Kalra S, Goyal MK, Goyal K, Singh R, Vuthaluru AR, Goyal O. Unlocking the colon clock: Bridging the gap in colonic transit time studies for optimal management of chronic constipation. World J Gastrointest Pharmacol Ther 2026; 17(1): 111615 [DOI: 10.4292/wjgpt.v17.i1.111615]
Corresponding Author of This Article
Omesh Goyal, MD, Professor, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, Punjab, India. dromeshgoyal@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 5, 2026 (publication date) through Feb 11, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Pharmacology and Therapeutics
ISSN
2150-5349
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Kalra S, Goyal MK, Goyal K, Singh R, Vuthaluru AR, Goyal O. Unlocking the colon clock: Bridging the gap in colonic transit time studies for optimal management of chronic constipation. World J Gastrointest Pharmacol Ther 2026; 17(1): 111615 [DOI: 10.4292/wjgpt.v17.i1.111615]
Shivam Kalra, Internal Medicine, Trident Medical Center, Charleston, SC 29405, United States
Manjeet Kumar Goyal, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Kartikay Goyal, Medicine, Government Medical College and Hospital, Chandigarh 160030, Chandīgarh, India
Rajdeep Singh, Department of Gastroenterology, J P Medical Centre, Chandigarh 160019, Chandīgarh, India
Ashita Rukmini Vuthaluru, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Co-first authors: Shivam Kalra and Manjeet Kumar Goyal.
Author contributions: Kalra S and Goyal MK provided equal contributions to the manuscript, meriting co-first authorship. Kalra S, Goyal MK, Goyal K, Singh R, Vuthaluru AR, and Goyal O contributed to writing the original draft and reviewed and edited all subsequent versions of the manuscript; Kalra S, Goyal MK, Goyal K, Singh R, and Vuthaluru AR performed the literature search; Kalra S, Goyal MK, and Goyal O performed the conceptualization and supervision of the study, as well as validation and visualization of the data. All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Omesh Goyal, MD, Professor, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, Punjab, India. dromeshgoyal@gmail.com
Received: July 4, 2025 Revised: August 25, 2025 Accepted: January 7, 2026 Published online: March 5, 2026 Processing time: 222 Days and 7.9 Hours
Abstract
Functional constipation affects up to 15% of the global population, significantly affecting the quality of life and imposing substantial clinical and economic burdens. Colonic transit time (CTT) studies have emerged as a pivotal diagnostic tool for distinguishing various types of functional constipation (i.e., slow transit constipation, normal transit constipation, and ano-rectal dyssynergia), thereby guiding personalized treatment strategies and enabling precise monitoring of therapeutic response. CTT studies using radiopaque markers (ROM) have been the most widely used technique by researchers worldwide. Despite its affordability and high diagnostic yield, the ROM CTT study remains grossly underutilized in routine clinical practice largely due to a pervasive lack of awareness among physicians regarding its methodological nuances and clinical advantages. This narrative review systematically examined the multifaceted role of ROM CTT studies in clinical practice. It underscored how ethnic, dietary, and lifestyle factors profoundly influence colonic motility, thereby necessitating the development of population-specific diagnostic protocols. The review also highlighted the significant variability in imaging methodologies, such as differences in radiographic timing and patient positioning (supine vs erect), which further complicate the interpretation and reliability of CTT assessments. By drawing on a wide spectrum of research, this review advocated for enhanced physician education and the implementation of standardized, evidence-based protocols. Such initiatives are critical to optimizing the diagnostic accuracy and clinical utility of ROM CTT studies, ultimately leading to more effective management of refractory constipation and improved patient outcomes.
Core Tip: Colonic transit time (CTT) assessment using radiopaque markers (ROM) is a cost-effective, underutilized tool for subtyping functional constipation and guiding therapy. This review highlighted the need for standardized ROM CTT protocols tailored to regional transit characteristics, especially in Asian populations. It underscored the importance of multicentric normative data, clinician awareness, and technological innovations like artificial intelligence-assisted marker analysis to elevate the ROM CTT study from a research tool to a routine diagnostic modality.
