|
1
|
Rajindrajith S, Boey CCM, Devanarayana NM, Niriella MA, Thapar N, Benninga MA. Navigating through 65 years of insights: lessons learned on functional abdominal pain in children. Eur J Pediatr 2024; 183:3689-3703. [PMID: 38972964 DOI: 10.1007/s00431-024-05667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
In 1958, Apley and Naish authored a groundbreaking paper in Archives of Disease in Childhood, elucidating the epidemiology and risk factors of recurrent abdominal pain in children-a subject that had confounded clinicians of their time. Surprisingly, even after 65 years, there are several unanswered questions regarding the etiology, pathophysiology, and management of pediatric abdominal pain. Contrary to the prevailing notion that children naturally outgrow functional abdominal pain, compelling evidence suggests it's possible these children develop a number of clinically significant psychological issues that could profoundly impact their quality of life and, consequently, future health and educational outcomes. In this light, we aimed to comprehensively review the current literature to update the knowledge of practicing clinicians on functional abdominal pain, summarizing the evidence from the last 65 years.Conclusion: The enduring unanswered questions surrounding childhood abdominal pain continue to challenge clinicians, resulting in unnecessary investigations, thereby contributing to substantial healthcare expenditures. It is also evident that children with long-standing symptoms would progress to adulthood with the potential to develop irritable bowel syndrome and many psychological disturbances. Several key interventions using pharmacological agents, such as amitriptyline, showed that some of these drugs are no more effective than the placebo in clinical trials. Several research during the recent past suggest that psychological interventions such as gut-directed hypnotherapy alleviate symptoms and ensure better prognosis in the long run. Therefore, clinicians and researchers must join hands to explore the pathophysiological mechanisms underpinning functional abdominal pain and novel therapeutic strategies to ensure the well-being of these children. What is Known: • Functional abdominal pain disorders are common among children, with a worldwide prevalence of 13.5% of children suffering from at least one of these disorders • These disorders contribute to a significant reduction in the quality of life of affected children and their families and lead to an array of psychological problems What is New: • The biological basis of functional abdominal pain is becoming more explicit, including complex interactions between altered microbiome, deranged motility, and psychological dysfunction with gut-brain interactions • Novel approaches giving minimal emphasis on pharmacological interventions and exploring psychological interventions are showing promising results.
Collapse
Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo 8, 00800, Western Province, Sri Lanka.
| | - Christopher Chiong-Meng Boey
- Department of Paediatrics, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | | | | | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
|
2
|
Lindert J, Erkel D, Schulze F, Hofer M, Rzepka E, Märzheuser S. Is the Transrectal Diameter (TRD) Suitable for Assessing Faecal Loads and Monitoring Bowel Management in Children with Hirschsprung Disease-ReKiSo Study: Prospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:921. [PMID: 39201856 PMCID: PMC11353099 DOI: 10.3390/children11080921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/12/2024] [Accepted: 07/27/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Constipation and outlet obstruction may persist after successful pull-through in Hirschsprung Disease (HD). The radiographic assessment of the faecal load is widely used but exposes the child to radiation. This study aims to evaluate whether the transrectal diameter (TRD) assessed with ultrasound correlates with symptoms of faecal load and whether the TRD normalises when symptoms disappear. METHOD Children with HD after pullthrough and functional constipation presenting to our colorectal clinic between 4/23 and 4/24 were assessed for symptoms of constipation, smearing and outlet obstruction, as well as healthy controls. Ultrasound measurement of the TRD was conducted. Bowel management was initiated according to our institutional pathway using Peristeen© irrigation after an orthograde disimpaction regime. RESULTS A total of 193 children underwent TRD assessment. Of 60 children with HD, 26 (43.3%) presented with obstructive symptoms, and 34 (56.7%) were asymptomatic. In asymptomatic patients with HD, the mean TRD of 2.26 cm (SD 0.61) was significantly (p < 0.001) lower than in HD with symptoms, with a mean TRD of 3.35 cm (SD 1.03). Individuals without colorectal pathology had a mean TRD of 2.04 cm (SD 0.37), and children with functional constipation and symptoms showed a mean TRD of 4.36 cm (SD 1.32). The mean TRD after symptom resolution was 2.37 cm. CONCLUSIONS Children with HD without obstructive symptoms have a TRD < 3 cm, as do controls. The transrectal diameter allows the clinician to sonographically assess the faecal load in children with HD at the bedside without radiation. The TRD is useful for monitoring a bowel management program in children with HD.
Collapse
Affiliation(s)
- Judith Lindert
- Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany; (D.E.); (F.S.); (M.H.); (E.R.); (S.M.)
| | | | | | | | | | | |
Collapse
|
|
3
|
Rodriguez L. Testing in functional constipation-What's new and what works. Aliment Pharmacol Ther 2024; 60 Suppl 1:S30-S41. [PMID: 38940015 DOI: 10.1111/apt.17857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 06/29/2024]
Abstract
BACKGROUND Constipation is among the most common symptoms prompting a consultation with a paediatric gastroenterologist. While most patients will respond to lifestyle and dietary changes and conventional therapy, some may require diagnostic studies. AIM To review the diagnostics studies used to evaluate children with functional constipation. MATERIALS AND METHODS There is no evidence to support the routine use of abdominal X-rays in the evaluation of paediatric constipation. Colon transit by radiopaque markers (ROM) should be indicated when medical history does not match clinical findings, to guide colon manometry (CM) performance and to discriminate between faecal incontinence from functional constipation and non-retentive faecal incontinence. Colon scintigraphy may be useful as an alternative to ROM. Lumbar spine MRI may be indicated to evaluate for spinal abnormalities. The role of defecography has not been properly evaluated in children. Anorectal manometry in children is indicated primarily to evaluate anal resting pressure, presence and quality of the recto-anal inhibitory reflex and simulated defecation manoeuvres. The CM is indicated to guide surgical interventions after failing medical therapy. CONCLUSIONS The goal of these studies is to identify treatable causes of constipation. Most of these studies are designed to evaluate anatomy, transit and/or colon/rectum motility function and are primarily indicated in those who fail to respond to conventional therapy.
Collapse
Affiliation(s)
- Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
|
4
|
Quitadamo P, Tambucci R, Mancini V, Campanozzi A, Caldaro T, Giorgio V, Pensabene L, Isoldi S, Mallardo S, Fusaro F, Staiano A, Salvatore S, Borrelli O. Diagnostic and therapeutic approach to children with chronic refractory constipation: Consensus report by the SIGENP motility working group. Dig Liver Dis 2024; 56:406-420. [PMID: 38104028 DOI: 10.1016/j.dld.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, San Carlo Hospital, Milan, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Giorgio
- UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Fabio Fusaro
- Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Digestive and Endoscopic Surgery, Gastroenterology and Nutrition, Intestinal Failure Rehabilitation Research Group, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| |
Collapse
|
|
5
|
Rajindrajith S, Hathagoda W, Ganewatte E, Devanarayana NM, Thapar N, Benninga M. Imaging in pediatric disorders of the gut-brain interactions: current best practice and future directions. Expert Rev Gastroenterol Hepatol 2023; 17:1255-1266. [PMID: 37997030 DOI: 10.1080/17474124.2023.2288164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Disorders of Gut-Brain Interactions (DGBI) are a common clinical problem in children and pose significant challenges to the attending pediatrician. Radiological investigations are commonly ordered to evaluate these children. AREA COVERED This review focuses on the current best practice of using radiological investigations in DGBIs and how novel radiological investigations could revolutionize the assessment and therapeutic approach of DGBI in children. EXPERT OPINION We believe imaging in DGBI is still in its early stages, but it has the potential to revolutionize how we diagnose and treat children with DGBI. As the understanding of the gut-brain axis continues to grow, we can expect to see the disappearance of conventional imaging techniques and the emergence of more sophisticated imaging techniques with less radiation exposure in the future which provide more clinically meaningful information regarding the gut-brain axis and its influence on intestinal function. Some of the novel imaging modalities will be able to broaden our horizon of understanding DGBI in children providing more useful therapeutic options to minimize their suffering.
