Bran tablets and diverticular disease

A new method for the determination of gastrointestinal transit times

A new method for the determination of the gastrointestinal transit time (TT) is described. The normal range of the TT was 40--95 h in 58 normal subjects. No age or sex variation of the TT was disclosed. In 25 out-patients with the irritable bowel syndrome the TT was determined before and after 3 weeks' treatment with Vi-Siblin. Of these patients, 20% initially showed a prolonged TT; this decreased during treatment with Vi-Siblin. In the patients with normal TT, this remained unchanged during the treatment. Our study suggests that patients with long TT, long intervals between bowel movements, and frequent attacks of colicky abdominal pain may derive benefit from a plant fibre supplement to their diet. The method for the determination of the TT described is well suited to out-patient studies--also in large populations--since it is relatively easy to perform, stool collection is unnecessary, and the method shows good reproducibility.

Comparison of rectosigmoid myoelectrical activity in the irritable colon syndrome during relapses and remissions

Recent studies have suggested that a high incidence of 0.05 Hz (3 c/m) slow wave electrical activity is present within the rectosigmoid of patients with the irritable colon syndrome during symptomatic phases. However, it is known that this is a chronic relapsing disorder and in this study we have compared myoelectrical recordings, using an on-line frequency analyser, during periods of severe symptoms and asymptomatic phases. Treatment with either bran (in the form of bran tablets) or an antispasmodic resulted in 12 of the 20 patients becoming free from symptoms after one to three months. In those patients who were initially constipated a statistically significant increase in mean stool weight and a decrease in mean transit time occurred, but this was not associated with any alteration in either percentage motility or electrical activity. In patients with predominant diarrhoea no statistically significant difference occurred in either transit time or stool weight after treatment nor did the abnormal myoelectrical activity return towards normal with symptomatic improvement. These results suggest that a fixed basic myoelectrical abnormality exists which is unrelated to symptoms. This may help to explain the chronic relapsing nature of the irritable colon syndrome.

Sigmoid motility and clinical results after transverse taeniamyotomy for diverticular disease

The purpose of our investigation was to evaluate the effect of multiple transverse taeniamyotomy on sigmoid motility and on the clinical picture of 8 patients affected by symptomatic, uncomplicated diverticular disease of the sigmoid, selected for the operation after the failure of medical therapy. We recorded rectosigmoid intraluminal pressures and the manometric tracings were correlated with the corresponding photofluorograms before and after the operation for 1 year.

Motility indices were computed and a significant decrease after meals and Prostigmin was found in patients who underwent transverse taeniamyotomy. These functional changes were accompanied by a marked clinical recovery, expressed in terms of relief from lower abdominal pain and improvement in bowel movements.

Considering the functional and clinical disadvantages reported after colectomy and longitudinal myotomy, and observing our results after transverse taeniamyotomy, even though they are short term results, we conclude that the latter operation is an effective procedure for the treatment of diverticular disease with muscular hypertrophy and high intracolonic pressure which has not responded to a medical and dietetic regimen.

Is there a myoelectrical abnormality in the irritable colon syndrome?

Although recent work has suggested that an abnormality of the 0.05 Hz (3 c/m) slow wave electrical activity exists in the distal colon of patients with the irritable colon syndrome, it is not established whether this is related to altered bowel habit alone, or whether it is specific to the irritable colon syndrome. We have therefore studied 10 patients referred with this disorder and compared their colonic myoelectrical pattern with 10 patients suffering from assorted disorders with similar symptoms--for example, chronic pancreatitis, diverticular disease, ulcerative colitis, etc. Transit time, stool weights, percentage motility, and slow wave electrical activity were measured in each patient. The two groups were well matched for age and patients with similar symptoms in the two groups had similar values for transit time and percentage motility. There was a statistically significant increase in the 3 c/m electrical activity in patients with the irritable colon syndrome unrelated to the degree of diarrhoea or constipation. It would appear, therefore, that the abnormally high incidence of 3 c/m electrical activity in the colon is specific to the irritable colon syndrome and not merely a feature of altered bowel habit.

Effects of bran on serum cholesterol, faecal mass, fat, bile acids and neutral sterols, and biliary lipids in patients with diverticular disease of the colon

Twenty-two patients with symptomatic diverticular disease of the colon were randomly allocated to control and high-fibre groups so that the long-term effect (up to 12 months) of bran on serum, faecal and biliary lipids could be studied. Even in cases of high initial values, faecal mass was increased by bran and the change was positively correlated with the change in dietary fibre. Faecal fat and dry weight were also increased. Faecal bile acids were initially slightly raised and were positively correlated with wet weight both off and on bran. The latter significantly decreased the excretion and concentration of bile acids, in particular the high initial values. The change in bile acids was not correlated with the change in dietary fibre or faecal wet weight. Sterol balance values indicated that the bran-induced decrease in faecal bile acids was associated with a lower cholesterol synthesis. Serum cholesterol decreased significantly in two hypercholesterolaemic individuals only. Correlations between different parameters revealed that the higher the initial level or the greater the drop in cholesterol synthesis, the greater the decrease in serum cholesterol. Bran had no effect on the biliary saturation of cholesterol. The percentage of biliary deoxycholate was negatively correlated with faecal mass (less so with faecal bile acid output) both before and during bran and was significantly decreased by bran. The percentage of cholic acid increased correspondingly and that of chenodeoxycholate remained unchanged. Faecal bile acids also indicated that the synthesis of the two primary bile acids was lowered by bran to the same degree.

Results of colectomy for diverticular disease of the colon

A retrospective study of 71 patients who had a colonic resection for diverticular disease at one hospital during a 7-year period was undertaken. Patients were divided into those undergoing surgery for complications of diverticular disease (49) and those in whom abdominal pain and an altered bowel habit were attributed to the presence of diverticular disease in the absence of any detectable complication (22). In both groups major complications occurred after operation. The incidence of complications was greater when surgery was undertaken in stages to effect colonic resection and restoration of intestinal continuity. Symptoms were more often cured or relieved in those patients undergoing surgery for complicated diverticular disease than in those with 'uncomplicated' disease. These poor results may be due to incorrectly attributing symptoms to diverticula which happened to be present.