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Pediatric Surgery International

, Volume 25, Issue 6, pp 465–472 | Cite as

Gastrointestinal transit in children with chronic idiopathic constipation

  • Jonathan R. Sutcliffe
  • Sebastian K. King
  • John M. Hutson
  • David J. Cook
  • Bridget R. SouthwellEmail author
Original Article

Abstract

Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated.

Purpose

The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation.

Methods

Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively.

Results

Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups.

Conclusion

Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic transit.

Keywords

Anorectal retention Colonic dysmotility Scintigraphy Slow transit constipation Transit study 

Notes

Acknowledgments

We would like to thank the Departments of Radiology and Nuclear Medicine at the Royal Children’s Hospital, Melbourne, for help in obtaining scintigraphy data. This work was funded in part by a grant from the National Health and Medical Research Council of Australia (216704).

References

  1. 1.
    Kamm MA (2003) Constipation and its management. BMJ 327(7413):459–460PubMedCrossRefGoogle Scholar
  2. 2.
    Loening-Baucke V (1993) Chronic constipation in children. Gastroenterology 105(5):1557–1564PubMedGoogle Scholar
  3. 3.
    Youssef NN, Di Lorenzo C (2001) Childhood constipation: evaluation and treatment. J Clin Gastroenterol 33(3):199–205PubMedCrossRefGoogle Scholar
  4. 4.
    van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA (2003) Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 125(2):357–363PubMedCrossRefGoogle Scholar
  5. 5.
    Procter E, Loader P (2003) A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Child Care Health Dev 29(2):103–109PubMedCrossRefGoogle Scholar
  6. 6.
    McLean RG, King DW, Talley NA, Tait AD, Freiman J (1999) The utilization of colon transit scintigraphy in the diagnostic algorithm for patients with chronic constipation. Dig Dis Sci 44(1):41–47PubMedCrossRefGoogle Scholar
  7. 7.
    Wexner SD, Jorge JM (1994) Colorectal physiological tests: use or abuse of technology? Eur J Surg 160(3):167–174PubMedGoogle Scholar
  8. 8.
    O’Suilleabhain C, Anderson JH, McKee RF, Finlay IG (2001) Strategy for the surgical management of patients with idiopathic megarectum and megacolon. Br J Surg 88(10):1392–1396CrossRefGoogle Scholar
  9. 9.
    Wald A (1986) Colonic transit and anorectal manometry in chronic idiopathic constipation. Arch Intern Med 146(9):1713–1716PubMedCrossRefGoogle Scholar
  10. 10.
    Benninga MA, Buller HA, Tytgat GN, Akkermans LM, Bossuyt PM, Taminiau JA (1996) Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr 23(3):241–251PubMedCrossRefGoogle Scholar
  11. 11.
    Shin YM, Southwell BR, Stanton MP, Hutson JM (2002) Signs and symptoms of slow-transit constipation versus functional retention. J Pediatr Surg 37(12):1762–1765PubMedCrossRefGoogle Scholar
  12. 12.
    Krevsky B, Maurer AH, Fisher RS (1989) Patterns of colonic transit in chronic idiopathic constipation. Am J Gastroenterol 84(2):127–132PubMedGoogle Scholar
  13. 13.
    Cook BJ, Lim E, Cook D, Hughes J, Chow CW, Stanton MP, Bidarkar SS, Southwell BR, Hutson JM (2005) Radionuclear transit to assess sites of delay in large bowel transit in children with chronic idiopathic constipation. J Pediatr Surg 40(3):478–483PubMedCrossRefGoogle Scholar
  14. 14.
    Stivland T, Camilleri M, Vassallo M, Proano M, Rath D, Brown M, Thomforde G, Pemberton J, Phillips S (1991) Scintigraphic measurement of regional gut transit in idiopathic constipation. Gastroenterology 101(1):107–115PubMedGoogle Scholar
  15. 15.
    Freedman PN, Goldberg PA, Fataar AB, Mann MM (2006) A comparison of methods of assessment of scintigraphic colon transit. J Nucl Med Technol 34(2):76–81PubMedGoogle Scholar
  16. 16.
    Notghi A, Hutchinson R, Kumar D, Tulley N, Harding LK (1994) Use of geometric center and parametric images in scintigraphic colonic transit studies. Gastroenterology 107(5):1270–1277PubMedGoogle Scholar
  17. 17.
