Motility diagnosis in chronic constipation

: Scintigraphy is generally considered as gold-standard for the diagnosis of delayed gastric emptying. The 13C-acetate and -octanoate breath tests represent an alternative to this method, which has been extensively validated. Gastric and small bowel manometry are very important tools for the research of motility disorders. In clinical practice, this method has only few indications. Sonographic measurement of gastric emptying is a useful procedure for the diagnosis of delayed gastric emptying, provided that the investigation is done by an experienced person. It is not clear so far, whether MRI is an alternative to the methods mentioned above. If delayed gastric emptying is excluded, the H2-lactulose breath test is a simple screening test for the disorders of small bowel transit. Colonic transit time can reliably be measured with radiopaque markers. Anorectal disorders are diagnosed by manometry and defecography. MRI-defecography gives additional information compared to the conventional defecography. These methods have an important role in the evaluation of chronic constipation. The rational combination of the displayed methods is the most appropriate way to approach the patients' problems.