Skip to main content

Advertisement

SpringerLink
Log in

Gastrointestinal transit in children with chronic idiopathic constipation

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

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

Purpose

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

Methods

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

Results

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

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kamm MA (2003) Constipation and its management. BMJ 327(7413):459–460

    Article  PubMed  Google Scholar 

  2. Loening-Baucke V (1993) Chronic constipation in children. Gastroenterology 105(5):1557–1564

    PubMed  CAS  Google Scholar 

  3. Youssef NN, Di Lorenzo C (2001) Childhood constipation: evaluation and treatment. J Clin Gastroenterol 33(3):199–205

    Article  PubMed  CAS  Google Scholar 

  4. van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA (2003) Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 125(2):357–363

    Article  PubMed  Google Scholar 

  5. Procter E, Loader P (2003) A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Child Care Health Dev 29(2):103–109

    Article  PubMed  CAS  Google Scholar 

  6. McLean RG, King DW, Talley NA, Tait AD, Freiman J (1999) The utilization of colon transit scintigraphy in the diagnostic algorithm for patients with chronic constipation. Dig Dis Sci 44(1):41–47

    Article  PubMed  CAS  Google Scholar 

  7. Wexner SD, Jorge JM (1994) Colorectal physiological tests: use or abuse of technology? Eur J Surg 160(3):167–174

    PubMed  CAS  Google Scholar 

  8. O’Suilleabhain C, Anderson JH, McKee RF, Finlay IG (2001) Strategy for the surgical management of patients with idiopathic megarectum and megacolon. Br J Surg 88(10):1392–1396

    Article  Google Scholar 

  9. Wald A (1986) Colonic transit and anorectal manometry in chronic idiopathic constipation. Arch Intern Med 146(9):1713–1716

    Article  PubMed  CAS  Google Scholar 

  10. Benninga MA, Buller HA, Tytgat GN, Akkermans LM, Bossuyt PM, Taminiau JA (1996) Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr 23(3):241–251

    Article  PubMed  CAS  Google Scholar 

  11. Shin YM, Southwell BR, Stanton MP, Hutson JM (2002) Signs and symptoms of slow-transit constipation versus functional retention. J Pediatr Surg 37(12):1762–1765

    Article  PubMed  Google Scholar 

  12. Krevsky B, Maurer AH, Fisher RS (1989) Patterns of colonic transit in chronic idiopathic constipation. Am J Gastroenterol 84(2):127–132

    PubMed  CAS  Google Scholar 

  13. Cook BJ, Lim E, Cook D, Hughes J, Chow CW, Stanton MP, Bidarkar SS, Southwell BR, Hutson JM (2005) Radionuclear transit to assess sites of delay in large bowel transit in children with chronic idiopathic constipation. J Pediatr Surg 40(3):478–483

    Article  PubMed  Google Scholar 

  14. Stivland T, Camilleri M, Vassallo M, Proano M, Rath D, Brown M, Thomforde G, Pemberton J, Phillips S (1991) Scintigraphic measurement of regional gut transit in idiopathic constipation. Gastroenterology 101(1):107–115

    PubMed  CAS  Google Scholar 

  15. Freedman PN, Goldberg PA, Fataar AB, Mann MM (2006) A comparison of methods of assessment of scintigraphic colon transit. J Nucl Med Technol 34(2):76–81

    PubMed  Google Scholar 

  16. Notghi A, Hutchinson R, Kumar D, Tulley N, Harding LK (1994) Use of geometric center and parametric images in scintigraphic colonic transit studies. Gastroenterology 107(5):1270–1277

    PubMed  CAS  Google Scholar 

  17. Chitkara DK, Bredenoord AJ, Cremonini F, Delgado-Aros S, Smoot RL, El-Youssef M, Freese D, Camilleri M (2004) The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol 99(8):1579–1584

    Article  PubMed  Google Scholar 

  18. Cremonini F, Mullan BP, Camilleri M, Burton DD, Rank MR (2002) Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther 16(10):1781–1790

    Article  PubMed  CAS  Google Scholar 

  19. Gutierrez C, Marco A, Nogales A, Tebar R (2002) Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation. J Pediatr Gastroenterol Nutr 35(1):31–38

    Article  PubMed  Google Scholar 

  20. Landis JKG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  21. Zaslavsky C, da Silveira TR, Maguilnik I (1998) Total and segmental colonic transit time with radio-opaque markers in adolescents with functional constipation. J Pediatr Gastroenterol Nutr 27(2):138–142

