Novel Techniques to Study Colonic Motor Function in Children Authors
Pediatric Gastroenterology (S Orenstein, Section Editor)
First Online: 14 July 2013 DOI:
Cite this article as: Belkind-Gerson, J., Tran, K. & Di Lorenzo, C. Curr Gastroenterol Rep (2013) 15: 335. doi:10.1007/s11894-013-0335-3
Colonic motility is an essential component of normal colonic physiology and it controls essential bodily functions such as stool propulsion, storage, and expulsion. Disordered colonic motility may present with constipation or diarrhea as well as associated symptoms such as bloating, gas, pain, incontinence, and others. In order to assess colonic motor function, practitioners may use studies that either investigate transit time or that evaluate peristaltic activity. Transit time is the result of both the effectiveness of propulsive pressures and the physical characteristics of the stools. Its measurement allows one to quantify the extent and severity of the colonic dysfunction and permits the assessment of response to therapy. Various methods exist to investigate colon transit time and motility. In this review, we will focus on newer techniques for these investigations, including: scintigraphic transit studies, anorectal manometry, colonic manometry, and studies using a wireless motility capsule.
This article is part of the Topical Collection on
References Papers of particular interest, published recently, have been highlighted as: • Of importance
Krevsky B, Maurer AH, Fisher RS. Patterns of colonic transit in chronic idiopathic constipation. Am J Gastroenterol. 1989;84(2):127–32.
Cook BJ, Lim E, Cook D, et al. Radionuclear transit to assess sites of delay in large bowel transit in children with chronic idiopathic constipation. J Pediatr Surg. 2005;40(3):478–83.
Sutcliffe JR, King SK, Hutson JM, et al. Gastrointestinal transit in children with chronic idiopathic constipation. Pediatr Surg Int. 2009;25(6):465–72.
Gutierrez C, Marco A, Nogales A, et al. Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation. J Pediatr Gastroenterol Nutr. 2002;35(1):31–8.
Camilleri M, Zinsmeister AR. Towards a relatively inexpensive, noninvasive, accurate test for colonic motility disorders. Gastroenterology. 1992;103(1):36–42.
Bonapace ES, Maurer AH, Davidoff S, et al. Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms. Am J Gastroenterol. 2000;95(10):2838–47.
Freedman PN, Goldberg PA, Fataar AB, et al. A comparison of methods of assessment of scintigraphic colon transit. J Nucl Med Technol. 2006;34(2):76–81.
Stivland T, Camilleri M, Vassallo M, et al. Scintigraphic measurement of regional gut transit in idiopathic constipation. Gastroenterology. 1991;101(1):107–15.
Yik YI, Cook DJ, Veysey DM, et al. How common is colonic elongation in children with slow-transit constipation or anorectal retention? J Pediatr Surg. 2012;47(7):1414–20.
Scott SM, Picon L, Knowles CH, et al. Automated quantitative analysis of nocturnal jejunal motor activity identifies abnormalities in individuals and subgroups of patients with slow transit constipation. Am J Gastroenterol. 2003;98(5):1123–34.
Gunay A, Gurbuz AK, Narin Y, et al. Gallbladder and gastric motility in patients with idiopathic slow-transit constipation. South Med J. 2004;97(2):124–8.
Yik YI, Cain TM, Tudball CF, et al. Nuclear transit studies of patients with intractable chronic constipation reveal a subgroup with rapid proximal colonic transit. J Pediatr Surg. 2011;46(7):1406–11.
Cremonini F, Mullan BP, Camilleri M, et al. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther. 2002;16(10):1781–90.
Nam YS, Pikarsky AJ, Wexner SD, et al. Reproducibility of colonic transit study in patients with chronic constipation. Dis Colon Rectum. 2001;44(1):86–92.
Szarka LA, Camilleri M. Methods for the assessment of small-bowel and colonic transit. Semin Nucl Med. 2012;42(2):113–23.
Rao SS, Singh S. Clinical utility of colonic and anorectal manometry in chronic constipation. J Clin Gastroenterol. 2010;44(9):597–609.
Rao SS, Azpiroz F, Diamant N, et al. Minimum standards of anorectal manometry. Neurogastroenterol Motil. 2002;14(5):553–9.
De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr. 2005;146(6):787–92.
• Noelting J, Ratuapli SK, Bharucha AE, et al. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530–6.
Describes normal values for high-resolution anorectal manometry in adult females and correlates the rectoanal gradient to the balloon expulsion test
Feinberg L, Mahajan L, Steffen R. The constipated child: is there a correlation between symptoms and manometric findings? J Pediatr Gastroenterol Nutr. 2008;47(5):607–11.
Gladman MA, Scott SM, Williams NS, et al. Clinical and physiological findings, and possible aetiological factors of rectal hyposensitivity. Br J Surg. 2003;90(7):860–6.
