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Background

Symptoms resembling irritable bowel syndrome are reported by 41% of patients with Crohn's disease (CD) otherwise found to be in remission. The symptoms are independently associated with fatigue and reduced quality of life. Low-grade inflammation may be part of the aetiology. Additionally, motility studies indicate that gastrointestinal dysmotility is also present in quiescent CD however, such studies are scarce. In clinical practice, it is important to distinguish between symptoms caused by inflammation and those mainly caused by dysmotility since the 2 conditions should be treated differently. The aim of the present study was to assess total and regional gastrointestinal transit times in patients with CD and abdominal pain/discomfort in the absence of inflammatory activity.

Methods

Methods for ambulatory clinical evaluation of whole-gut motility are not widely available. We employed a novel, telemetric capsule system, 3D-Transit, for ambulatory evaluation of total and regional gastrointestinal transit times in 14 patients with CD. Changes in position and orientation of the ingested capsule, in relation to a detector worn by the subject during passage of the capsule, reflect the contractile activity in the different gut segments according to time. From this information transit times could be calculated. The CD patients had ileocaecal and/or colonic disease and they all suffered gastrointestinal pain/discomfort despite normal CRP and faecal calprotectin <150 mg/L. Data were compared with similar data from 20 healthy volunteers obtained with the 3D-Transit system. Non-parametric test for unpaired data was performed to test statistical significance with the significance level set at 0.05.

Results

Median total gastrointestinal transit time was 27.6 hours (9.6–56.4 h) in controls versus 47.2 hours (23.5–156.2 h) in patients with CD (P = 0.04), median gastric emptying time was 3.3 hours (0.1–5.9 h) in controls versus 3.4 hours (0.7–21.2 h) in CD (P = 0.73), median small intestinal transit time was 4.9 hours (3.4–8.3 h) in controls versus 9.4 hours (2.8–16.1 h) in CD (P = 0.66) and median colorectal transit time was 18.2 hours (1.5–43.7 h) in controls versus 26.8 hours (1.1–146.7 h) in CD (P = 0.08). Seven of the 14 (50%) patients had at least one regional transit time beyond the upper range observed in the healthy volunteers (prolonged gastric emptying n = 3, prolonged small intestinal transit time n = 2, prolonged colorectal transit time n = 3, and prolonged total gastrointestinal transit time n = 3).

Conclusions

Our study indicates that prolonged total gastrointestinal transit time and especially prolonged colorectal transit time is present in patients with quiescent CD suffering abdominal pain/discomfort. This finding is valuable in clinical practice where prokinetics and laxatives should be considered alternatives to enhanced anti-inflammatory therapy. Hence, we propose assessment of gastrointestinal transit time in this group of patients.

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Copyright © 2017 Crohn's & Colitis Foundation of America, Inc.
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