title: Nuclear transit studies of patients with intractable chronic constipation reveal a subgroup with rapid proximal colonic transit.
abstract: OBJECTIVE
  Nuclear transit studies (NTS) allow us to follow transit through the stomach and the small and large intestines. We identified children with chronic constipation with rapid proximal colonic transit and characterized their clinical features.
  
  
  METHODS
  We reviewed NTS from 1998 to 2009 to identify patients with chronic constipation and rapid proximal colonic transit, defined as greater than 25% of tracer beyond hepatic flexure at 6 hour and/or greater than 25% of tracer beyond end of descending colon at 24 hour. This was correlated with clinical symptoms and outcome from patient records.
  
  
  RESULTS
  Five hundred twenty children with chronic constipation underwent investigation by NTS, and 64 (12%) were identified with rapid proximal colonic transit. The clinical history, symptoms, and outcome in 55 of 64 available for analysis frequently showed family history of allergy (10.9%) and symptoms associated with food allergy/intolerance: abdominal pain (80%), anal fissure (27.3%), and other allergic symptoms (43.6%). Eighteen children were treated with dietary exclusion, with resolution of symptoms in 9 (50%).
  
  
  CONCLUSIONS
  Some children with intractable chronic constipation have rapid proximal colonic transit, have symptoms consistent with possible food allergy/intolerance, and may respond to dietary exclusion. The NTS can identify these patients with rapid proximal transit that may be secondary to food intolerance.
authors.affiliation: F Douglas Stephens Surgical Research and Gut Motility Laboratories, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Yee Ian
authors.initials: YI
authors.lastname: Yik
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Cain
authors.forename: Coral F
authors.initials: CF
authors.lastname: Tudball
authors.forename: David J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Bridget R
authors.initials: BR
authors.lastname: Southwell
authors.forename: John M
authors.initials: JM
authors.lastname: Hutson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000465:Algorithms; D001706:Biopsy; D002908:Chronic Disease; D002951:Citrates; D003248:Constipation / Q000145:classification / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D004802:Eosinophilia / Q000209:etiology; D005401:Fissure in Ano / Q000209:etiology; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy; D005708:Gallium; D005710:Gallium Radioisotopes; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000235:genetics; D054368:Laxatives / Q000627:therapeutic use; D016269:Milk Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors
chemical_list: D002951:Citrates; D005710:Gallium Radioisotopes; D054368:Laxatives; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D005708:Gallium; C103850:gallium citrate