Collapse
Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Wathsala Hathagoda
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | | | | | - Nikhil Thapar
- Department of Gastroenterology, Hepatology, and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Marc Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
|
6
|
Rajindrajith S, Devanarayana NM, Thapar N, Benninga MA. Myths and misconceptions about childhood constipation. Eur J Pediatr 2023; 182:1447-1458. [PMID: 36689003 DOI: 10.1007/s00431-023-04821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
Many widely held beliefs and assumptions concerning childhood constipation continue to interfere with rational management of childhood constipation. Although many still believe that constipation is not a common disease, about 9.5% of the world's children suffer from chronic constipation. Most of these children live in non-Western countries. There are major misconceptions about the etiology of constipation as a significant proportion of clinicians still believe that constipation is caused by some form an organic pathology, whereas in reality, the majority have functional constipation. Contrary to a commonly held belief that children outgrow constipation without long-term problems, there is evidence that constipation leads to significant bowel and psychological consequences and has a major impact on the quality of life which detrimentally affects future health and education. Finally, ineffective management strategies such as increasing fiber and water in the diet, and short duration of treatment owing to the fear that long-term laxative treatment leads to colonic dysfunction, interfere with effective therapeutic strategies. Conclusions: It is apparent that myths and misconception often lead to wrong assumptions regarding the distribution of the disease, its etiology, pathophysiology, and management leading to ordering incorrect investigations and ineffective therapeutic strategies while spending large sums of public funds unnecessarily. Poorly treated constipation leads to deleterious psychological consequences predisposing children to develop significant psychological damage and bowel dysfunctions. This review aims to challenge these myths about various elements of constipation by exploring the existing literature and encouraging clinicians to have a fresh look at old concepts that could interfere with the well-being of children with constipation. What is Known: • Childhood constipation is a growing problem in the world leading to significant suffering and high healthcare expenditure • Myths and misconceptions lead to poor management strategies causing psychological and bowel damage What is New: • Organic, systemic, and bowel disorders leading to constipation are uncommon, and in the majority, it arises due to deliberate fecal withholding and most investigations ordered by clinicians are not very helpful in the management • Most non-pharmacological interventions are not effective in the day-to-day management of childhood constipation. The use of laxatives is considered to be the first-line management strategy.
Collapse
Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka.
| | | | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University, of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
|
7
|
Inter and Intraobserver Variation in Interpretation of Fecal Loading on Abdominal Radiographs. J Pediatr Gastroenterol Nutr 2023; 76:295-299. [PMID: 36728727 DOI: 10.1097/mpg.0000000000003696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The current gold standard for the diagnosis of functional constipation is the ROME IV criteria. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) guidelines do not support the use of abdominal X-rays in establishing the diagnosis of constipation. Despite these recommendations, abdominal radiography is frequently performed to diagnose constipation. The objective of our study is to evaluate inter and intraobserver variation in interpretation of fecal loading on abdominal radiographs. METHODS Electronic records of 100 children seen in the emergency room for gastrointestinal symptoms who had an abdominal radiograph performed were included. Four physicians from each specialty including gastroenterology, radiology, and emergency medicine interpreted the radiographs independently. Initially, subjective interpretations, followed by interpretations for intraobserver variation were obtained. Subsequently, all physicians were trained and asked to score the X-rays objectively using Barr and Blethyn scoring systems. Consistency between inter and intraobserver ratings of radiographic interpretation was evaluated using the Kappa coefficient ( k ) which ranges from 0 (no agreement) to 1.0 (perfect agreement). RESULTS For subjective interpretations, k values showed a fixed margin k of 0.18 indicating poor agreement among 12 observers. Intraobserver k to look for reproducibility showed significant variability ranging from 0.08 (poor) to 0.61 (fair) agreement. Objective scoring results for Blethyn showed a k of 0.14 indicating poor agreement among 12 providers. CONCLUSIONS Reliability and reproducibility of X-rays for diagnosis and grading of constipation is questionable given poor to fair agreement for both inter and intraobserver comparisons. Our study supports the current recommendation of ESPGHAN and NASPGHAN to not use abdominal X-rays to diagnose constipation.
Collapse
|
|
8
|
Colonic stool burden on computed tomography does not correlate with bowel habit: a cross-sectional study. Abdom Radiol (NY) 2021; 46:506-516. [PMID: 32761405 DOI: 10.1007/s00261-020-02689-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Stool burden on abdominal radiographs is not reflective of constipation, perhaps because of variable fecal shadowing or limited inter-rater agreement. These limitations are hypothetically mitigated by computed tomography (CT). This research aimed (i) to evaluate whether bowel movement frequency, stool form, or a diagnosis of functional constipation correlate or associate with stool burden identified on CT, and (ii) to investigate whether physicians use CT in their assessment of a patients' bowel function. METHODS Patients attending for non-emergent abdominal CT imaging were invited to participate by completing a bowel questionnaire. Stool burden identified on imaging was determined and inter-rater reliability was evaluated in a subgroup of patients (n = 20). Descriptive and comparative analyses were performed. An online questionnaire evaluated the use of abdominal imaging in assessing patients' bowel function in a cross-section of ordering physicians. RESULTS The patient response rate was 19% (96/516). No clinically useful associations between fecal burden and stool form, bowel motion frequency, gastrointestinal symptoms or a diagnosis of constipation was identified. The physician response rate was 35% (33/94). Opportunistic use of data was more common than deliberate use. However, an abdominal radiograph or CT scan had been requested by 42% and 18% of physicians respectively to assess patient's chronic bowel habit. Approximately 30% of physicians believed evidence supported this practice. CONCLUSIONS Physicians may use abdominal CT in their assessment of patients' chronic bowel habits. However, objective assessment does not support this practice. Colonic stool burden does not correlate with patient-reported symptoms or a criteria-based diagnosis of constipation.
Collapse
|
|
9
|
Raahave D, Jensen AK. Increased colon transit time and faecal load in irritable bowel syndrome. World J Gastrointest Pharmacol Ther 2021; 12:13-20. [PMID: 33564493 PMCID: PMC7844574 DOI: 10.4292/wjgpt.v12.i1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a bowel disorder involving abdominal pain or discomfort along with irregularity of stool form and passage frequency. The pathophysiology is poorly understood and seems to be multifactorial. Investigations of possible causes of IBS have included only a few colonic transit studies and no simultaneous determination of the colonic faecal content.
AIM To compare colon transit time and faecal load between IBS-patients and healthy control subjects.
METHODS The study included 140 patients with IBS, with a mean age of 50.0 years. The control group comprised 44 healthy persons with a mean age of 43.4 years, who were selected at random from the National Civil Register. Both the patient group and the control group underwent a marker study to measure colon transit time (CTT) and to calculate a faecal loading score. The patient group underwent treatment with a combined prokinetic regime, after which their CTT and faecal loading were reassessed. Analyses were performed to compare measurements between the control group and the patient group before and after treatment.
RESULTS Compared to healthy controls, IBS-patients exhibited a significantly prolonged mean CTT (45.48 h vs 24.75 h, P = 0.0002) and significantly greater mean faecal loading scores in all colonic segments (P < 0.001). Among IBS patients, we found no significant differences between the 48 h and 96 h radiographs. Among patients exhibiting increased CTT and faecal loading, approximately half exhibited a palpable mass in the right iliac fossa. After intervention with a prokinetic treatment, the mean CTT among IBS patients was reduced from 45.48 h to 34.50 h (P = 0.091), with the post-treatment CTT not significantly differing from the CTT among control subjects (P = 0.095). The faecal loading score among IBS patients did not significantly differ before and after treatment (P = 0.442). The post-treatment faecal loading score in IBS patients remained significantly higher compared to that in controls (5.3 vs 4.3, P = 0.014). After treatment, half of the IBS-patients were relieved of bloating, while the majority no longer experienced abdominal pain and achieved a daily consistent stool.
CONCLUSION IBS-patients exhibited prolonged CTT and heavier faecal loading. These assessments may aid in diagnosis. Faecal retention may contribute to IBS symptoms, which can be treated using a prokinetic regime.
Collapse
Affiliation(s)
- Dennis Raahave
- Department of Gastroenterology and Surgery, Copenhagen University North Sealand Hospital, Hilleroed 3400, Denmark
| | - Andreas K Jensen
- Faculty of Health Sciences, Section of Biostatistics, University of Copenhagen, Hilleroed 3400, Denmark
| |
Collapse
|
|
10
|
Torres Molina S, Herrera Flores I, Torrejón Macedo J, Gómez Delgado A, Madrazo de la Garza J. Association between abdominal pain and fecal impaction grade assessed through radiography in constipated patients at a pediatric emergency service. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
|
11
|
Anwar Ul Haq MM, Lyons H, Halim M. Pediatric Abdominal X-rays in the Acute Care Setting - Are We Overdiagnosing Constipation? Cureus 2020; 12:e7283. [PMID: 32300503 PMCID: PMC7159144 DOI: 10.7759/cureus.7283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Constipation represents 3% of all office visits to pediatricians and 10% - 45% of consultations with pediatric gastroenterologists. It has been reliably established that the role of abdominal x-rays (AXR) in the diagnosis of constipation in pediatrics is limited; yet, significant overdiagnosis of constipation exists when plain abdominal x-rays are used in the acute setting for abdominal pain or to screen for other disorders. This results in loss of time, resources, exposure to unnecessary radiation, and potentially missing the primary diagnosis. The purpose of this study is to determine the sensitivity and specificity of AXR in diagnosing constipation in the acute setting. Objectives To determine 1) the sensitivity and specificity of plain AXR in the diagnosis of constipation and 2) the effect of age, race, gender, comorbid conditions, and practice setting on the diagnosis of constipation. Methods This study was a historical cohort study of children (two to 18 years of age) who were seen at Ascension St. John Children’s Hospital between March 2015 - March 2018 and who had a plain AXR performed during an emergency department (ED) visit or inpatient stay. If AXR results contained keywords, such as “constipation,” “stool load,” “fecal retention,” and “fecal load,” the ambulatory medical record, Athena® (http://www.athenahealth.com), was searched to determine if the child had an ambulatory visit in the ensuing 45 days. Chart review was conducted to assess if the diagnosis of constipation was later confirmed by history and physical examination by a pediatrician or gastroenterologist at that visit. By comparing data from both encounters, the sensitivity and specificity of plain AXR in diagnosing constipation was assessed. All data were analyzed using the Statistical Package for Social Sciences (SPSS), v. 25.0 (IBM SPSS Statistics, Armonk, NY) and a p-value of 0.05 or less was considered to indicate statistical significance. Results Over the three-year study period, 1,383 AXRs were performed on 1,116 patients. The sensitivity of AXR in the diagnosis of constipation was 73.8%, specificity 26.8%, positive predictive value 46.4%, and negative predictive value of 54.3%. Pediatric gastroenterologists were more likely to diagnose constipation (63.2%) compared to pediatricians (41.4%) and pediatric surgeons (33.3%) (p = 0.04). Conclusions AXRs are not a reliable means of diagnosing constipation. Overall, we found similar sensitivity and specificity of AXR in diagnosing constipation compared to previous studies. Yet, our study gives new insight into the practices around diagnosing constipation in a single-center community hospital pediatric acute setting and the radiology department. This further emphasizes the need to review current practices and impart more education both in the acute care setting and radiology department.
