title: The effect of food withdrawal in children with rapid-transit constipation.
abstract: BACKGROUND
  Rapid proximal colonic transit with anorectal holdup is a subtype of chronic constipation linked to food intolerance. We aimed to determine the effectiveness of dietary exclusion as a treatment for constipated children with rapid-transit constipation by scintigraphy.
  
  
  METHODS
  Questionnaires on diet and symptoms were mailed out to 125 children with chronic constipation and rapid proximal colonic transit on nuclear transit study at our institute between 1998 and 2014 years. Patients were given instructions and encouraged to undertake a six-food elimination diet targeting common protein allergens (dairy, wheat, soy, eggs, nuts, seafood). Answers were completed by circling an option or on visual analogue scale. Results were evaluated statistically using GraphPad Prism 6 by a Wilcoxon matched-pairs rank test. P < 0.05 was considered significant.
  
  
  RESULTS
  We received 44/125 responses, 26 patients [mean age 11 years (5-21)] had attempted elimination diet and 18 had not. Dairy and wheat were the most common foods eliminated and symptomatic improvement was greater for patients who had completely eliminated foods. Constipation, abdominal pain and pain on defecation were reduced (p < 0.01). Laxative usage decreased, although this was not statistically significant. Families encountered problems with dietary exclusion, particularly expense. Assistance from a dietician or nutritionist was sought by >50 % of families.
  
  
  CONCLUSIONS
  Dietary exclusion is a promising strategy to treat constipation in children with rapid proximal colonic transit. However, it was hard for many families, demonstrating the need for identifying the cause more specifically and a better set of instructions for the family and/or dietitian to follow.
authors.affiliation: FD Stephens Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Kearsey
authors.affiliation: FD Stephens Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia. john.hutson@rch.org.au.|Urology Department, The Royal Children's Hospital, Melbourne, Australia. john.hutson@rch.org.au.|Department of Paediatrics, University of Melbourne, Melbourne, Australia. john.hutson@rch.org.au.
authors.forename: J M
authors.initials: JM
authors.lastname: Hutson
authors.affiliation: FD Stephens Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: B R
authors.initials: BR
authors.lastname: Southwell
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D003106:Colon / Q000503:physiopathology*; D003248:Constipation / Q000503:physiopathology / Q000628:therapy*; D003672:Defecation; D005260:Female; D005502:Food; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: Food intolerance; Nuclear transit study; Paediatrics; Rapid-transit constipation