Indications / Directions

Measurement of Colonic Transit Time with Radiopaque Markers

Measurement of colonic transit time with radiopaque markers is a useful diagnostic test in the investigation and assessment of many gastrointestinal disorders, and is considered (by most gastroenterologists) as the gold standard for measurement both in adults and children. The severity of the transit problem is quantifiable by the transit test and the result may be an important variable; it may facilitate the decision on further diagnostic procedures, it effects the choice of therapy and long-term prognosis.

The technique provides valuable clinical information and has been proven to be reliable and reproducible. A colonic transit test may also be useful for exclusion of more generalized motor disturbance that might preclude a surgical approach. The technique provides a robust, inexpensive, and practical measurement and is easy to set up at every unit having a device for X-ray.

Evaluate colonic transit from a single radiograph

Transit-Pelletsmethod™ combine with Transit-Pellets™ radiopaque markers, have the sensitivity to disclose gender differences, pathophysiological abnormalities in colonic transit time, and pharmacological effects and can be used for assessment of colonic transit time as part of a one-visit transit evaluation. All measurements are performed on the seventh day and will provide a comprehensive colonic transit profile calculated from a single radiograph. The method can differentiate between normal, delayed and rapid colonic transit in men and women and assess transit in different colonic segments indicating e.g. colonic inertia and outlet obstruction.

Indications for colonic transit measurement

Transit-Pelletsmethod™ combined with Transit-Pellets™ radiopaque markers is particularly useful for evaluation of patients with bothersome constipation and with constipation- and diarrhoea dominated Irritable Bowel Syndrome (IBS). Unique for Transit-Pelletsmethod™ and Transit-Pellets™ radiopaque markers is the possibility to evaluate patients with chronic diarrhoea – the method can demonstrate abnormalities in transit and can be helpful for patients with e.g. bile acid diarrhoea.

Instructions for colonic transit measurement

The patient swallows ten (10) Transit-Pellets™ radiopaque markers for six consecutive days. On day seven an abdominal radiograph is taken. The interval between the first marker intake and the X-ray must be six days (approx. 144 hours). By dividing the particle dose on day six, by taking five (5) markers in the morning * and five (5) markers in the evening **, it is also possible to measure rapid transit time from the radiograph.

The principle for the execution of colonic transit test with Transit-Pelletsmethod™ and Transit-Pellets™ radiopaque markers

Times specified above are examples only.
The radiology examination should be scheduled 12 hours after the evening dose day six.

Rod-shaped radiopaque markers day six

The markers on day six have a different shape. If correctly taken, these markers should be located mainly proximal to the ring markers in the colon. If transit is slow, these markers are located in caecum ascending colon and help to delineate this segment. The rod-shaped markers can also provide important information in case of rapid transit.

Abdominal radiograph day seven

Radiology examinations should be scheduled at a time that conforms to the time of the last marker intake, i.e. 12 hours after the last dose was ingested on day six, which is prerequisite for an accurate measurement of colonic transit time with Transit-Pelletsmethod™. The number of retained markers and their location in the colon, colonic transit time of each patient is calculated and compared to reference values (Reading the Results). Note that all markers, regardless of shape, contribute to the final value.

Upper reference values in days (percentile 95) for segmental colonic transit time in adult men and women with the Transit-Pelletsmethod™ (Abrahamsson et al 1988). The total OATT values are based on measurements in 114 adult women and 85 adult men.

Transit-Pellets™ GI Monitoring System

The radiologist or any designated staff count the number of ring- and rod-shaped markers and look at how the markers are spread across the colon. Occasionally markers may be observed in the ilium. If that’s the case, those markers should be included in the total number of markers.

  • Register the result from the patient’s X-ray in Transit-Pellets™ GI Monitoring System
  • The system computes, consolidates and compare the patient’s values with reference values
  • The system generates a detailed report and reliable statistics of the current view
  • Customize and create a PDF-file for printing or saving in the medical report
  • The report and graph provides a good basis for continued treatment and contribute to a good and stimulating dialogue between physician and patient

Application of the result

  • Inform the patient!
  • Delayed transit → Intensified obstipation treatment
  • Slow transit in sigmoid colon-rectum → Investigate possible Outlet obstruction
  • Feeling of severe constipation but normal transit → Irritable Bowel Syndrome (IBS)?
  • Chronic diarrhoea and rapid transit in distal colon → Bile acid diarrhoea?

For further information, please see Clinical Instruction for Use.