Collapse
Affiliation(s)
| | - Hernando Lyons
- Pediatric Gastroenterology, Ascension St. John Hospital, Detroit, USA
| | | |
Collapse
|
|
12
|
Pleasant V, Sammarco A, Keeney-Bonthrone G, Bell S, Saad R, Berger MB. Use of X-ray to Assess Fecal Loading in Patients with Gastrointestinal Symptoms. Dig Dis Sci 2019; 64:3589-3595. [PMID: 31388854 DOI: 10.1007/s10620-019-05770-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS There is currently no gold standard for evaluating stool burden in the colon for patients with gastrointestinal symptoms. We aim to examine the relationship between fecal loading on single view abdominal X-ray imaging and gastrointestinal symptoms such as constipation, diarrhea, bloating, and accidental bowel leakage in adult outpatients. METHODS This retrospective, cross-sectional study examined patients seen at University of Michigan from 2005 to 2017. Chart review of demographic information, reported gastrointestinal symptoms, past medical history, and abdominal radiographic imaging was performed. Bivariate analysis was performed to assess associations between these characteristics and fecal loading. Factors independently associated with fecal loading were identified using logistic regression. Significance was established at p < 0.05. RESULTS In total, 319 patients who had an X-ray were included in the final analysis, with 84.0% demonstrating fecal loading on the initial X-ray and most reporting constipation as a symptom (n = 214, 84.3%, p = 0.0334). In logistic regression, a chief complaint of constipation had higher odds of being associated with fecal loading on X-ray compared to diarrhea (adjusted OR 6.41; CI 1.51-27.24, p = 0.0118). Bloating as a reported symptom was statistically significant with an adjusted OR of 2.56 (CI 1.10-5.96, p = 0.0286). CONCLUSIONS Constipation (as a chief complaint) and bloating (as a symptom) were associated with fecal loading on X-ray imaging, while accidental bowel leakage and diarrhea were not.
Collapse
Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Anne Sammarco
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Department of Obstetrics and Gynecology, Rush University Medical Center, 1725 W. Harrison St., Ste 1138, Chicago, IL, 60612, USA
| | | | - Sarah Bell
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Richard Saad
- Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mitchell B Berger
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Main Line HealthCare Urogynecology Associates, Riddle Hospital, Health Center 3, 1098 W. Baltimore Pike, Ste. 3404, Media, PA, 19063, USA
| |
Collapse
|
|
13
|
Torres Molina S, Herrera Flores I, Torrejón Macedo JA, Gómez Delgado A, Madrazo de la Garza JA. Association between abdominal pain and fecal impaction grade assessed through radiography in constipated patients at a pediatric emergency service. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 85:235-239. [PMID: 31495541 DOI: 10.1016/j.rgmx.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND AIM Abdominal pain in children is a frequent cause of emergency room consultation. An important group of those patients presents with chronic constipation and fecal impaction. Plain abdominal x-ray is widely used for making a diagnosis and ruling out the need for surgical treatment. The present study examined the association between pain intensity and fecal impaction grade. MATERIALS AND METHODS An analytic cross-sectional study was conducted that compared 2 radiographic scales to determine the association between the grade of fecal impaction observed and abdominal pain intensity in patients that sought medical attention at an emergency service within a 7-month period. The analysis was carried out by 2 different observers, utilizing 2 different radiographic scales to confirm their reproducibility. The degree of interobserver agreement was measured using the Kappa coefficient and the association between abdominal pain and fecal impaction grade was measured through the Spearman correlation coefficient. RESULTS There was a significant association between pain intensity and the radiographic grade of fecal impaction (P<.05) for the radiographic scale by segments and its interobserver agreement was high, compared with the scale by percentage. CONCLUSIONS Radiographic scales may be useful in the evaluation and treatment of patients with abdominal pain and constipation. The segmental scale showed less interobserver variability, suggesting its proposal as an alternative in the evaluation and follow-up of patients with chronic constipation.
Collapse
Affiliation(s)
- S Torres Molina
- Departamento de pediatría, Hospital Star Médica Infantil Privado, CDMX, México.
| | - I Herrera Flores
- Imagenología, Hospital Star Médica Infantil Privado, CDMX, México
| | | | - A Gómez Delgado
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, CMN Siglo XXI, IMSS, CDMX, México
| | | |
Collapse
|
|
14
|
Colonic Stool Burden a Useful Surrogate for Slow Transit Constipation as Determined by a Radiopaque Transit Study. Am J Gastroenterol 2019; 114:519-523. [PMID: 30730352 DOI: 10.14309/ajg.0000000000000149] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Plain film abdominal x-ray (AXR) is frequently used in the evaluation of constipation, but studies assessing the association between stool burden on AXR and colonic transit have been limited. We sought to investigate the relationship between colonic stool burden and slow transit constipation, as determined by a radiopaque marker (ROM) transit study. METHODS A retrospective cohort population was assembled, consisting of adult patients with chronic constipation who underwent testing with both a ROM study and anorectal manometry at 2 tertiary care centers over 5 years. Stool burden was graded by 2 independent observers, with colonic transit being assessed by the Hinton method. RESULTS Of 361 patients, 145 (40.3%) had slow transit constipation, and women were more likely than men to have slow transit constipation (42.3% vs 26.5%, P = 0.04). The mean stool burden scores by observer 1 and observer 2 for patients with slow transit constipation were significantly higher than the mean stool burden scores for patients with normal transit constipation (8.1 ± 1.6 vs 6.9 ± 1.9, P < 0.0001; 8.5 ± 1.5 vs 5.8 ± 1.6, P < 0.0001). The Pearson correlation coefficient for the stool burden score and number of remaining ROMs was 0.31 (moderate) for observer 1 (P < 0.0001) and 0.62 (strong) for observer 2 (P < 0.0001), whereas the Pearson correlation coefficient for interrater reliability of the stool burden score was 0.58 (P < 0.0001), indicating a strong correlation. The ideal score cutoff for both observers was 7, with moderate agreement by Cohen's kappa (0.43, P < 0.0001). CONCLUSIONS Stool burden assessment on AXR may be a reliable alternative ROM study in the assessment of colonic transit.
Collapse
|
|
15
|
Lamanna A, Dughetti LD, Jordan-Ely JA, Dobson KM, Dynan M, Foo A, Kooiman LMP, Murakami N, Fiuza K, Foroughi S, Leal M, Vidmar S, Catto-Smith AG, Hutson JM, Southwell BR. Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate. JGH OPEN 2018; 2:144-151. [PMID: 30483580 PMCID: PMC6207039 DOI: 10.1002/jgh3.12062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/23/2018] [Indexed: 01/05/2023]
Abstract
Background and Aim Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction. Methods Children with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X-ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X-rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2-8 sachets (14.7 g/sachet) on days 1-2, reducing to 2-6 sachets on day 3. The SPS dose was 15-20 drops on days 2-3. Results Eighty-nine children (4-18 years) produced a large volume of soft stool (median/inter-quartile-range: 2.2/1.6-3.1 L) over 7 days. Stool volume on X-rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change. Conclusions A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying.