    Article  PubMed  CAS  Google Scholar 

  22. Bautista Casasnovas A, Varela Cives R, Villanueva Jeremias A, Castro-Gago M, Cadranel S, Tojo Sierra R (1991) Measurement of colonic transit time in children. J Pediatr Gastroenterol Nutr 13(1):42–45

    Article  PubMed  CAS  Google Scholar 

  23. Krevsky B, Malmud LS, D’Ercole F, Maurer AH, Fisher RS (1986) Colonic transit scintigraphy. A physiologic approach to the quantitative measurement of colonic transit in humans. Gastroenterology 91(5):1102–1112

    PubMed  CAS  Google Scholar 

  24. Notghi A, Harding LK, Kumar D (1993) Radioisotope determination of regional colonic transit in severe constipation. Gut 34(9):1289

    Article  PubMed  CAS  Google Scholar 

  25. Maurer AH, Krevsky B (1995) Whole-gut transit scintigraphy in the evaluation of small-bowel and colon transit disorders. Semin Nucl Med 25(4):326–338

    Article  PubMed  CAS  Google Scholar 

  26. Notghi A, Mills A, Hutchinson R, Kumar D, Harding LK (1995) Reporting simplified colonic transit studies using radionuclides: clinician friendly reports. Gut 36(2):274–275

    Article  PubMed  CAS  Google Scholar 

  27. Parkman HP, Miller MA, Fisher RS (1995) Role of nuclear medicine in evaluating patients with suspected gastrointestinal motility disorders. Semin Nucl Med 25(4):289–305

    Article  PubMed  CAS  Google Scholar 

  28. Stanghellini V, Tosetti C, Corinaldesi R (2000) Standards for non-invasive methods for gastrointestinal motility: scintigraphy. A position statement from the Gruppo Italiano di Studio Motilita Apparato Digerente (GISMAD). Dig Liver Dis 32(5):447–452

    Article  PubMed  CAS  Google Scholar 

  29. Notghi A, Kumar D, Panagamuwa B, Tulley NJ, Hesslewood SR, Harding LK (1993) Measurement of colonic transit time using radionuclide imaging: analysis by condensed images. Nucl Med Commun 14(3):204–211

    Article  PubMed  CAS  Google Scholar 

  30. van der Sijp JR, Kamm MA, Nightingale JM, Britton KE, Mather SJ, Morris GP, Akkermans LM, Lennard-Jones JE (1993) Radioisotope determination of regional colonic transit in severe constipation: comparison with radio opaque markers. Gut 34(3):402–408

    Article  PubMed  Google Scholar 

  31. Eising EG, von der Ohe MR (1998) Differentiation of prolonged colonic transit using scintigraphy with indium-111-labeled polystyrene pellets. J Nucl Med 39(6):1062–1066

    PubMed  CAS  Google Scholar 

  32. Ohlsson B, Truedsson M, Bengtsson M, Torstenson R, Sjolund K, Bjornsson ES, Simren M (2005) Effects of long-term treatment with oxytocin in chronic constipation; a double blind, placebo-controlled pilot trial. Neurogastroenterol Motil 17(5):697–704

    Article  PubMed  CAS  Google Scholar 

  33. Proano M, Camilleri M, Phillips SF, Brown ML, Thomforde GM (1990) Transit of solids through the human colon: regional quantification in the unprepared bowel. Am J Physiol 258(6 Pt 1):G856–G862

    PubMed  CAS  Google Scholar 

  34. Staiano A, Santoro L, De Marco R, Miele E, Fiorillo F, Auricchio A, Carpentieri ML, Celli J, Auricchio S (1999) Autonomic dysfunction in children with Hirschsprung’s disease. Dig Dis Sci 44(5):960–965

    Article  PubMed  CAS  Google Scholar 

  35. Chen ML, Keens TG (2004) Congenital central hypoventilation syndrome: not just another rare disorder. Paediatr Respir Rev 5(3):182–189

    Article  PubMed  Google Scholar 

  36. Knowles CH, Scott SM, Wellmer A, Misra VP, Pilot MA, Williams NS, Anand P (1999) Sensory and autonomic neuropathy in patients with idiopathic slow-transit constipation. Br J Surg 86(1):54–60

    Article  PubMed  CAS  Google Scholar 

  37. Bonapace ES, Maurer AH, Davidoff S, Krevsky B, Fisher RS, Parkman HP (2000) Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms. Am J Gastroenterol 95(10):2838–2847

    Article  PubMed  CAS  Google Scholar 

  38. Scott SM, Picon L, Knowles CH, Fourquet F, Yazaki E, Williams NS, Lunniss PJ, Wingate DL (2003) Automated quantitative analysis of nocturnal jejunal motor activity identifies abnormalities in individuals and subgroups of patients with slow transit constipation. Am J Gastroenterol 98(5):1123–1134

