Defaecation disorders in children, colonic transit time versus the Barr-score

Abstract

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate the presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children. On clinical grounds, patients (median age 8 years (5-14 years)) could be divided into three groups; constipation, isolated encopresis/soiling and recurrent abdominal pain. Barr-scores, a method for assessment of stool retention using plain abdominal radiographs, were obtained in the first 101 patients, for comparison with CTT measurements as to the clinical outcome. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter- and intra-observer reliability. This is the first study which shows that clinical differences in constipated children are associated with different colonic transit patterns. The usefulness of CTT measurements lies in the objectivation of complaints and the discrimination of certain transit patterns. Conclusion. Abdominal radiographs, even when assessed with the Barr-score proved unreliable in diagnosing constipation.(ABSTRACT TRUNCATED AT 250 WORDS)

Value of Abdominal Radiography, Colonic Transit Time, and Rectal Ultrasound Scanning in the Diagnosis of Idiopathic Constipation in Children: A Systematic Review

“…Bijos et al calculated a recto-pelvic ratio by dividing the transverse diameter of the rectal ampulla by the transverse diameter of the pelvis. 31 In children with functional constipation, the mean recto pelvic ratio was 0.22 AE 0.05, compared with 0.15 AE 0.04 in healthy control subjects. The difference was statistically significant in all age groups.…”

“…No diagnostic accuracy study (n=8;CTT;X-ray) [9][10][11][12][13][14][15][16] No children included (n=1;ultrasound) 17 No control group (n=1;CTT) 18 No reference standard defined (n=2;ultrasound;X-ray) 19,20 Patients with severe comorbidity (n=1;CTT) 21 Systematic review, no QUADAS (n=1;CTT) 22 Included papers (n=10) Systematic review including 6 studies on abdominal radiography (n=1) 23 Diagnostic value of abdominal radiography (n=2) 24,25 Diagnostic value of CTT (n=3) [25][26][27] Diagnostic value of Ultrasonography (n=4) [25][26][27][28][29][30][31] Figure. …”

Treatment of defaecation problems in children: the role of education, demystification and toilet training

“…any other criteria of constipation [3,4,14]. Children with organic causes of faecal incontinence such as, muscle disorders, spina bi®da, anal atresia and Hirschsprung disease or mental retardation were excluded.…”

Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar

“…1,3 It also involves constitutional factors, a low-fiber diet, and motility disorders of the digestive tract characterized by an increase in intestinal transit time, especially in the colon. 1,4,5 Hypothetically, distension of the colonic wall may compromise its contraction and propulsive force, or even be accompanied by the absence of high-amplitude peristaltic colonic waves, which propel stool toward the rectum. This situation has been described in children with severe refractory constipation, in whom colonic manometry did not reveal high-amplitude peristaltic colonic waves, even after stimulation of a meal (gastrocolic reflex) or administration of a peristaltic stimulant.…”