Gastrointestinal transit in children with chronic idiopathic constipation.
Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated.


OBJECTIVE
The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation.


METHODS
Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively.


RESULTS
Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups.


CONCLUSIONS
Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic transit.
Department of General Surgery, Royal Children's Hospital, Melbourne, Australia.
Jonathan R
JR
Sutcliffe
Sebastian K
SK
King
John M
JM
Hutson
David J
DJ
Cook
Bridget R
BR
Southwell
D001003:Anal Canal / Q000000981:diagnostic imaging*; D002648:Child; D002908:Chronic Disease; D003106:Colon / Q000000981:diagnostic imaging*; D003248:Constipation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005772:Gastrointestinal Transit; D006801:Humans; D011877:Radionuclide Imaging