Collapse
Affiliation(s)
- Anthony Lamanna
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Lauren D Dughetti
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Julie A Jordan-Ely
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Kyla M Dobson
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Megan Dynan
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Adeline Foo
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia
| | - Louise M P Kooiman
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,University of Groningen Groningen The Netherlands
| | - Naomi Murakami
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,RMIT University Bundoora Victoria Australia.,Universidade Federal Fluminense (UFF) Niterói Rio de Janeiro Brazil
| | - Kaic Fiuza
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,University of South Australia Adelaide South Australia Australia.,Universidade Federal Fluminense (UFF) Niterói Rio de Janeiro Brazil
| | - Siavash Foroughi
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Systems Biology and Personalised Medicine Division The Walter and Eliza Hall Institute of Medical Research Melbourne Victoria Australia
| | - Marcelo Leal
- Gastroenterology and Clinical Nutrition Royal Children's Hospital Parkville Victoria Australia
| | - Suzanna Vidmar
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Clinical Epidemiology & Biostatistics Unit Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Anthony G Catto-Smith
- Department of Paediatrics University of Melbourne Melbourne Victoria Australia.,Gastroenterology and Clinical Nutrition Royal Children's Hospital Parkville Victoria Australia.,Gastroenterology Department Lady Cilento Children's Hospital Brisbane Queensland Australia
| | - John M Hutson
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia.,Department of Urology Royal Children's Hospital Melbourne Victoria Australia
| | - Bridget R Southwell
- Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia.,Department of Paediatrics University of Melbourne Melbourne Victoria Australia.,Department of Urology Royal Children's Hospital Melbourne Victoria Australia
| |
Collapse
|
|
16
|
Abdominal radiograph usage trends in the setting of constipation: a 10-year experience. Abdom Radiol (NY) 2018; 43:2231-2238. [PMID: 29392367 DOI: 10.1007/s00261-018-1466-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Limited data are available to guide the use of abdominal radiographs in the setting of constipation, especially in adults. Anecdotally, there has been a recent increase in such examinations. We sought to determine ordering trends for abdominal radiographs ordered to assess constipation, as well as to better understand referring clinician and radiologist opinion on such examinations. METHODS We conducted a retrospective review of all abdominal radiographs performed between 2004 and 2014 at our institution with a primary indication of constipation. We also surveyed clinicians and radiologists regarding their opinions and practices involving such examinations. RESULTS Constipation radiograph volume increased by approximately 56% over the 10-year period, while volume of all other abdominal radiographs decreased. Growth was greatest in adult females. Both radiologists and clinicians agree that constipation is a clinical diagnosis and are neutral as to whether radiographs help make the diagnosis. Clinicians somewhat agree that radiographs are helpful in determining management and find quantitation of stool burden within the radiology report helpful. Radiologists tend to find radiographs inaccurate at quantifying stool burden. Clinicians tend to agree that the increasing use of radiographs for constipation is appropriate while radiologists disagree. Education on these trends did not affect the intended future ordering practice of referring clinicians. CONCLUSIONS Constipation abdominal radiograph volume has disproportionately increased, especially in adult women. Clinicians and radiologists agree that constipation is a clinical diagnosis. Otherwise, the groups tend to have differing opinions on the utility of such examinations. Clinicians indicated no intention to change their ordering practices. Further investigation is needed to better define the role of imaging for this indication, including how the radiologist may best interpret and report such examinations.
Collapse
|
|
17
|
The Role of Bowel Management in Children with Bladder and Bowel Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
|
18
|
Abstract
Constipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children experiences functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. During the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review.
Collapse
|
|
19
|
Choi YJ, Seo BS, Lee JH, Jeong SJ. Treatment of fecal retention is important in the management of overactive bladder in children. Neurourol Urodyn 2017; 36:490-494. [DOI: 10.1002/nau.22963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- You Jin Choi
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| | - Bo Seon Seo
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| | - Jun Ho Lee
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| | - Su Jin Jeong
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| |
Collapse
|
|
20
|
Rezazadeh A, Javaherizadeh H, Chahardahcherik F, Yavarahmadi MH, Sadjadei N, Tahmasebi M. RELIABILITY OF BARR, LEECH, AND BLETHYN SCORE IN USING OF PLAIN RADIOGRAPHY IN DETERMINING FECAL IMPACTION IN CHILDREN WITH AND WITHOUT CONSTIPATION. ARQUIVOS DE GASTROENTEROLOGIA 2016; 53:141-5. [PMID: 27438417 DOI: 10.1590/s0004-28032016000300004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/04/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND - Several scoring was developed for evaluation of children with fecal retention using plain radiograph. There are controversies about specificity and sensitivity of these scoring system. OBJECTIVES - The aim of this study was to evaluate Barr, Blethyn, and Leech score in evaluation of fecal load in plain radiograph. METHODS - This case control study was conducted on children aged 2-14 years old with abdominal pain who visited Abuzar children's Hospital of Ahvaz University of Medical Sciences. This study was conducted in fall season. Children with history of previous abdominal surgery, any systemic illness including sickle cell anemia were excluded. Children with constipation were placed in case group. Subjects without constipation were placed in control group. Subjects without exclusion criteria were examined by physician who is blind to aim of the study. Careful history and physical examination was done. Demographic features, history of gastrointestinal problem, duration of abdominal pain, defecation habit, stool consistency (loose, hard), and results of physical examination were recorded. Rome III criteria was used for definition of constipation. Abdominal x-ray was ordered for each patients. Abdominal radiography was reviewed by radiologist. Barr, Leach, and Blethyn scores were calculated for each case. RESULTS - In this study 102 children with functional constipation and 102 children without constipation as a control were included. Mean ±SD for case and control group was 68.39±34.88 and 69.46±32.60 (P=0.82).Leech score (mean ±SD) was 11.05±2.177 and 5.67±3.228 for case and control group respectively (P<0.0001). Barr score (mean ±SD) was 14.86±3.54 and 7.16±5.59 for case and control group respectively (P=<0.0001). Blethyn (mean ±SD) score was 1.97±0.667 and 1.04±0.900 for case and control group respectively (P=0.000). Sensitivity and specificity of Barr score was 83% and 79% respectively. Sensitivity and specificity of Leech score was 92% and 80% respectively. Sensitivity and specificity of Blethyn score was 79% and 92% respectively. CONCLUSION - Barr, Blethyn and Leech scores were significantly higher in children with abdominal pain and constipation in contrast to children with abdominal pain and without constipation. Sensitivity of Leech score was more than Barr and Blethyn scoring systems. Specificity of Blethyn score was more than Barr and Leech score.
Collapse
Affiliation(s)
- Afshin Rezazadeh
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hazhir Javaherizadeh
- Nursing Care Research Center in Chronic Diseases and Dept. of Pediatric Gastroenterology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Nooshin Sadjadei
- Nursing Care Research Center in Chronic Diseases and Dept. of Pediatric Gastroenterology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Tahmasebi
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
|
21
|
Benninga MA, Tabbers MM, van Rijn RR. How to use a plain abdominal radiograph in children with functional defecation disorders. Arch Dis Child Educ Pract Ed 2016; 101:187-93. [PMID: 27325615 DOI: 10.1136/archdischild-2015-309140] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 12/29/2022]
Abstract
Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology varies from relatively mild, such as crying before passage of soft stools or infrequent defecation to severe problems with faecal impaction and the daily involuntary loss of faeces in the underwear. Conventional radiography is widely available, relatively cheap and is non-invasive. The drawback however, is radiation exposure. This review describes and evaluates the value of different existing scoring methods to assess faecal loading on an abdominal radiograph with or without the use of radio-opaque markers, to measure colonic transit time, in the diagnosis of these defecation-related FGIDs. Insufficient evidence exists for a diagnostic association between clinical symptoms of functional constipation or functional nonretentive faecal incontinence and faecal loading on an abdominal radiograph. Furthermore, evidence does not support the routine use of colonic transit studies to diagnose functional constipation. Colonic transit time measurement may be considered in discriminating between functional constipation and functional non-retentive faecal incontinence and in patients in which the diagnosis is not clear such as having an unreliable medical history. In children with the suspicion of defecation-related FGIDs, the diagnosis should be made based on the Rome IV criteria.
Collapse
Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - M M Tabbers
- Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| | - R R van Rijn
- Department of Paediatric Radiology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
|
22
|
Kurowski J, Kaur S, Katsogridakis Y, Wershil BK, Bass LM. Educational Module Improves Emergency Department Evaluation for Suspected Constipation. J Pediatr 2015; 167:706-10.e1. [PMID: 26163084 DOI: 10.1016/j.jpeds.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/04/2015] [Accepted: 06/03/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine abdominal radiograph use and frequency of digital rectal examinations in children presenting to the emergency department (ED) with abdominal pain and suspected constipation and to determine the impact of an educational module on their use. STUDY DESIGN Retrospective chart review of patients evaluated at a pediatric ED because of the complaint of abdominal pain who had the discharge diagnosis of constipation over two 2-month periods, one before and one after an educational module. RESULTS Comparing pre- and posteducational module periods, there was a significant decrease in abdominal radiograph utilization (69.5% vs 26.4%, respectively, P ≤ .001) and significant increase in performance of digital rectal examination (22.9% vs 47.3%, respectively, P ≤ .001). We demonstrated a 33.6% reduction in abdominal radiograph in children who had a digital rectal examination as part of their examination. Overall, we demonstrated a 43.1% decrease in patients receiving an abdominal radiograph. When time and costs of an abdominal radiograph are considered, this results in significant cost savings. CONCLUSIONS An educational module reviewing the established criteria for the diagnosis of constipation and presented to ED providers results in increased use of digital rectal examination and decreased use of abdominal radiograph in patients evaluated for abdominal pain and ultimately diagnosed with constipation. The change also was associated with reduction in cost and time and radiation exposure in the ED for these patients.