    Article  PubMed  CAS  Google Scholar 

  39. Gunay A, Gurbuz AK, Narin Y, Ozel AM, Yazgan Y (2004) Gallbladder and gastric motility in patients with idiopathic slow-transit constipation. South Med J 97(2):124–128

    Article  PubMed  Google Scholar 

  40. Stewart DR, Nixon GW, Johnson DG, Condon VR (1977) Neonatal small left colon syndrome. Ann Surg 186(6):741–745

    Article  PubMed  CAS  Google Scholar 

  41. King SK, Sutcliffe JR, Hutson JM (2005) Laparoscopic seromuscular colonic biopsies: a surgeon’s experience. J Pediatr Surg 40(2):381–384

    Article  PubMed  Google Scholar 

  42. Chiba T, Thomforde GM, Kost LJ, Allen RG, Phillips SF (2000) Motilides accelerate regional gastrointestinal transit in the dog. Aliment Pharmacol Ther 14(7):955–960

    Article  PubMed  CAS  Google Scholar 

  43. Krevsky B, Maurer AH, Malmud LS, Fisher RS (1989) Cisapride accelerates colonic transit in constipated patients with colonic inertia. Am J Gastroenterol 84(8):882–887

    PubMed  CAS  Google Scholar 

  44. King SK, Sutcliffe JR, Southwell BR, Chait PG, Hutson JM (2005) The antegrade continence enema successfully treats idiopathic slow-transit constipation. J Pediatr Surg 40(12):1935–1940

    Article  PubMed  Google Scholar 

  45. Youssef NN, Pensabene L, Barksdale E Jr, Di Lorenzo C (2004) Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation? J Pediatr Surg 39(1):73–77

    Article  PubMed  Google Scholar 

  46. Southwell BR, King SK, Hutson JM (2005) Chronic constipation in children: organic disorders are a major cause. J Paediatr Child Health 41(1–2):1–15

    Article  PubMed  CAS  Google Scholar 

  47. Chase J, Robertson VJ, Southwell B, Hutson J, Gibb S (2005) Pilot study using transcutaneous electrical stimulation (interferential current) to treat chronic treatment-resistant constipation and soiling in children. J Gastroenterol Hepatol 20(7):1054–1061

    PubMed  Google Scholar 

  48. Clarke MCC, Chase JW, Gibb S, Robertson VJ, Catto-Smith AG, Hutson JM, Southwell BR (2009) Decreased colonic transit time after transcutaneous interferential electrical stimulation in children with slow transit constipation. J Pediatr Surg 44(2):408–412

    Article  PubMed  Google Scholar 

  49. Clarke MCC, Chase JW, Gibb S, Hutson JM, and Southwell BR (2009) Improvement in quality of life in children with slow transit constipation following treatment with transcutaneous electrical stimulation. J Pediatr Surg (in press, June)

  50. Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Pediatr Surg 31(4):580–583

    Article  PubMed  CAS  Google Scholar 

  51. Hutson JM, Chow CW, Hurley MR, Uemura S, Wheatley JM, Catto-Smith AG (1997) Deficiency of substance P-immunoreactive nerve fibres in children with intractable constipation: a form of intestinal neuronal dysplasia. J Paediatr Child Health 33(3):187–189

    Article  PubMed  CAS  Google Scholar 

  52. Nam YS, Pikarsky AJ, Wexner SD, Singh JJ, Weiss EG, Nogueras JJ, Choi JS, Hwang YH (2001) Reproducibility of colonic transit study in patients with chronic constipation. Dis Colon Rectum 44(1):86–92

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of General Surgery, Royal Children’s Hospital, Melbourne, Australia

    Jonathan R. Sutcliffe, Sebastian K. King & John M. Hutson

  2. Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Melbourne, 3052, Australia

    Sebastian K. King, John M. Hutson & Bridget R. Southwell

  3. Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Sebastian K. King, John M. Hutson & Bridget R. Southwell

  4. Department of Medical Imaging, Royal Children’s Hospital, Melbourne, Australia

    David J. Cook

Authors
  1. Jonathan R. Sutcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian K. King
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John M. Hutson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David J. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bridget R. Southwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bridget R. Southwell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sutcliffe, J.R., King, S.K., Hutson, J.M. et al. Gastrointestinal transit in children with chronic idiopathic constipation. Pediatr Surg Int 25, 465–472 (2009). https://doi.org/10.1007/s00383-009-2374-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-009-2374-2

Keywords

Search

Navigation