# Rapid Small Bowel Transit Time



## 16088 (Apr 19, 2007)

I Have IBS with constant upper stomach pain. My last test was a small bowel series. I got a copy of the report but have not seen my doctor yet. All normal again except it said I had rapid transit time. Has anyone else been told they have this ? Also, I know most people with IBS do not do well with dairy. I used to eat very little or none at al. But since I drink non fat milk my D has stopped but not the pain? I don't know if this will help anyone else.Fairy


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## flux (Dec 13, 1998)

Fairy1 said:


> I Have IBS with constant upper stomach pain. My last test was a small bowel series. I got a copy of the report but have not seen my doctor yet. All normal again except it said I had rapid transit time. Has anyone else been told they have this ?


Some people have, but you and they most likely do _not_ have a "rapid transit time". This test is just an indication of how fast barium moves through system, not food. Food is very different and one cannot use this test to gauge the true food transit time.


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## kpv (Jan 17, 2005)

I was diagnosed with "Rapid Transit" as my main problem. My Barium test we over in 10 minutes the liquid went through me so fast. My Doctor said that was my main issue and was the first time he put me on Lomotil to slow my Gut down and it worked wonders at the time.


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## flux (Dec 13, 1998)

kpv said:


> I was diagnosed with "Rapid Transit" as my main problem. My Barium test we over in 10 minutes the liquid went through me so fast. My Doctor said that was my main issue and was the first time he put me on Lomotil to slow my Gut down and it worked wonders at the time.


This is an example of what I was referring to earlier. You do not have rapid transit. I imagine you'd probably had diarrhea and the Lomotil can be used to treat that. It actually works mainly by decreasing secretion and increasing absorption. It doesn't really slow down the gut. Whatever your problem, it was not "rapid transit" This just may have been your misunderstanding of your doctor's explanation, or perhaps your doctor misunderstands your condition.







There actually is no condition known to medical science as "rapid transit".


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## kpv (Jan 17, 2005)

Thats the first I have heard of that, Thanks for the info FLux. I have had 2 doctors (Gastro) diagnose me with Rapid Transit. Guess its more a condition than anythign else.They both explained that since my body digested to fast it was casuing my diarrhea and pain. But your right I cant ever find anyone else who evens knows what Rapid Transit is.


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## flux (Dec 13, 1998)

> I have had 2 doctors (Gastro) diagnose me with Rapid Transit. Guess its more a condition than anythign else.They both explained that since my body digested to fast it was casuing my diarrhea and pain


It sounds like you have IBS and the doctors for some odd reason (they both went to a Martian medical school, perhaps), are mislabeling your condition as "rapid transit"."Rapid transit" can occur, but is generally iatrogenic, something that results from some medical intervention, such as a surgery that removes part of the small intestine. And even then it's not really rapid transit, but rather "shortened transit" since the remaining intestine is not moving digesta too fast; there just isn't enough of it get the job done. People who have it have steatorrhea and for that reason must eat a very high fat diet to get back what's lost or if enough intestine is lost, they must be fed intravenously. Recently, there have attempts to surgically remove a segment of remaining intestine and put back in backwards to slow down total transit time to give food more time to absorb.


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## kpv (Jan 17, 2005)

My current doctor just plian diagnosed me as IBS , I mentioned the RT and he didnt seem much concerend about it. Most of my Doctors up until the last few years seemed to have attneded Martian shool. LOL. They were clueless about IBS and basically said it was in my head.


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## TimidTummy (May 31, 2007)

Your post really interested me because my sister had a similar finding on an upper GI series. My father and I both have symptoms consistent with IBS, and my sister has also had bouts of unexplained abdominal pain. She had an upper GI once when she went to the ER for pain. On the first image after she drank the contrast (I think it was 10-15 minutes), the contrast had already passed all the way through the small intestine and was in her colon. They stopped the test.I don't know what to make of that aside from that it must be related to abnormal GI motility.


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## flux (Dec 13, 1998)

TimidTummy said:


> I don't know what to make of that aside from that it must be related to abnormal GI motility.


If the barium got stuck, something would be wrong; otherwise, no reason to think it's abnormal.


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## TimidTummy (May 31, 2007)

flux said:


> If the barium got stuck, something would be wrong; otherwise, no reason to think it's abnormal.