Camilleri M, Bharucha AE, di Lorenzo C, et al. American Neurogastroenterology and Motility Society consensus statement on intraluminal measurement of gastrointestinal and colonic motility in clinical practice. Neurogastroenterol Motil. 2008;20(12):1269–82.
Di Lorenzo C, Hillemeier C, Hyman P, et al. Manometry studies in children: minimum standards for procedures. Neurogastroenterol Motil. 2002;14(4):411–20.
Hussain SZ, Di Lorenzo C. Motility disorders. Diagnosis and treatment for the pediatric patient. Pediatr Clin North Am. 2002;49(1):27–51.
van den Berg MM, Hogan M, Caniano DA, et al. Colonic manometry as predictor of cecostomy success in children with defecation disorders. J Pediatr Surg. 2006;41(4):730–6. discussion 730-6.
Dinning PG, Benninga MA, Southwell BR, et al. Paediatric and adult colonic manometry: a tool to help unravel the pathophysiology of constipation. World J Gastroenterol. 2010;16(41):5162–72.
• Liem O, Burgers RE, Connor FL, et al. Solid-state vs water-perfused catheters to measure colonic high-amplitude propagating contractions. Neurogastroenterol Motil. 2012;24(4):345–e167.
Solid-state catheters are more sensitive in recording High Amplitude Propagated Contractions in children with defecation disorders compared with water perfusion
Schang JC, Hemond M, Hebert M, et al. Changes in colonic myoelectric spiking activity during stimulation by bisacodyl. Can J Physiol Pharmacol. 1986;64(1):39–43.
• Giorgio V, Borrelli O, Smith VV, et al. High-resolution colonic manometry accurately predicts colonic neuromuscular pathological phenotype in pediatric slow transit constipation. Neurogastroenterol Motil. 2013;25(1):70-8 e8-9.
Conventional manometric parameters and area under the curve during a 1-min period following bisacodyl-induced High Amplitude Propagated Contractions is increased in multiple colonic segments in neuropathic pediatric slow transit constipation and constitutes a sensitive and specific biomarker of neuropathy
Arkwright JW, Underhill ID, Maunder SA, et al. Design of a high-sensor count fibre optic manometry catheter for in-vivo colonic diagnostics. Opt Express. 2009;17(25):22423–31.
Arkwright JW, Blenman NG, Underhill ID, et al. In-vivo demonstration of a high resolution optical fiber manometry catheter for diagnosis of gastrointestinal motility disorders. Opt Express. 2009;17(6):4500–8.
Dinning PG, Arkwright JW, Gregersen H, et al. Technical advances in monitoring human motility patterns. Neurogastroenterol Motil. 2010;22(4):366–80.
Davidson JB, O'Grady G, Arkwright JW, et al. Anatomical registration and three-dimensional visualization of low and high-resolution pan-colonic manometry recordings. Neurogastroenterol Motil. 2011;23(4):387–90. e171.
Dinning PG, Zarate N, Hunt LM, et al. Pancolonic spatiotemporal mapping reveals regional deficiencies in, and disorganization of colonic propagating pressure waves in severe constipation. Neurogastroenterol Motil. 2010;22(12):e340–9.
• Green AD, Belkind-Gerson J, Surjanhata BC, et al. Wireless Motility Capsule Test in Children with Upper Gastrointestinal Symptoms. J Pediatr. 2013.
First report of Wireless Motility Capsule use in Pediatrics. In children with upper GI symptoms, a Wireless Motility Capsule may be more sensitive than antroduodenal manometry.
Maqbool S, Parkman HP, Friedenberg FK. Wireless capsule motility: comparison of the SmartPill GI monitoring system with scintigraphy for measuring whole gut transit. Dig Dis Sci. 2009;54(10):2167–74.
Kuo B, McCallum RW, Koch KL, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27(2):186–96.
Papadopoulou A, Clayden GS, Booth IW. The clinical value of solid marker transit studies in childhood constipation and soiling. Eur J Pediatr. 1994;153(8):560–4.
Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43(3):e1-13.
Rao SS. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastrointest Endosc Clin N Am. 2009;19(1):117–39. vii.
Rao SS, Kuo B, McCallum RW, et al. Investigation of colonic and whole-gut transit with wireless motility capsule and radiopaque markers in constipation. Clin Gastroenterol Hepatol. 2009;7(5):537–44.
Camilleri M, Thorne NK, Ringel Y, et al. Wireless pH-motility capsule for colonic transit: prospective comparison with radiopaque markers in chronic constipation. Neurogastroenterol Motil. 2010;22(8):874–82. e233.
Hasler WL, Saad RJ, Rao SS, et al. Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS. Am J Physiol Gastrointest Liver Physiol. 2009;297(6):G1107–14.
Saad RJ, Hasler WL. A technical review and clinical assessment of the wireless motility capsule. Gastroenterol Hepatol (N Y). 2011;7(12):795–804.
© Springer Science+Business Media New York 2013