    Chitkara DK, Bredenoord AJ, Cremonini F, Delgado-Aros S, Smoot RL, El-Youssef M, Freese D, Camilleri M (2004) The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol 99(8):1579–1584PubMedCrossRefGoogle Scholar
  18. 18.
    Cremonini F, Mullan BP, Camilleri M, Burton DD, Rank MR (2002) Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther 16(10):1781–1790PubMedCrossRefGoogle Scholar
  19. 19.
    Gutierrez C, Marco A, Nogales A, Tebar R (2002) Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation. J Pediatr Gastroenterol Nutr 35(1):31–38PubMedCrossRefGoogle Scholar
  20. 20.
    Landis JKG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  21. 21.
    Zaslavsky C, da Silveira TR, Maguilnik I (1998) Total and segmental colonic transit time with radio-opaque markers in adolescents with functional constipation. J Pediatr Gastroenterol Nutr 27(2):138–142PubMedCrossRefGoogle Scholar
  22. 22.
    Bautista Casasnovas A, Varela Cives R, Villanueva Jeremias A, Castro-Gago M, Cadranel S, Tojo Sierra R (1991) Measurement of colonic transit time in children. J Pediatr Gastroenterol Nutr 13(1):42–45PubMedCrossRefGoogle Scholar
  23. 23.
    Krevsky B, Malmud LS, D’Ercole F, Maurer AH, Fisher RS (1986) Colonic transit scintigraphy. A physiologic approach to the quantitative measurement of colonic transit in humans. Gastroenterology 91(5):1102–1112PubMedGoogle Scholar
  24. 24.
    Notghi A, Harding LK, Kumar D (1993) Radioisotope determination of regional colonic transit in severe constipation. Gut 34(9):1289PubMedCrossRefGoogle Scholar
  25. 25.
    Maurer AH, Krevsky B (1995) Whole-gut transit scintigraphy in the evaluation of small-bowel and colon transit disorders. Semin Nucl Med 25(4):326–338PubMedCrossRefGoogle Scholar
  26. 26.
    Notghi A, Mills A, Hutchinson R, Kumar D, Harding LK (1995) Reporting simplified colonic transit studies using radionuclides: clinician friendly reports. Gut 36(2):274–275PubMedCrossRefGoogle Scholar
  27. 27.
    Parkman HP, Miller MA, Fisher RS (1995) Role of nuclear medicine in evaluating patients with suspected gastrointestinal motility disorders. Semin Nucl Med 25(4):289–305PubMedCrossRefGoogle Scholar
  28. 28.
    Stanghellini V, Tosetti C, Corinaldesi R (2000) Standards for non-invasive methods for gastrointestinal motility: scintigraphy. A position statement from the Gruppo Italiano di Studio Motilita Apparato Digerente (GISMAD). Dig Liver Dis 32(5):447–452PubMedCrossRefGoogle Scholar
  29. 29.
    Notghi A, Kumar D, Panagamuwa B, Tulley NJ, Hesslewood SR, Harding LK (1993) Measurement of colonic transit time using radionuclide imaging: analysis by condensed images. Nucl Med Commun 14(3):204–211PubMedCrossRefGoogle Scholar
  30. 30.
    van der Sijp JR, 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):402–408PubMedCrossRefGoogle Scholar
  31. 31.
    Eising EG, von der Ohe MR (1998) Differentiation of prolonged colonic transit using scintigraphy with indium-111-labeled polystyrene pellets. J Nucl Med 39(6):1062–1066PubMedGoogle Scholar
  32. 32.
    Ohlsson B, Truedsson M, Bengtsson M, Torstenson R, Sjolund K, Bjornsson ES, Simren M (2005) Effects of long-term treatment with oxytocin in chronic constipation; a double blind, placebo-controlled pilot trial. Neurogastroenterol Motil 17(5):697–704PubMedCrossRefGoogle Scholar
  33. 33.
    Proano M, Camilleri M, Phillips SF, Brown ML, Thomforde GM (1990) Transit of solids through the human colon: regional quantification in the unprepared bowel. Am J Physiol 258(6 Pt 1):G856–G862PubMedGoogle Scholar
  34. 34.
    Staiano A, Santoro L, De Marco R, Miele E, Fiorillo F, Auricchio A, Carpentieri ML, Celli J, Auricchio S (1999) Autonomic dysfunction in children with Hirschsprung’s disease. Dig Dis Sci 44(5):960–965PubMedCrossRefGoogle Scholar
  35. 35.
    Chen ML, Keens TG (2004) Congenital central hypoventilation syndrome: not just another rare disorder. Paediatr Respir Rev 5(3):182–189PubMedCrossRefGoogle Scholar
  36. 36.
    Knowles CH, Scott SM, Wellmer A, Misra VP, Pilot MA, Williams NS, Anand P (1999) Sensory and autonomic neuropathy in patients with idiopathic slow-transit constipation. Br J Surg 86(1):54–60PubMedCrossRefGoogle Scholar