Collapse
Affiliation(s)
- Jacob Kurowski
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sunpreet Kaur
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yiannis Katsogridakis
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Barry K Wershil
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lee M Bass
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
|
23
|
Affiliation(s)
- RA Brown
- Department of Paediatric Surgery, University of Cape Town, Cape Town
| | - RJ Wood
- Red Cross War Memorial Children's Hospital, Cape Town; Panorama Mediclinic, Cape Town
| |
Collapse
|
|
24
|
Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258-74. [PMID: 24345831 DOI: 10.1097/mpg.0000000000000266] [Citation(s) in RCA: 624] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. METHODS Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. RESULTS This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. CONCLUSIONS This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.
Collapse
|
|
25
|
Bush NC, Shah A, Barber T, Yang M, Bernstein I, Snodgrass W. Randomized, double-blind, placebo-controlled trial of polyethylene glycol (MiraLAX®) for urinary urge symptoms. J Pediatr Urol 2013; 9:597-604. [PMID: 23127806 PMCID: PMC3641652 DOI: 10.1016/j.jpurol.2012.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 10/09/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Polyethylene glycol (PEG) is common first-line therapy for urinary symptoms despite minimal evidence-based support. We performed a randomized, double-blind, placebo-controlled study of PEG for initial treatment of overactive bladder (OAB) symptoms in children. PATIENTS AND METHODS Patients aged >3 years underwent baseline urinary symptom questionnaire (USQ, scored 0-16), bowel symptom questionnaire (scored 0-20) and abdominal X-ray (KUB). Patients were randomized to placebo/PEG regardless of parent's perception of constipation. After 1 month, patients completed follow-up questionnaires and KUB. Improvement was defined as decrease in USQ (ΔUSQ) ≥ 3 points. Secondary analyses compared urinary and bowel symptoms to KUB. RESULTS Of 138 enrolled patients, 71 (51.4%) completed 1 month of therapy. Analyses of those randomized to placebo vs. PEG and non-completers demonstrated similar demographics, baseline symptoms, and KUB. Patients treated with placebo and PEG both had significant improvement in USQ scores (p < 0.0001). Patients treated with placebo and PEG responded similarly to placebo (ΔUSQ 3.7 vs. 3.4, p = 0.773), with improvement in nearly half (48.5% PEG vs. 44.7% placebo). There was no correlation between KUB and urinary or bowel symptoms. CONCLUSIONS Nearly 50% of patients with urinary urge symptoms treated with either placebo or PEG for 1 month had improvement in urinary symptoms. KUB did not correlate with baseline or follow-up urinary or bowel symptoms.
Collapse
Affiliation(s)
- Nicol Corbin Bush
- Department of Pediatric Urology, University of Texas Southwestern Medical Center, Dallas, TX 75207, USA.
| | | | | | | | | | | |
Collapse
|
|
26
|
Dysfunctional Elimination Syndromes—How Closely Linked are Constipation and Encopresis with Specific Lower Urinary Tract Conditions? J Urol 2013; 190:1015-20. [DOI: 10.1016/j.juro.2013.03.111] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 11/22/2022]
|
|
27
|
Definition of Reliable, Objective Criteria by Abdominal Radiography to Identify Occult Constipation in Children with Lower Urinary Tract Symptoms. J Urol 2013; 189:1519-23. [DOI: 10.1016/j.juro.2012.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/20/2022]
|
|
28
|
Berger MY, Tabbers MM, Kurver MJ, Boluyt N, Benninga MA. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr 2012; 161:44-50.e1-2. [PMID: 22341242 DOI: 10.1016/j.jpeds.2011.12.045] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 11/21/2011] [Accepted: 12/28/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a systematic review evaluating the value of abdominal radiography, colonic transit time (CTT), and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children. STUDY DESIGN Eligible studies were those assessing diagnostic accuracy of abdominal radiography, CTT, or rectal ultrasound scanning in children suspected for idiopathic constipation. Methodological quality of the included studies was assessed with the Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews checklist. RESULTS One systematic review summarized 6 studies on abdominal radiography until 2004. The additional 9 studies evaluated abdominal radiography (n = 2), CTT (n = 3), and ultrasound scanning (n = 4). All studies except two used a case-control study design, which will lead to overestimation of test accuracy. Furthermore, none of the studies interpreted the results of the abdominal radiography, ultrasound scanning, or CTT without knowledge of the clinical diagnosis of constipation. The sensitivity of abdominal radiography, as studied in 6 studies, ranged from 80% (95% CI, 65-90) to 60% (95% CI, 46-72), and its specificity ranged from 99% (95% CI, 95-100) to 43% (95% CI, 18-71). Only one study presented test characteristics of CTT, and two studies presented test characteristics of ultrasonography. CONCLUSION We found insufficient evidence for a diagnostic association between clinical symptoms of constipation and fecal loading on abdominal radiographs, CTT, and rectal diameter on ultrasound scanning in children.
Collapse
Affiliation(s)
- Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center, Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|
|
29
|
Yik YI, Cook DJ, Veysey DM, Tudball CF, Cain TM, Southwell BR, Hutson JM. How common is colonic elongation in children with slow-transit constipation or anorectal retention? J Pediatr Surg 2012; 47:1414-20. [PMID: 22813806 DOI: 10.1016/j.jpedsurg.2012.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Colonic elongation is reported as a possible cause for slow colonic transit, as it is observed in patients with slow-transit constipation (STC). This study aimed to determine the frequency of colonic elongation in children with STC or anorectal retention using radioimaging. We hypothesized that transverse colon elongation may occur in patients with STC, whereas sigmoid colon elongates in patients with anorectal retention. METHODS Nuclear transit scintigraphy performed for chronic constipation (1999-2011) was analyzed qualitatively for elongated transverse colon or sigmoid colon. Three major colonic transit patterns were identified: slow transit in the proximal colon (STC), normal proximal colonic transit with anorectal retention (NT-AR), and rapid proximal transit ± anorectal retention (RT). χ(2) Test was used for statistical analysis (P < .05 significant). RESULTS From 1999 to 2011, 626 children had nuclear transit scintigraphy. Transverse colon elongation occurred more frequently in STC (73/322, or 23%) compared with NT-AR (9/127, or 7%) and RT (5/177, or 3%; P < .0001). Sigmoid colon elongation was equally common in NT-AR (8/127, or 6%) compared with RT (10/177, or 6%) and STC (14/322, or 4%; P < .9). CONCLUSION Transverse colon elongation is more common in STC (23%), whereas sigmoid colon elongation is not more common in anorectal retention. Colonic elongation may be the cause or the result of the underlying slow colonic transit.
Collapse
Affiliation(s)
- Yee Ian Yik
- F Douglas Stephens Surgical Research and Gut Motility Laboratories, Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | | | | | | | | |
Collapse
|
|
30
|
Abstract
Urinary tract infections (UTIs) in children are commonly seen in the emergency department and pose several challenges to establishing the proper diagnosis and determining management. This article reviews pediatric UTI and addresses epidemiology, diagnosis, treatment, and imaging, and their importance to the practicing emergency medicine provider. Accurate and timely diagnosis of pediatric UTI can prevent short-term complications, such as severe pyelonephritis or sepsis, and long-term sequelae including scarring of the kidneys, hypertension, and ultimately chronic renal insufficiency and need for transplant.
Collapse
Affiliation(s)
- Rahul G Bhat
- Department of Emergency Medicine, Georgetown University Hospital, Washington, DC 20007, USA
| | | | | |
Collapse
|
|
31
|
Moylan S, Armstrong J, Diaz-Saldano D, Saker M, Yerkes EB, Lindgren BW. Are abdominal x-rays a reliable way to assess for constipation? J Urol 2010; 184:1692-8. [PMID: 20728159 DOI: 10.1016/j.juro.2010.05.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Currently to our knowledge no validated reliable tools are available to evaluate constipation in children. Abdominal x-rays are often done in clinical practice to evaluate patients with lower urinary tract symptoms. Although 3 previously published rating tools exist to score constipation based on x-ray, there is little information on their merits. We assessed these 3 tools for reliability among multiple practitioners. MATERIALS AND METHODS We retrospectively analyzed abdominal x-rays in a cohort of 80 patients between ages 4 and 12 years. X-rays were independently assessed by each of us using the previously published Barr, Leech and Blethyn scoring tools. Scores were analyzed for reliability using standard statistical methods. RESULTS The range of weighted κ score, indicating reliability, were 0.0491 to 0.4809 for the Barr, 0.1195 to 0.2730 for the Leech and 0.0454 to 0.4514 for the Blethyn method. Guidelines for κ scores are greater than 0.75-excellent, 0.4 to 0.75-good and 0 to 0.4-marginal reproducibility. ICC, another reliability measure, was 0.02577 for the Barr, 0.3313 for the Leech and 0.201 for the Blethyn method. ICC interpretations are greater than 0.75-excellent, 0.4 to 0.75-good and 0 to 0.4-poor. There was a trend toward good interrater reliability between more experienced urology practitioners with the Barr and Blethyn tools (0.48 and 0.45, respectively) but not between less experienced raters or with the Leech tool. CONCLUSIONS Currently available scoring tools to evaluate constipation by x-ray do not have good reliability among multiple examiners. Further research is needed to develop an alternate tool to increase the reliability of x-ray to assess constipation between multiple raters.
