Oro-Anal Transit Time and Colon Manometry: Predictability and Outcomes in Children With Functional Constipation

Abstract

Objectives: The primary objective of the study was to evaluate the correlation of oro-anal transit time (OTT) using SITZMARKS® (Konsyl Pharmaceuticals Inc., Easton, MD, USA) with colonic manometry (CM) in children with chronic idiopathic constipation (CIC). The secondary objective was to determine the clinical utility of these studies in directing treatment strategies.Methods: A retrospective chart review of 44 children with CIC was evaluated with both OTT and CM. The median follow-up was one year (0.3 to 7).Results: Seventeen children had normal OTT, and 27 had abnormal OTT (slow-transit constipation (STC)). There was no statistical difference between the percentage of children with abnormal CM (13) test results categorized by OTT (23.5% normal OTT vs. 33% abnormal OTT, p = 0.73). A change in therapy was accepted by all 13 children with abnormal CM, but only 26/31 (84%) of the children had normal CM. The CM test results prompted acceptance of treatment change (appendicectomy or medication escalation) in 89% of children. Overall, 31/44 (70%) of children undergoing CM testing had improvement in clinical symptoms. More children with abnormal CM testing improved vs. normal CM but did not reach significance (85% vs. 65%, p = 0.28). Conclusion: Contrary to previous studies, OTT results did not predict the presence of colonic dysmotility based on colon motility testing. Colonic manometry testing resulted in the acceptance of a change in therapy in approximately 90% of children. More children with colonic dysmotility improved versus those with normal CM studies. Other interventions beyond stimulant laxatives should be considered in children with refractory constipation.