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The Diagnostic Test

Select Therapeutic Option Based on Colonic Transit Time for the Diagnosis of Chronic Constipation

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SITZMARKS diagnostic test helps physicians select the best therapeutic option, based on colonic transit time, for adult patients with severe constipation who have otherwise negative GI evaluations.
Catalog No. 8100              Catalog No. 8100-24DD              Catalog No. 8100-24TC

Indication: Adult patients with severe constipation but otherwise negative GI evaluations. SITZMARKS are to be dispensed only by physicians to patients for oral intake.

SUGGESTED DIRECTIONS TO THE PHYSICIAN:

Simplified SITZMARKS Method:

(1 capsule: Catalog No. 8100)

Step 1:

  1. On day 1, direct patient to take SITZMARKS capsule by mouth with water, preferably with confirmation by office observation. Instruct patient to abstain from using laxatives, enemas or suppositories of any kind for 5 days.
  2. Arrange a flat-plate abdominal X-ray on day 5 to determine the location and the extent of elimination of the radiopaque markers.
  3. Patients who expel at least 80% (19 or more) markers have grossly normal colonic transit.
  4. Patients who retain 6 or more markers may have follow-up abdominal X-rays within several days.
  5. For patients whose markers accumulate in the rectosigmoid or when markers are retained diffusely, Step 2 may be warranted.

Step 2:

If more than 20% (5-6 markers) are retained by day 5:
  1. Instruct patient to take a bulking agent (such as KONSYL) daily for 1 to 2 weeks. Encourage liquid intake to maximize product efficacy.
  2. Instruct patient to take another SITZMARKS capsule in 1 to 2 weeks and repeat X-rays in 5 days to determine location and extent of elimination of the markers.

Reading the Results:

If over 80% of the markers are passed by day 5, colonic transit is grossly normal. If remaining markers are scattered about the colon, the condition is most likely hypomotilty or colonic inertia. If remaining markers are accumulated in the rectum or rectosigmoid, the condition is most likely functional outlet delay, e.g., internal rectal prolapse, anismus.

A. If 5 or fewer markers remain, patient has grossly normal colonic transit. B. Most rings are scattered about the colon. Patient most likely has hypomotility or colonic inertia. C. Most rings are gathered in the rectosigmoid. Patient has functional outlet obstruction.

Segmental SITZMARKS Method:

(3 capsules: 8100 (0 Marker), 8100-24DD (D Marker), 8100-24TC (Tri-Chamber Marker))

Metcalf Protocol:

  1. On day 1, day 2, and day 3, administer one SITZMARKS capsule, (patients should be instructed to take the O marker on day 1, the Double D marker on day 2, and the Tri-Chamber markers on day 3), by mouth with water, preferably with confirmation by office observation. Instruct patient to abstain from using laxatives, enemas or suppositories of any kind for 5 days.
  2. Arrange a flat-plate abdominal X-ray on day 4 and, if necessary, again on day 7 to determine location and the extent of elimination of the radiopaque markers.
  3. The total number of markers in each segment is used to determine transit time regardless of the type.

    Ascending (Right) Colon

    Descending (Left) Colon

    Rectosigmoid

    Colon
      4th day

    12

    14

    14

    		 40
      7th day

    0

    0

    2

    		 2

    Transit Time

    12 hours

    14 hours

    16 hours

    42 hours
    Normal Values:
      Ascending (Right) Colon
    =
    		  11.3 hours
      Descending (Left) Colon
    =
    		  11.3 hours
      Rectosigmoid
    =
    		  12.4 hours
      Total   35 hours
  4. If, on day 4, there are more than a total of 50 markers, transit time is abnormal and an X-ray needs to be taken on day 7.
  5. If total colonic transit time is more than 70 hours, then transit in any segment is abnormal if more than 30 hours.

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