Collapse
Affiliation(s)
- Susan Moylan
- Division of Urology, Children's Memorial Hospital, Chicago, Illinois 60614, USA
| | | | | | | | | | | |
Collapse
|
|
32
|
Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr 2010; 51:155-9. [PMID: 20453675 PMCID: PMC2910825 DOI: 10.1097/mpg.0b013e3181cb4309] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Abdominal x-rays are used diagnostically in the evaluation of children with constipation. However, their clinical utility has not been established. The aim of the study was to assess the accuracy of different methods in identifying children with functional constipation (FC) or nonretentive fecal incontinence (NRFI). PATIENTS AND METHODS Retrospective review of abdominal x-rays in which colonic transit (CT), Barr, Leech, and fecal loading (FL) scores were blindly measured by blinded pediatric gastroenterologists and a radiologist. Children were classified a priori as FC or NRFI. RESULTS One hundred sixty patients (125 FC, 35 NRFI) were studied. There were significant differences (P < 0.05) when comparing those with FC and those with NRFI: CT: 51 +/- 18 vs 40 +/- 21 hours; Barr: 14 +/- 5 vs 11 +/- 4; Leech: 10 +/- 2 vs 8 +/- 2; FL: 2 +/- 0.5 vs 1.7 +/- 0.4. More than 20% of FC had normal Barr and Leech scores, whereas >50% of NRFI had abnormal scores. CT discriminated better between FC and NRFI. There was a significant correlation (P < 0.05) between CT and Barr (0.45), Leech (0.41) and FL scores (0.36), and between Barr and Leech scores (r = 0.94). There was good intraobserver correlation between Barr, Leech, and FL scores but poor interobserver reproducibility. CONCLUSIONS Although significant differences in overall FC and NRFI scores exist, the discriminative value is low for all scores. There is poor interobserver reproducibility of the Barr, Leech, and FL scores. These findings confirm the limited value of the plain abdominal x-ray in the evaluation of children with constipation.
Collapse
|
|
33
|
Bacterial overgrowth and methane production in children with encopresis. J Pediatr 2010; 156:766-70, 770.e1. [PMID: 20036380 DOI: 10.1016/j.jpeds.2009.10.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/14/2009] [Accepted: 10/30/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis. STUDY DESIGN Radiographic fecal impaction (FI) scores were assessed in children with secondary, retentive encopresis and compared with the breath test results. Breath tests with hypoosmotic lactulose solution were performed in both the study patients (n = 50) and gastrointestinal control subjects (n = 39) groups. RESULTS The FI scores were significantly higher in the patients with encopresis who were methane producers (P < .01). SIBO was diagnosed in 21 of 50 (42%) patients with encopresis and 9 of 39 (23%) of control subjects (P = .06). Methane was produced in 56% of the patients with encopresis versus 23.1% of the control subjects in the gastrointestinal group (P < .01). Fasting methane level was elevated in 48% versus 10.3 %, respectively (P < .01). CONCLUSIONS Children with FI and encopresis had a higher prevalence of SIBO, elevated basal methane levels, and higher methane production. Methane production was associated with more severe colonic impaction. Further study is needed to determine whether methane production is a primary or secondary factor in the pathogenesis of SIBO and encopresis.
Collapse
|
|
34
|
Koh H, Lee MJ, Kim MJ, Shin JI, Chung KS. Simple diagnostic approach to childhood fecal retention using the Leech score and Bristol stool form scale in medical practice. J Gastroenterol Hepatol 2010; 25:334-8. [PMID: 19817956 DOI: 10.1111/j.1440-1746.2009.06015.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM To assess fecal retention, plain abdominal radiography is frequently used to complement the clinical history and physical examination, and three scoring systems have been proposed by Barr, Blethyn, and Leech on a single abdominal radiography. The aim of the present study was to find simple and useful diagnostic tools for an approach to fecal retention by correlation of the three scoring systems with the clinical characteristics. METHODS This study included 76 children (5.6-15.4 years, male : female = 33:43) who presented with various gastrointestinal complaints and 20 healthy children from the years 2004-2008. Defecation characteristics, abdominal pain, anorexia and nausea, the Bristol stool form scale, and colonic transit time were studied. Plain abdominal radiographs were independently scored with the three scoring systems by a pediatrician and a radiologist. RESULTS The k-value of the Leech score (0.912) between two of the observers was higher than the others (Barr 0.870 and Blethyn 0.670), and the correlation coefficients of the Leech scoring system by a pediatrician in relation to the colonic transit time (r = 0.861, P < 0.001) and the Bristol stool form scale (r = -0.818, P < 0.001) were highest in the constipated children. Furthermore, there were statistically significant associations between the Leech scoring system and the defecation frequency per week (r = -0.569 and -0.625 in two observers) or abdominal pain (r = 0.574 and 0.567). CONCLUSIONS The Leech score and the Bristol stool form scale may be simple and useful diagnostic tools for pediatricians to access childhood fecal loading in outpatient clinics along with a thorough clinical history.
Collapse
Affiliation(s)
- Hong Koh
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea
| | | | | | | | | |
Collapse
|
|
35
|
Diamanti A, Bracci F, Reale A, Crisogianni M, Pisani M, Castro M. Incidence, clinical presentation, and management of constipation in a pediatric ED. Am J Emerg Med 2010; 28:189-94. [DOI: 10.1016/j.ajem.2008.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 11/07/2008] [Accepted: 11/08/2008] [Indexed: 12/27/2022] Open
|
|
36
|
Kokke FT, Sittig JS, de Bruijn A, Wiersma T, Van Rijn RR, Limpen JL, Houwen RH, Fischer K, Benninga MA. Starreveld scoring method in diagnosing childhood constipation. Pediatr Radiol 2010; 40:1789-93. [PMID: 20593172 PMCID: PMC2950268 DOI: 10.1007/s00247-010-1725-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/18/2010] [Accepted: 04/25/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Four scoring methods exist to assess severity of fecal loading on plain abdominal radiographs in constipated patients (Barr-, Starreveld-, Blethyn- and Leech). So far, the Starreveld score was used only in adult patients. OBJECTIVE To determine accuracy and intra- and inter-observer agreement of the Starreveld scoring method in the diagnosis of functional constipation among pediatric patients. In addition, we compared the Starreveld with the Barr scoring method. MATERIALS AND METHODS Thirty-four constipated and 34 non-constipated children were included. Abdominal radiographs, obtained before treatment, were rated (Starreveld- and Barr) by 4 observers. A second observation after 4 weeks was done by 3 observers. Cut-off level for the Starreveld score, accuracy as measured by the area under the receiver operator characteristics curve, and inter- and intra-observer agreement were calculated. RESULTS Cut-off value for the Starreveld score was 10. AUC for Starreveld score was 0.54 and for Barr score 0.38, indicating poor discriminating power. Inter-observer agreement was 0.49-0.52 4 (Starreveld) and 0.44 (Barr), which is considered moderate. Intra-observer agreement was 0.52-0.71 (Starreveld) and 0.62- 0.76 (Barr). CONCLUSION The Starreveld scoring method to assess fecal loading on a plain abdominal radiograph is of limited value in the diagnosis of childhood constipation.
Collapse
Affiliation(s)
- Fredericus T. Kokke
- Pediatric Gastroenterology, Wilhelmina Childrens Hospital, KE 1.144.3, PO Box 85090, Utrecht, 3508 AB The Netherlands
| | - Judith S. Sittig
- Pediatrics Wilhelmina Childrens Hospital, Utrecht, The Netherlands
| | | | | | - Rick R. Van Rijn
- Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jan L. Limpen
- Pediatrics Wilhelmina Childrens Hospital, Utrecht, The Netherlands
| | - Roderick H. Houwen
- Pediatric Gastroenterology, Wilhelmina Childrens Hospital, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Epidemiology, Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Marc A. Benninga
- Pediatric Gastroenterology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
|
37
|
Abstract
PURPOSE OF REVIEW Chronic constipation remains one of the most frequent complaints in primary and subspecialty pediatric clinics. It is associated with significant emotional and economic burden for both the children and the caregivers. Recently, advances have expanded our understanding of the pathophysiology and treatment options for children with chronic constipation. Here, we review current strategies addressing the cause, diagnostic technologies and treatments of chronic constipation. RECENT FINDINGS There is some new information presented here on techniques for diagnosis and long-term complications associated with chronic childhood constipation. Comparative data on current laxatives and the development of medications with novel mechanisms of action are reviewed for a glimpse into the horizon of possible new treatments for children with chronic constipation. Studies on effects of growth, quality of life, dietary fiber and symptoms, which may coexist with constipation, are discussed. SUMMARY The recent literature on chronic constipation has provided some new knowledge providing a more evidence-based approach to treating these patients. We review the scope of this problem and the estimated cost of treating constipation. The availability of long-term outcome data enhances our understanding of the natural history of this problem. Newer pharmacological approaches provide optimism for treatment for this common problem.
