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

  • Gastroenterology/Hepatology
  • Original Paper
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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. Marker studies should be performed in the second stage of evaluation after failure of initial therapy.

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Abbreviations

CTT :

colonic transit time

ES :

encopresis/soiling

PC :

paediatric constipation

RAP :

recurrent abdominal pain

References

  1. Altman DG (1991) Practical statistics for medical research. Chapman and Hall. London

    Google Scholar 

  2. Apley J, Naish N (1958) Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child 33:165–170

    Google Scholar 

  3. Arhan P, Devroede G, Jehannin B, Faverdin C, Révillon Y, Lefevre D, Pellerin D (1983) Idiopathic disorders of fecal continence in children. Pediatrics 71:774–779

    Google Scholar 

  4. Arhan P, Devroede G, Jehannin B, Lanza M, Faverdin C, Dornic C, Persoz B, Tétreault L, Perey B, Pellerin D (1981) Segmental colonic transit time. Dis Colon Rectum 24:625–629

    Google Scholar 

  5. Arhan P, Favérdin CI, Bouchóucha, Brésson JL, Pellerin D (1989) Using the radio-opaque marker technique in children. In: Read NW (ed) Gastrointestinal motility: which test? Wrightson Biomedical Publishing Ltd, pp 175–180

  6. Barr RG, Levine MD, Wilkinson RH, Mulvihill D (1979) Occult stool retention: a clinical tool for its evaluation in school-aged children. Clin Pediatr 18:674–679

    Google Scholar 

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

    Google Scholar 

  8. Benninga MA, Büller HA, Akkermans LM, Taminiau JA (1993) Does slow transit constipation exist in children? Gastroenterology 104:A475

    Google Scholar 

  9. Benninga MA, Büller HA, Heymans HSA, Tytgat GNJ, Taminiau JAJM (1994) Is encopresis always the result of constipation? Arch Dis Child 71:186–193

    Google Scholar 

  10. Bouchoucha M, Devroede G, Arhan P, Strom B, Weber J, Cugnenc PH, Denis P Barbier JP (1992) What is the meaning of colorectal transit time measurement. Dis Colon Rectum 35:773–782

    Google Scholar 

  11. Chaussaude S, Khyari A, Roche H, Garret M, Gaudric M, Couturier D, Guerre J (1989) Determination of total and segmental colonic transit time in constipated patients. Results in 91 patients with a new simplified method. Dig Dis Sci 34:1168–1172

    Google Scholar 

  12. Corazziari E, Cucchiara S, Staiano A, Romaniello G, Tamburrinin O, Torsoli A, Auricchio S (1985) Gastrointestinal transit time, frequency of defaecation, and anorectal manometry in healthy and constipated children. J Pediatr 106:379–382

    Google Scholar 

  13. Cucchiara S, Coremans G, Staiano A, Corazziari E, Romaniello G, Di Lorenzo C, Tamburrini O, Auricchio S (1984) Gastrointestinal transit time and anorectal manometry in children with fecal soiling. J Pediatr Gastroenterol Nutr 3:545–550

    Google Scholar 

  14. Cummings JH, Jenkins DJA, Wiggins HS (1976) Measurement of the mean transit time of dietary residue through the human gut. Gut 17:210–218

    Google Scholar 

  15. Devroede G (1983) Constipation: mechanisms and management. In: Sleisenger MH, Fordtran JD (eds) Gastrointestinal disease: pathophysiology, diagnosis, treatment. WB Saunders, Philadelphia, pp 288–308

    Google Scholar 

  16. Ducrotte P, Rodomanska B, Weber J, Guillard JF, Lerebours E, Hecketsweiler P, Galmiche JP, Colin R, Denis P (1986) Colonic transit time of radiopaque markers and rectoanal manometry in patients complaining of constipation. Dis Colon Rectum 29:630–634

    Google Scholar 

  17. Hinton JM, Lennard-Jones JE (1968) Constipation: definition and classification. Postgrad Med J 44:720

    Google Scholar 

  18. Hinton JM, Lennard-Jones JE, Young AC (1969) A new method for studying gut transit times using radiopaque markers. Gut 10:842–847

    Google Scholar 

  19. Kamm MA, Sijp JRM van der, Hawley PR, Philipps RKS, Lennard-Jones JE (1991) Left Hemicolectomy with Rectal excision for severe idiopathic constipation. Int J Colorect Dis 6:49–51

    Google Scholar 

  20. Krevski B, Malmud LS, Maurer AH, Siegel JA, Fisher RS (1988) Cisapride accelerates colonic transit in constipated patients with colonic inertia. Gastroenterology 94:A239

    Google Scholar 

  21. Levine MD (1982) Encopresis: its potentation, evaluation and alleviation. Pediatr Clin North AM 29:315–330

    Google Scholar 

  22. Levitt MD, Duane WC (1972) Floating stools-flatus versus fat. N Eng J Med 286:973–975

    Google Scholar 

  23. Likongo Y, Devroede G, Schang JC, Arhan P, Vobecky S, Novert H, Carmel M, Lamoureux G, Strom B, Dugay C (1986) Hepato colonic dysgenesis: a cause of constipation with colonic inertia. Dig Dis Sci 31:993–1003

    Google Scholar 

  24. Manning G, Wyman JB, Heaton KW (1976) How trustworthy are bowel histories? Comparison of recalled and recorded information. BMJ 2:213–214

    Google Scholar 

  25. Martelli H, Devroede G, Arhan P, Duguay C (1978) Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology 75:623–631

    Google Scholar 

  26. Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG (1987) Simplified assessment of segmental colonic transit. Gastroenterology 92:40–47

    Google Scholar 

  27. Meunier P, Marechal JM, Beaujeu J de (1979) Rectoanal pressures and rectal sensitivity studies in chronic childhood constipation. Gastroenterology 77:330–336

    Google Scholar 

  28. Pemberton JH, Rath DM, Ilstrup DM (1991) Evaluation and surgical treatment of severe chronic constipation. Ann Surg 214:403–413

    Google Scholar 

  29. Preston DM, Lennard-Jones JE (1985) Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation. Dig Dis Sci 30:289–294

    Google Scholar 

  30. Preston DM, Lennard-Jones JE (1986) Severe chronic constipation of young women: ‘idiopathic slow transit constipation’. Gut 27:41–48

    Google Scholar 

  31. 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:G856-G862

    Google Scholar 

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

    Google Scholar 

  33. Verduron A, Devroede G, Bouchoucha M, Arhan P, Schang JC, Poisson J, Hémond M, Hébert M (1988) Megarectum. Dig Dis Sci 33:1164–1174

    Google Scholar 

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

    Google Scholar 

  35. Wald A, Hinds JP, Caruana J (1989) Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology 97:932–937

    Google Scholar 

  36. Watier A, Devroede G, Duranceau A (1983) Constipation with colonic inertia: a manifestation of systemic disease? Dig Dis Sci 28:1025–1033

    Google Scholar 

  37. Younoszai MK, Tolaymat N (1989) Chronic functional constipation in infants and children. In: Lebenthal E (ed) Textbook of gastroenterology and nutrition in infancy, 2nd ed. Ravenpress, New York, pp 1311–1326

    Google Scholar 

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Benninga, M.A., Büller, H.A., Staalman, C.R. et al. Defaecation disorders in children, colonic transit time versus the Barr-score. Eur J Pediatr 154, 277–284 (1995). https://doi.org/10.1007/BF01957362

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  • DOI: https://doi.org/10.1007/BF01957362

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