Most people have a small bowel transit time of 30 min - 3 hours, so <10-15 minutes falls outside the range of most people. When a rapid transit time is coupled with symptoms, I would disagree with you and say there is a reason to think it's abnormal. Several studies have documented statistically significant decreases in small bowel transit time in IBS patients versus controls, and there are plausible theories on how this could lead to symptom production. See:Cann P.A., Read N.W., Brown C.. Irritable bowel syndrome: Relationship of disorders in the transit of a single solid meal to symptom patterns. Gut 1983;24:405-411.John M Hebden M.D, Elaine Blackshaw, Massimo D'Amato M.D, Alan C Perkins Ph.D, Robin C Spiller M.D (2002) Abnormalities of GI transit in bloated irritable bowel syndrome: effect of bran on transit and symptoms The American Journal of Gastroenterology 97 (9), 2315-2320http://www.ajronline.org/cgi/reprint/174/3/866


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## flux (Dec 13, 1998)

TimidTummy said:


> Most people have a small bowel transit time of 30 min - 3 hours, so <10-15 minutes falls outside the range of most people.


Only that's *not* the range of small bowel transit time, that's the range of barium transit, which is clinically meaningless unless the barium gets stuck.Testing small bowel transit requires scintigraphy with radioactively-labeled solid food. Only two centers in the United States are equipped to do this, the Mayo clinic in Rochester and Temple University in Philadelphia. If you had any test anywhere else, the result is irrelevant with regard to small bowel transit.


> When a rapid transit time is coupled with symptoms, I would disagree with you and say there is a reason to think it's abnormal.


The symptoms described are *not* symptoms of rapid transit, nor is the transit time rapid to begin with. For 10-15 minutes for solid food, the main symptom would be death.









> Several studies have documented statistically significant decreases in small bowel transit time in IBS patients versus controls,


This isn't exactly correct. Motility varies widely among healthy people and what you find in IBSers you can find in healthy people if you really look hard. It's just a matter of whose studies one looks at. in addition, only studies using scintigraphy of radioactively-labeled food would be valid. Finally, what would constitute abnormality would lead to symptoms very different from IBS and is seen in primarily in people who have short bowel syndrome. Rapid transit would impair absorption and that *never occurs in IBS, ever*


> and there are plausible theories on how this could lead to symptom production.


This is impossible as IBS is not associated with symptoms of "rapid small bowel transit". There are really no natural medical conditions which lead to this state, anyway.


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## TimidTummy (May 31, 2007)

flux said:


> Actually, that's *not* the range of small bowel transit time, that's the range of barium transit, which is clinically meaningless unless the barium gets stuck.Testing small bowel transit requires scintigraphy with radioactively-labeled solid food. Only two centers in the United States are equipped to do this, the Mayo clinic in Rochester and Temple University in Philadelphia. If you had any test anywhere else, the result is irrelevant with regard to small bowel transit.The symptoms described are *not* symptoms of rapid transit, nor is the transit time rapid to begin with. For 10-15 minutes for solid food, the main symptom would be death.
> 
> 
> 
> ...


I was talking about barium transit times, as that was the test that my sister had. Again, I'm not sure where you're getting your information, but I disagree with you that the test is clinically meaningless. I do agree that the meaning is currently unknown, but that does not mean "meaningless." IBS is very poorly understood. Any assertion that it definitely has no relation to GI motility contradicts many published studies and current theories. Your conclusions here are premature, as we really do not understand this disease yet.


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## flux (Dec 13, 1998)

TimidTummy said:


> Again, I'm not sure where you're getting your information, but I disagree with you that the test is clinically meaningless. I do agree that the meaning is currently unknown, but that does not mean "meaningless." IBS is very poorly understood. Your conclusions here are premature, as we really do not understand this disease yet.


Where are the symptoms? IBSers do not have any symptoms that would result from rapid transit. Short-bowel syndrome is really the only condition that results in "rapid" transit and even then that effect is due to gut surface area and not transit time. The symptoms of it are severe steatorrhea. No person has ever experienced this symptom from IBS.


> Any assertion that it definitely has no relation to GI motility contradicts many published studies and current theories.


This is simply untrue. There are actually very few studies on this because there are so few places with the means to study it. Here's one, which found no rapid transithttp://www.ncbi.nlm.nih.gov/sites/entrez?D...oSearch=3803129


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## TimidTummy (May 31, 2007)

flux said:


> This is simply untrue. There are actually very few studies on this because there are so few places with the means to study it. Here's one, which found no rapid transithttp://www.ncbi.nlm.nih.gov/sites/entrez?D...oSearch=3803129