Collapse
|
|
38
|
Diagnostic accuracy of the Barr and Blethyn radiological scoring systems for childhood constipation assessed using colonic transit time as the gold standard. Pediatr Radiol 2009; 39:664-7. [PMID: 19277628 DOI: 10.1007/s00247-009-1205-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 01/15/2009] [Accepted: 01/21/2009] [Indexed: 01/16/2023]
Abstract
BACKGROUND Constipation is a common childhood symptom and abdominal radiography is advocated in diagnosis and management. OBJECTIVE To assess the reproducibility and diagnostic accuracy of the Barr and Blethyn systems for quantifying constipation on abdominal radiographs in children. MATERIALS AND METHODS Radiographs were scored by three observers of increasing radiological experience (student, junior doctor, consultant). Abdominal radiographs produced during measurement of colonic transit time (CTT) were classified as constipated or normal based on the value of the transit time, and were scored using both systems by observers blinded to the CTT. Abdominal radiographs obtained in children for reasons other than constipation were classed as normal and similarly scored. Reproducibility was measured using the kappa statistic. Diagnostic accuracy was measured using the area under the curve (AUC) for the receiver operator characteristic (ROC) curve. RESULTS Using either system, scores were higher for constipated children (P<0.01). The consultant produced higher scores than the other observers (P<0.01). Interobserver reproducibility was moderate with the best kappa value only 0.48. The best correlation between score and CTT was 0.51 (junior doctor scores). Diagnostic accuracy of the scores was only moderate, with the largest AUC for a ROC curve of 0.84 for the consultant using the Barr score. CONCLUSIONS Scoring of abdominal radiographs in the assessment of childhood constipation should be abandoned because it is dependent on the experience of the observer, is poorly reproducible, and does not accurately discriminate between constipated children and children without constipation.
Collapse
|
|
39
|
Vasudev AS. Voiding Disorders in Children. APOLLO MEDICINE 2009. [DOI: 10.1016/s0976-0016(11)60182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
|
40
|
Cowlam S, Vinayagam R, Khan U, Marsden S, Minty I, Moncur P, Bain I, Yiannakou YJ. Blinded comparison of faecal loading on plain radiography versus radio-opaque marker transit studies in the assessment of constipation. Clin Radiol 2008; 63:1326-31. [PMID: 18996262 DOI: 10.1016/j.crad.2008.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/02/2008] [Accepted: 06/03/2008] [Indexed: 01/14/2023]
Abstract
AIM To compare faecal loading on plain radiography versus radio-opaque marker transit studies in the assessment of constipation. METHODS The study group was a convenience sample of patients attending the Durham Constipation Clinic. All patients underwent transit studies according to an established protocol, and severity of constipation was assessed contemporaneously using a validated questionnaire (PAC-SYM). Transit studies were performed using radio-opaque markers that were ingested over 3 consecutive days, with a radiograph taken on the fourth day. Digital images of the radiograph were digitally altered to remove all traces of the transit markers without affecting the underlying pattern of faecal loading. Four observers assessed faecal loading independently; two clinicians (C1 and C2) and two radiologists (R1 and R2). C1 and R1 used a previously described formal scoring method of assessing faecal loading, whereas C2 and R2 assessed the images as if they were in a clinic or reporting session, grading the faecal loading as mild, moderate, or severe. RESULTS One hundred patients were recruited out of 186 presenting in a 2-year period. All patients completed assessments. The correlation between observers was only fair to moderate (r ranging from 0.34-0.51). There were some surprisingly marked disagreements in 10-18% of assessments. The correlation between faecal loading and transit was weak for all observers (r ranging from 0.261-0.311). Symptom severity did not correlate with faecal loading. CONCLUSION These results suggest that there is considerable inter-observer variation in the radiological assessment of faecal loading, irrespective of the training or method used by the observer, and that there is very poor correlation with colonic transit. The diagnosis of constipation, and the assessment of severity, is best performed clinically.
Collapse
Affiliation(s)
- S Cowlam
- Sunderland Royal Hospital, Sunderland, UK
| | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Allen HA, Austin JC, Boyt MA, Hawtrey CE, Cooper CS. Evaluation of Constipation by Abdominal Radiographs Correlated with Treatment Outcome in Children with Dysfunctional Elimination. Urology 2007; 69:966-9. [PMID: 17482944 DOI: 10.1016/j.urology.2007.01.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 11/06/2006] [Accepted: 01/21/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze the utility of assessing degree of constipation by abdominal radiograph (KUB) in relation to symptoms and urodynamic data in children with dysfunctional elimination. METHODS A retrospective review of children with concomitant constipation and daytime incontinence was performed. Inclusion required at least two consecutive visits with KUB and noninvasive uroflowmetry. Patients were excluded for anticholinergic medication use or neurogenic or anatomic abnormalities. Rectal fecal quantification and presence of stool throughout the colon was assessed on KUB and categorized as "empty," "normal amount of stool," or "fecal distention of rectum (FDR)." RESULTS Twenty-six patients met inclusion requirements (6 boys, 20 girls; average age, 7.7 +/- 2.2 years). The average time between the initial and subsequent visit was 12.5 +/- 7.8 weeks. Initial KUB revealed FDR in 17. No statistical significance was found between FDR on initial or final KUB and outcome of wetting symptoms, nor could a relationship between FDR uroflow parameters at either visit be demonstrated. CONCLUSIONS No correlation between any uroflowmetry parameter and the presence of FDR at the initial or final visits could be demonstrated. Similarly, no statistical significance between FDR on final or initial KUB and outcome of wetting symptoms was established.
Collapse
Affiliation(s)
- Heidi A Allen
- Division of Pediatric Urology, Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1089, USA
| | | | | | | | | |
Collapse
|
|
42
|
Bongers MEJ, Voskuijl WP, van Rijn RR, Benninga MA. The value of the abdominal radiograph in children with functional gastrointestinal disorders. Eur J Radiol 2006; 59:8-13. [PMID: 16632293 DOI: 10.1016/j.ejrad.2006.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 02/24/2006] [Accepted: 03/01/2006] [Indexed: 01/20/2023]
Abstract
Functional gastrointestinal disorder is a common problem in childhood. The symptoms vary from a relative mild gastrointestinal problem such as abdominal pain or infrequent defecation to severe problems with fecal impaction and fecal incontinence. The aim of this review is to describe and evaluate the value of the different existing methods to assess fecal loading on an abdominal radiograph with or without the use of radio-opaque markers in the diagnosis of functional abdominal pain, functional constipation and functional non-retentive fecal incontinence. In our opinion, the abdominal radiograph has limited value in the diagnostic work-up of children with functional gastrointestinal disorders.
Collapse
Affiliation(s)
- Marloes E J Bongers
- Department of Pediatric Gastroenterology and Nutrition, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
|
43
|
Eslick GD, Chalasani V, Salama AB. Idiopathic pneumoperitoneum. Eur J Intern Med 2006; 17:141-143. [PMID: 16490696 DOI: 10.1016/j.ejim.2005.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 08/15/2005] [Indexed: 11/20/2022]
Abstract
We report a case of idiopathic pneumoperitoenum in a 75-year-old male who presented to the Emergency Department with vague left-sided abdominal pain. There was no history of recent trauma. Exploratory laparotomy was negative. He made an uneventful post-operative recovery and was discharged home 6 days after the exploratory laparotomy. A repeat chest X-ray done prior to discharge showed no evidence of a pneumoperitoneum.
Collapse
Affiliation(s)
- Guy D Eslick
- Department of Medicine, The University of Sydney, Nepean Hospital, Level 5, South Block, Penrith, New South Wales, Australia.
| | | | | |
Collapse
|
|
44
|
van den Bosch M, Graafmans D, Nievelstein R, Beek E. Systematic assessment of constipation on plain abdominal radiographs in children. Pediatr Radiol 2006; 36:224-6. [PMID: 16418835 DOI: 10.1007/s00247-005-0065-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 11/01/2005] [Indexed: 01/11/2023]
Abstract
BACKGROUND Constipation in childhood is common and its clinical assessment is often difficult. Plain abdominal radiography is simple and used to quantify constipation. Three scoring systems, those of Barr et al., Leech et al. and Blethyn et al., have been developed to quantify fecal loading on the abdominal radiograph. OBJECTIVE In order to determine which method is the most useful in clinical practice, we assessed the reproducibility of the three scoring systems. MATERIALS AND METHODS Plain abdominal radiographs from 40 clinically constipated children were retrospectively reviewed by two paediatric radiologists on two separate occasions. The radiographs were scored according to three different systems developed by Barr et al., Leech et al., Blethyn et al. Intraobserver variability and interobserver reproducibility were determined for each system. Kappa coefficients were calculated as indicators of inter- and intraobserver agreement for categorical outcome variables. RESULTS The Leech score showed the highest reproducibility: the intraobserver agreement was high for both observers (kappa values of 0.88 and 1.00, respectively, P<0.05). Furthermore, the interobserver agreement was also high: kappa 0.91 in the first round and 0.84 in the second. CONCLUSIONS The Leech score proved to be a highly reproducible tool for assessment of childhood constipation and is of value in clinical practice for systematic assessment of constipation on plain abdominal radiographs in children.
