Abstract
Assessment of constipation in childhood is difficult, particularly when the presenting symptom is spurious diarrhoea or faecal incontinence. We have therefore assessed the clinical usefulness, reliability and acceptibility of a solid marker transit technique in 52 patients with constipation (median age 8.0 years; range 2–13.5 years) at two referral centres. Median duration of symptoms was 60 months. Soiling was a prominent feature in 43 children (83%). Ten, 3 mm pieces of 6FG radio-opaque Silastic tubing were given orally at 9am on days 1, 2 and 3 and a plain abdominal film taken on day 5. Laxative treatment was not interrupted. Each film was divided into right colon, left colon and rectosigmoid areas, using bony landmarks, and the marker content of each area counted. The coefficient of variation of intra and inter-observer errors was 3.1% and 2.1% respectively. By day 5, 7% (group median) of markers were still in the right colon, 17% in the left colon and 42% in the rectosigmoid. Twenty-one patients(40%) had normal transit, 4 (8%) mild delay, 9 (17%) moderate and 18 (35%) severe transit delay. Marker distribution indicated slow pancolonic transit in 29% and slow segmental transit in 10%. In 21%, clustering of markers in the rectosigmoid suggested outlet obstruction. A significant correlation was found between both transit delay and marker distribution and the severity of clinical symptoms of constipation and soiling. Repeat studies in six children following colonic evacuation revealed significant improvement (P< 0.05) in marker transit. The test was well tolerated and was useful in establishing the diagnosis of constipation in children with soiling or spurious diarrhoea and in assessment of its severity and its response to treatment.
Similar content being viewed by others
Abbreviations
- RC :
-
right colon
- LC :
-
left colon
- RS :
-
rectosigmoid
References
Arhan P, Derroede G, Hehannin B (1981) Segmental colonic transit time. Dis Colon Rectum 24: 625–629
Bassotti G, Gaburri M, Imbimbo PB, Rossi I, Farroni F, Pelli MA, et al (1988) Colonic mass movements in idiopathic chronic constipation. Gut 29: 1173–1179
Batista Casanovas A, Varela Gives R, Villaneva Jeremias A, Gastro-Gago M, Cadranel S, Tojo Sierra R (1991) Measurement of colonic transit time in children. J Paediatr Gastroenterol Nutr 13: 42–45
Chaussade S, Khyari A, Roch H, Guerre M, Gandrie M, Catourier D, Guerre J (1989) Determination of total and segmental colonic transit time in constipated patients. Dig Dis Sci 34 (8): 1168–1172
Davidson M, Kugler M, Bauer CH (1963) Diagnosis and management in children with severe and protracted constipation. J Paediatr 62: 261–275
Hansky J, Connel A (1962) Measurement of gastrointestinal transit time using radioactive chromium. Gut 3: 187–189
Hinton GM, Lennard-Jones JE, Young AC (1969) A new method for studying gut transit times using radio-opaque markers. Gut 10: 842–847
Kawimbe BM, Papachrysostomou M, Binnie NR, Clare N, Smith AN (1991) Outlet obstruction constipation(anismus) managed by biofeedback. Gut 32(10): 1175–1179
Krevsky B, Malmud LS, D'Ercole F, Maurer AH, Fisher RS (1986) Colonic transit scintigraphy. A physiological approach to quantitive measurements of colonic transit in humans. Gastroenterology 91: 1102–1112
Levin MD (1975) Children with encopresis: a descriptive analysis. Paediatrics 56: 412–416
Marteli H, Devroede G, Arhan P, Dugnay C (1978) Mechanisms of idiopathic constipation: outlet obstruction? Gastroenterology 75: 623–631
Metcalf AM, Philips SF, Zinmeister AR, McCarty R, Beart RW, Walf BG (1987) Simplified assessment of segmental colonic transit time. Gastroenterology 92: 40–47
Moreno-Osset E, Ballester J, Minguez M, Tomas-Ridocci M, Mora F, Benages A (1991) Chronic idiopathic constipation: the importance of transit time studies. Ital J Gastroenterol 23 8 [Suppl l]: 20–24
Ogorek CP, Reynolds JC (1987) Chronic constipation. Diagnosis and treatment. Endoscopy review. November- December; 1-7
Reynolds JC (1987) Chronic severe constipation. In: Cohen S, Soloway RD (eds) Functional disorders of the gastrointestinal tract. Churchill Livingstone, New York, pp 95–119
Rose GA (1964) Experience with the use of interrupted carmine red and continuous chromium sesquioxid marking of human faeces with reference to calcium, phosphorus and magnesium. Gut 5: 274–279
Sijp JR van der, Kamm MA, Nightingale JM, Britton KE, Mather SJ, Morris GP, Akkermans LM, Lennard-Jones JE (1993) Radioisotope determination of regional colonic transit in severe constipation: comparison with radio opaque markers. Gut 34 (3): 402–408
Wald A, Chandra R, Gabel S, Chiponis D (1987) Evaluation of biofeedback in childhood encopresis. J Paediatr Gastroenterol Nutr 6 (4): 554–558
Watier A, Derroede G, Duranceau A (1983) Constipation with colonic inertia: a manifestation of systemic disease? Dig Dis Sci 28: 1025–1033
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Papadopoulou, A., Clayden, G.S. & Booth, I.W. The clinical value of solid marker transit studies in childhood constipation and soiling. Eur J Pediatr 153, 560–564 (1994). https://doi.org/10.1007/BF02190658
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02190658