SCI have prolonged colonic

Paraplegia. 1995 Jun;33(6):308-15.
The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population.

Levi R, Hultling C, Nash MS, Seiger A.

Solberga Spinal Cord Injury Research Project, Karolinska Institute, Stockholm, Sweden.

Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention,

Dig Dis Sci. 1995 Aug;40(8):1763-9.
Comparison of bowel patterns in Hispanics and non-Hispanic whites.

Zuckerman MJ, Guerra LG, Drossman DA, Foland JA, Gregory GG.

Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso 79905, USA.

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanics whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.-Mexico border. A forced-choice, self-report questionnaire was distributed to 1014 subjects and returned by 1000. Data from the 905 Hispanic and non-Hispanic white subjects were compared. Stool frequency was analyzed by multiple linear regression, and bowel dysfunction variables were analyzed by stepwise logistic regression, in ethnic and sex groups. Data were also analyzed controlling for age, socioeconomic status, dietary factors, and use of laxatives. There was a significant sex difference in mean number of stools per week reported (P < 0.0001): Hispanic males greater than Hispanic females (8.6 vs 7.5) and non-Hispanic white males greater than non-Hispanic white females (9.3 vs 7.2). The frequency of irritable bowel syndrome-type symptoms was greater in females than in males (23.4% vs 9.6%, P < 0.001) and was less in Hispanics than non-Hispanic whites (16.9% vs 21.8%, P < 0.05), but a significant ethnic difference was not found after controlling for covariates. Additionally, females reported more alternating bowel pattern (44.0% vs 28.5%, P < 0.001) and constipation (25.5% vs 12.4%, P < 0.01) than males, and non-Hispanic white females more abdominal pain than the other subgroups (P < 0.05). Ethnic differences in dietary factors that may be relevant to bowel function were identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7648977&dopt=Abstract constipation laxative colon cleansing

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