Collapse
Affiliation(s)
- Maurice van den Bosch
- Department of Radiology (Room E.01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
|
45
|
Dupont C, Leluyer B, Amar F, Kalach N, Benhamou PH, Mouterde O, Vannerom PY. A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose. J Pediatr Gastroenterol Nutr 2006; 42:178-85. [PMID: 16456412 DOI: 10.1097/01.mpg.0000189349.17549.a9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To determine the doses of polyethylene glycol (PEG) 4000 without additional salts allowing normal bowel habits in childhood functional constipation. METHODS This multicenter noncomparative study allocated children to 4 groups: 6-12 months, 13 months-3 years, 4-7 years, and 8-15 years. Constipation was defined as <1 stool/d for more than 1 month in children aged 6-12 months and <3 stools/w for more than 3 months in older children. Children randomly received either a nominal or a double starting dose. Treatment scheduled for 3 months could be adapted. Data were collected daily by the parents and rated at each visit by the investigator. RESULTS In the 96 children included, the median (interquartile) effective daily doses were by groups; 3.75 (2.50-5.00) g, 6.00 (4.00-7.43) g, 11.71 (7.00-16.00) g, and 16.00 (16.00-24.00) g, respectively, i.e., around 0.50 g/day/kg with a potential increment of the maintenance dose with higher initial dosages. More children had a final dosage identical to the initial one when started on the nominal dose (73%) than with the double one (42%, P < 0.003). More than 90% of children recovered normal bowel habits. Fecal soiling ceased in >60% of children with this symptom at enrolment. Fecal mass in the rectum and abdominal pain were markedly reduced and appetite improved. CONCLUSIONS A daily dose of PEG 4000 around 0.50 g/day/kg in children aged 6 months to 15 years is effective in more than 90% of constipated children and 60% of those with fecal soiling.
Collapse
Affiliation(s)
- Christophe Dupont
- Service de Neonatologie, Hôpital Cochin-Saint-Vincent-de-Paul, bât. Marcel Lelong, 74-82 Avenue Denfert Rochereau, 75674 Paris Cedex 14, France.
| | | | | | | | | | | | | |
Collapse
|
|
46
|
de Lorijn F, van Rijn RR, Heijmans J, Reitsma JB, Voskuijl WP, Henneman ODF, Taminiau JA, Benninga MA. The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy. Pediatr Radiol 2006; 36:43-9. [PMID: 16283286 DOI: 10.1007/s00247-005-0031-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 08/30/2005] [Accepted: 08/30/2005] [Indexed: 01/11/2023]
Abstract
BACKGROUND The data concerning the value of a plain abdominal radiograph in childhood constipation are inconsistent. Recently, positive results have been reported of a new radiographic scoring system, "the Leech method", for assessing faecal loading. OBJECTIVE To assess intra- and interobserver variability and determine diagnostic accuracy of the Leech method in identifying children with functional constipation (FC). MATERIALS AND METHODS A total of 89 children (median age 9.8 years) with functional gastrointestinal disorders were included in the study. Based on clinical parameters, 52 fulfilled the criteria for FC, six fulfilled the criteria for functional abdominal pain (FAP), and 31 for functional non-retentive faecal incontinence (FNRFI); the latter two groups provided the controls. To assess intra- and interobserver variability of the Leech method three scorers scored the same abdominal radiograph twice. A Leech score of 9 or more was considered as suggestive of constipation. ROC analysis was used to determine the diagnostic accuracy of the Leech method in separating patients with FC from control patients. RESULTS Significant intraobserver variability was found between two scorers (P=0.005 and P<0.0001), whereas there was no systematic difference between the two scores of the other scorer (P=0.89). The scores between scorers differed systematically and displayed large variability. The area under the ROC curve was 0.68 (95% CI 0.58-0.80), indicating poor diagnostic accuracy. CONCLUSIONS The Leech scoring method for assessing faecal loading on a plain abdominal radiograph is of limited value in the diagnosis of FC in children.
Collapse
Affiliation(s)
- Fleur de Lorijn
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
|
47
|
Giramonti KM, Kogan BA, Agboola OO, Ribons L, Dangman B. The association of constipation with childhood urinary tract infections. J Pediatr Urol 2005; 1:273-8. [PMID: 18947551 DOI: 10.1016/j.jpurol.2005.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 01/17/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previous studies have suggested a correlation between constipation and urinary tract infections (UTIs) in children. However, historical information about constipation may be unreliable and the relationship between a history of constipation and radiographic findings of fecal load is unclear. PATIENTS AND METHODS A total of 133 children undergoing an abdominal X-ray were evaluated. Parents were asked to complete a questionnaire on bowel habits. Three observers using a documented objective scoring system evaluated plain films of the abdomen. The symptom and radiographic scores were compared with the history and each other. RESULTS Out of the 133 children, 100 had documented previous UTIs and 33 did not. Children with prior UTIs had significantly more symptoms of constipation than those without prior UTIs (p<0.02). Children with a history of UTIs tended to have more fecal loading on radiographic studies than those without, although this difference was not statistically significant (p<0.11). When only children of >3 years old are evaluated, the trends persist, but neither were statistically significant (p<0.11 and 0.56, respectively). There was a poor correlation between the symptoms of constipation and fecal load on abdominal X-rays (correlation coefficient of 0.08). CONCLUSIONS Our findings support the concept that children with UTIs have a higher rate of constipation, especially by history. However, diagnosing constipation in individual patients is difficult. Not only is there a poor correlation between history and radiographic findings of constipation in any individual patient, but at this time there is no gold standard.
Collapse
Affiliation(s)
- Karla M Giramonti
- The Urological Institute of Northeastern New York and Department of Surgery, Albany Medical College, 23 Hackett Boulevard, Albany, NY 12208, USA.
| | | | | | | | | |
Collapse
|
|
48
|
Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
| | | | | |
Collapse
|
|
49
|
Borowitz SM, Sutphen JL. Recurrent vomiting and persistent gastroesophageal reflux caused by unrecognized constipation. Clin Pediatr (Phila) 2004; 43:461-6. [PMID: 15208751 DOI: 10.1177/000992280404300507] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over a 2-year period, 34 children were referred to the division of pediatric gastroenterology at the University of Virginia with chronic upper gastrointestinal symptoms whose symptoms rapidly and completely resolved when their unrecognized constipation was treated. The average age at presentation was 8.24 (SD 0.78) years and average duration of upper intestinal symptoms was 15.6 (SD 3.5) months. Twenty-six of 34 had experienced recurrent vomiting, 6 complained of chronic nausea, 17 had chronic symptoms of gastroesophageal reflux, and 20 complained of chronic or recurrent abdominal pain, most often in the epigastric region. Smaller numbers had experienced early satiety, choking, gagging, dysphagia, or intermittent diarrhea. Given the prevalence of constipation in childhood, it seems likely that many children who experience chronic upper intestinal symptoms may be suffering from chronic unrecognized constipation as the cause of their upper intestinal symptoms.
Collapse
Affiliation(s)
- Stephen M Borowitz
- Division of Pediatric Gastroenterology, University of Virginia, Charlottesville, Virginia 22908, USA
| | | |
Collapse
|
|
50
|
Abstract
BACKGROUND Constipation is a common problem in childhood, and various radiologic methods have been advocated for investigation. Colonic transit time (CTT) has been used in adults to investigate colonic motility, but few studies evaluate this method in children. Data on CTT in the normal paediatric population are scarce. METHODS The colonic transit time was measured in 22 healthy children (median age, 10 years; range, 4 to 15 years) by Abrahamsson's method. Children took bolus ingestions of radiopaque markers on 6 consecutive days, and on day 7 a single abdominal x-ray was performed. This was evaluated for total and segmental colonic transit time. RESULTS The mean total CTT was 40 hours, and the upper limit of normal (95th percentile) was 84 hours. The upper limit of normal for segmental transit time was as follows: 14 hours for the ascending, 33 hours for the transverse, 21 hours for the descending, and 41 hours for the rectosigmoid colon. CONCLUSIONS CTT provides an objective measure to assess childhood constipation. To date, 6 studies using 5 different methods have been published reporting values for healthy children. Comparing these, Abrahamson's method has low radiation exposure and is well tolerated. This study contributes additional normal values in children.
Collapse
Affiliation(s)
- S Wagener
- Alder Hey Children's Hospital, Liverpool England, UK
| | | | | | | | | |
Collapse
|