Red flags for potential CE retention identified in our study include known IBD (5.2% retention risk), previous small bowel follow-through demonstrating small bowel CD (37.5% retention risk), and BMI <5th percentile with known IBD (43% retention risk). Caution is advised in these pediatric patients before capsule ingestion.

Background Breath testing is becoming an important diagnostic method to evaluate many disease states. In light of rising healthcare costs, is important to develop a simple non-invasive tool to potentially identify pediatric patients who need endoscopy for suspected inflammatory bowel disease (IBD). Aim The primary aim of this study was to analyze exhaled volatile organic compounds (VOCs) to evaluate for the presence of a unique breath pattern to differentiate pediatric patients with (IBD) from healthy controls. Methods A cross-sectional, single-center study included pediatric IBD patients and healthy controls (age range, 5-21 years). The diagnosis of IBD was confirmed by endoscopic, histologic, and radiographic data. Exhaled breath was collected and analyzed using a selective ion flow tube mass spectroscopy (SIFT-MS) to identify new markers or patterns of IBD. Results 117 patients (62 with IBD and 55 healthy controls) were included in the study. Linear discriminant analysis and principle component analysis of mass scanning ion peak data demonstrated 21 pre-selected VOCs correctly classify patients with IBD or as healthy controls; p < 0.0001. Multivariable logistic regression analysis further showed 3 specific VOCs (1-octene, 1-decene, (E)-2-nonene) had excellent accuracy for predicting the presence of IBD with an area under the curve (AUC) of 0.96 (95% CI: 0.93, 0.99). No significant difference in VOCs was found between patients with Crohn's disease or ulcerative colitis and no significant correlation was seen with disease activity. Conclusion This pilot data supports the hypothesis that a unique breathprint potentially exists for pediatric IBD in the exhaled metabolome.

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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.