Colonic Transit Time and Fecal Impaction in Children and Adolescents With Cystic Fibrosis-associated Constipation

Abstract

Background: Constipation is prevalent in pediatric cystic fibrosis (CF) patients and colonic motility has not been studied in this population. In this study, we aimed to evaluate the total and segmental colonic transit time in children and adolescents with CF based on the presence of constipation and radiological fecal impaction. Methods: In this case series, all patients aged 3 to 20 years of a CF reference center were invited to participate. CF-associated constipation was diagnosed based on the European Society for Paediatric Gastroenterology Hepatology and Nutrition criteria. Total and segmental colonic transit time was determined using radiopaque markers. Fecal impaction on plain abdominal radiography was assessed based on the Barr score. Results: Of the 43 eligible patients, 34 (79%) agreed to participate. Constipation was found in 44.1% of children and adolescents, predominantly in girls. The total colonic transit time (medians of 42 and 24 hours, respectively, P ¼ 0.028) and the segmental right colon transit time (medians of 8 and 2 hours, respectively, P ¼ 0.012) were significantly longer in CF-associated constipation group than in the group of patients without constipation. The frequency of radiological fecal impaction was similar in patients with (50.0%) and without (64.2%) CF-associated constipation (P ¼ 0.70). There was no relationship between radiological fecal impaction and the total and segmental colonic transit time. Conclusions: Children and adolescents with CF-associated constipation had a longer total and segmental right colon transit time. Colonic transit time was similar in patients with and without radiological fecal impaction.

Constipation and cystic fibrosis. Slow movement

“…So far the ESPGHAN criteria were used in only two studies. In a small study 15 out of 34 patients, aged 3-20 years, turned out to be constipated (44%) [6] , while in a study amongst 230 patients, aged 0-18 years, a period prevalence of 47% (107/230) was found [5] . At the moment of this survey 46 out of the 230 patients were constipated, amounting to a point prevalence of 20% [5] .…”

Shengjing Runchang Decoction ameliorates spleen deficiency-induced constipation in children: An observational study

“…CTT mainly reflects whether the colonic transit function is normal or not, and if the CTT level is too low, it reflects the overactive colonic transit function in children. [ 28 ] GDNF is the most specific dopaminergic neurotrophic factor and a motor neuron trophic factor. Elevated GDNF expression indicates abnormal intestinal transport function, and decreased expression indicates improved intestinal transport function.…”

The current state of gastrointestinal motility evaluation in cystic fibrosis: a comprehensive literature review

“…Furthermore, in young adult pwCF who were nutritionally optimized and receiving adequate pancreatic enzyme replacement therapy, comparison of total GI and segmental colonic transit times to healthy controls utilizing ROMs demonstrated no significant difference ( 95 ). A recent case series of pediatric pwCF highlighted prolonged total and right colon transit time using ROMs in those with comorbid constipation; however, transit time values were overall shortened compared to available literature on patients with functional constipation ( 90 , 96 ). Interestingly, regardless of constipation diagnosis almost two-thirds of pwCF were found to have fecal impaction, which has been previously reported in the literature on pwCF ( 85 , 90 ).…”

“…Radiopaque (sitz) marker (ROM) studies have varying institutional protocols; however, involve ingestion of a specified marker quantity with interval abdominal X-rays to determine location ( 91 , 92 ). Based on location and interval time between X-rays, segmental and total colonic transit times can be extrapolated and have been standardized ( 90 - 94 ). In pediatric patients more than 3 years old, normal colonic transit times have been reported with no significant variation associated with sex or age ( 93 , 94 ).…”

“…An estimated prevalence between 32–57% for constipation in pwCF has been reported throughout the literature ( 3 , 83 - 89 ). Although not completely understood, constipation in CF appears to be multifactorial with stool impaction greatly affected by secretion of thick mucous and predisposition of the CF intestine to dysmotility; however, the influence of pancreatic insufficiency and low total fat absorption is debated ( 8 , 89 , 90 ). Distinct from healthy patients, those with CF may pass daily bowel movements despite imaging with evidence of a large stool burden and/or fecal impaction ( 3 , 83 - 90 ).…”