And here's one that did, which I already quoted above:Hebden JM. Blackshaw E. D'Amato M. Perkins AC. Spiller RC. Abnormalities of GI transit in bloated irritable bowel syndrome: effect of bran on transit and symptoms. [Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't] American Journal of Gastroenterology. 97(9):2315-20, 2002 Sep."The most striking finding was that the small bowel transit time of the rice pudding meal in the bloated IBS patients was 165 min less than in controls (Fig. 2). Transit in controls was significantly accelerated by bran but not significantly modifed in the already rapid transit IBS group. Even so, IBS patients still showed significantly faster small bowel transit when taking bran than controls."A search on Ovid for "gastrointestinal motility" and "irritable bowel syndrome" produces 81 results, so there are quite a few out there. Some of the latest theories about IBS relate to abnormalities in the enteric nervous system which regulates motility. Telling me that there is no relation between GI motility and IBS ignores most current work in the field, and makes me think you are either not as familiar as you claim to be with the research, or you have a biased opinion that ignores a lot of published data. You can debate this all you want but the evidence just isn't conclusive enough to prove the point one way or another. Thanks for the interesting discussion.


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## flux (Dec 13, 1998)

> Right. The symptoms of short bowel syndrome have more to do with malabsorption than with transit time.


Huh?, the "malabsorption" is due exclusively to the massively decreased total transit time because there is significantly less gut length to traverse. So a short bowel defines what is meant by "rapid transit".


> So how can you say that IBS patients do not have symptoms of rapid transit time, when we do not know for sure what symptoms rapid transit alone would cause?


We know from the patients with short bowel syndrome who have steatorrhea and malabsorption.


> There are some theories that have been proposed to explain how rapid transit could cause some IBS symptoms. They are just theories right now because we know so little about the disease.


Well, we do know quite a bit about IBS.I define rapid transit based on what's seen in short bowel patients, which produces steatorrhea and this is never seen in IBS patients.


> "The most striking finding was that the small bowel transit time of the rice pudding meal in the bloated IBS patients was 165 min less than in controls (Fig. 2).


Some IBSers may have more rapid transit than others, but there isn't even close to what's seen in short bowel.


> A search on Ovid for "gastrointestinal motility" and "irritable bowel syndrome" produces 81 results, so there are quite a few out there.


Only studies using scintigraphy in the small bowel would count So far, we have just three, one I found and two you found, although this last one you found was unusually well-done because it was double-blinded, crossover study. (There are way, way more than 81 generic motility/IBS studies out there.)The point I'm trying to get across is some patients like the two here are getting misinformation from their physicians being misdiagnosed with rapid transit even though they have had no test for it and no symptoms to suggest they have it. (Others in the past often confuse having a bowel movement after a meal and seeing food bits in the toilet and mistakenly thinking it was from the meal they just ate.)


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## TimidTummy (May 31, 2007)

flux said:


> Huh?, the "malabsorption" is due exclusively to the massively decreased total transit time because there is significantly less gut length to traverse. So a short bowel defines what is meant by "rapid transit".


A short bowel does not define what is meant by "rapid transit." It is at the extreme end of a spectrum of transit times. And short bowel syndrome is not due exclusively to massively decreased total transit time. It is also due to specific bowel segments' absence, and as stated by a nice summary article on eMedicine, "Not all patients with loss of significant amounts of small intestine develop the short-bowel syndrome. Important cofactors that help to determine whether the syndrome will develop or not include the premorbid length of small bowel, the segment of intestine that is lost, the age of the patient at the time of bowel loss, the remaining length of small bowel and colon, and the presence or absence of the ileocecal valve."http://www.emedicine.com/med/topic2746.htmFor example, loss of the jejunum leads to loss of certain hormones; loss of the terminal ileum leads to failure of reabsorption of bile salts and B-12; and loss of the critical ileocecal valve leads to worsening of symptoms and colonization of the large intestine with small intestine bacteria. A lot more is going on here than decreased transit time. It is a complex syndrome and comparing it to someone with IBS and decreased transit times seen on whatever type of test is used to measure transit is like the proverbial comparing apples and oranges. It's simply not a valid comparison, nor is it valid to say, "no IBS patient has ever had steatorrhea, therefore IBS patients must not have decreased transit time."I agree with you that there are a lot of misconceptions about IBS, and that some people may assume that if they have diarrhea 1 hour after eating, it is due to rapid transit. That, however, is not MY misconception, as I am fully aware that that symptom in me is due to my gastrocolic reflex, which seems to be rather overactive. Also, I think it is perfectly reasonable for a physician to tell a patient what their test findings were--ie, "your upper GI series with SBFT showed rapid transit of barium." That is not a diagnosis, it is a test finding. I tell my patients all the time about abnormal findings on tests that I have ordered, but an abnormal finding and a diagnosis are two different things as you have pointed out. Some day maybe we'll understand how to interpret those findings in the context of IBS. The abnormalities, if they are there, are going to be a lot more subtle than in short gut syndrome.


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