24-Hour colonic manometry in pediatric slow transit constipation shows significant reductions in antegrade propagation.
BACKGROUND
The physiological basis of slow transit constipation (STC) in children remains poorly understood. We wished to examine pan-colonic motility in a group of children with severe chronic constipation refractory to conservative therapy.


METHODS
We performed 24 h pan-colonic manometry in 18 children (13 boys, 11.6 +/- 0.9 yr, range 6.6-18.7 yr) with scintigraphically proven STC. A water-perfused, balloon tipped, 8-channel, silicone catheter with a 7.5 cm intersidehole distance was introduced through a previously formed appendicostomy. Comparison data were obtained from nasocolonic motility studies in 16 healthy young adult controls and per-appendicostomy motility studies in eight constipated children with anorectal retention and/or normal transit on scintigraphy (non-STC).


RESULTS
Antegrade propagating sequences (PS) were significantly less frequent (P < 0.01) in subjects with STC (29 +/- 4 per 24 h) compared to adult (53 +/- 4 per 24 h) and non-STC (70 +/- 14 per 24 h) subjects. High amplitude propagating sequences (HAPS) were of a normal frequency in STC subjects. Retrograde propagating sequences were significantly more frequent (P < 0.05) in non-STC subjects compared to STC and adult subjects. High amplitude retrograde propagating sequences were only identified in the STC and non-STC pediatric groups. The normal increase in motility index associated with waking and ingestion of a meal was absent in STC subjects.


CONCLUSIONS
Prolonged pancolonic manometry in children with STC showed significant impairment in antegrade propagating motor activity and failure to respond to normal physiological stimuli. Despite this, HAPS occurred with normal frequency. These findings suggest significant clinical differences between STC in children and adults.
King
Sebastian K
SK
Department of General Surgery, Royal Children's Hospital, Melbourne, Australia.
Catto-Smith
Anthony G
AG
Stanton
Michael P
MP
Sutcliffe
Jonathan R
JR
Simpson
Dianne
D
Cook
Ian
I
Dinning
Phil
P
Hutson
John M
JM
Southwell
Bridget R
BR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D003106:Colon / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003248:Constipation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry; D018670:Monitoring, Ambulatory; D016065:Myoelectric Complex, Migrating / Q000502:physiology*; D011859:Radiography; D011877:Radionuclide Imaging; D016138:Walking