  37. 37.
    Bonapace ES, Maurer AH, Davidoff S, Krevsky B, Fisher RS, Parkman HP (2000) Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms. Am J Gastroenterol 95(10):2838–2847PubMedCrossRefGoogle Scholar
  38. 38.
    Scott SM, Picon L, Knowles CH, Fourquet F, Yazaki E, Williams NS, Lunniss PJ, Wingate DL (2003) Automated quantitative analysis of nocturnal jejunal motor activity identifies abnormalities in individuals and subgroups of patients with slow transit constipation. Am J Gastroenterol 98(5):1123–1134PubMedCrossRefGoogle Scholar
  39. 39.
    Gunay A, Gurbuz AK, Narin Y, Ozel AM, Yazgan Y (2004) Gallbladder and gastric motility in patients with idiopathic slow-transit constipation. South Med J 97(2):124–128PubMedCrossRefGoogle Scholar
  40. 40.
    Stewart DR, Nixon GW, Johnson DG, Condon VR (1977) Neonatal small left colon syndrome. Ann Surg 186(6):741–745PubMedCrossRefGoogle Scholar
  41. 41.
    King SK, Sutcliffe JR, Hutson JM (2005) Laparoscopic seromuscular colonic biopsies: a surgeon’s experience. J Pediatr Surg 40(2):381–384PubMedCrossRefGoogle Scholar
  42. 42.
    Chiba T, Thomforde GM, Kost LJ, Allen RG, Phillips SF (2000) Motilides accelerate regional gastrointestinal transit in the dog. Aliment Pharmacol Ther 14(7):955–960PubMedCrossRefGoogle Scholar
  43. 43.
    Krevsky B, Maurer AH, Malmud LS, Fisher RS (1989) Cisapride accelerates colonic transit in constipated patients with colonic inertia. Am J Gastroenterol 84(8):882–887PubMedGoogle Scholar
  44. 44.
    King SK, Sutcliffe JR, Southwell BR, Chait PG, Hutson JM (2005) The antegrade continence enema successfully treats idiopathic slow-transit constipation. J Pediatr Surg 40(12):1935–1940PubMedCrossRefGoogle Scholar
  45. 45.
    Youssef NN, Pensabene L, Barksdale E Jr, Di Lorenzo C (2004) Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation? J Pediatr Surg 39(1):73–77PubMedCrossRefGoogle Scholar
  46. 46.
    Southwell BR, King SK, Hutson JM (2005) Chronic constipation in children: organic disorders are a major cause. J Paediatr Child Health 41(1–2):1–15PubMedCrossRefGoogle Scholar
  47. 47.
    Chase J, Robertson VJ, Southwell B, Hutson J, Gibb S (2005) Pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment-resistant constipation and soiling in children. J Gastroenterol Hepatol 20(7):1054–1061PubMedGoogle Scholar
  48. 48.
    Clarke MCC, Chase JW, Gibb S, Robertson VJ, Catto-Smith AG, Hutson JM, Southwell BR (2009) Decreased colonic transit time after transcutaneous interferential electrical stimulation in children with slow transit constipation. J Pediatr Surg 44(2):408–412PubMedCrossRefGoogle Scholar
  49. 49.
    Clarke MCC, Chase JW, Gibb S, Hutson JM, and Southwell BR (2009) Improvement in quality of life in children with slow transit constipation following treatment with transcutaneous electrical stimulation. J Pediatr Surg (in press, June)Google Scholar
  50. 50.
    Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Pediatr Surg 31(4):580–583PubMedCrossRefGoogle Scholar
  51. 51.
    Hutson JM, Chow CW, Hurley MR, Uemura S, Wheatley JM, Catto-Smith AG (1997) Deficiency of substance P-immunoreactive nerve fibres in children with intractable constipation: a form of intestinal neuronal dysplasia. J Paediatr Child Health 33(3):187–189PubMedCrossRefGoogle Scholar
  52. 52.
    Nam YS, Pikarsky AJ, Wexner SD, Singh JJ, Weiss EG, Nogueras JJ, Choi JS, Hwang YH (2001) Reproducibility of colonic transit study in patients with chronic constipation. Dis Colon Rectum 44(1):86–92PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jonathan R. Sutcliffe
    • 1
  • Sebastian K. King
    • 1
    • 2
    • 3
  • John M. Hutson
    • 1
    • 2
    • 3
  • David J. Cook
    • 4
  • Bridget R. Southwell
    • 2
    • 3
    Email author
  1. 1.Department of General SurgeryRoyal Children’s HospitalMelbourneAustralia
  2. 2.Murdoch Childrens Research InstituteRoyal Children’s HospitalMelbourneAustralia
  3. 3.Department of PaediatricsUniversity of MelbourneMelbourneAustralia
  4. 4.Department of Medical ImagingRoyal Children’s HospitalMelbourneAustralia

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