title: Nuclear transit study in children with chronic faecal soiling after Hirschsprung disease (HSCR) surgery has revealed a group with rapid proximal colonic treatment and possible adverse reactions to food.
abstract: OBJECTIVE
  Long-term problems with faecal incontinence occur in up to 50 % of patients after pull-through for Hirschsprung disease (HSCR). The cause often remains unknown, leading to empirical treatments. Using nuclear transit study, we found some patients surprisingly had rapid proximal colonic transit, suspicious of occult diarrhoea. We aimed to assess whether these patients had unrecognized adverse reactions to food.
  
  
  METHODS
  Patients (n = 10, all males, 9.6 year; 4.25-15.5 years) with persistent faecal incontinence following pull-through for HSCR referred to the senior author and after exclusion of anatomical defects, underwent nuclear transit studies. Most (8) subsequently underwent breath hydrogen tests for sugar malabsorption and were tested for adverse reactions to food. Exclusion diets for protein allergens, lactose or fructose were then trialed.
  
  
  RESULTS
  Of the 10 patients with rapid intestinal transit proven on nuclear transit study, breath hydrogen tests for fructose and/or lactose malabsorption were done in 8, and were positive in 7/8 patients. Exclusion diets contributed to either resolution or improvement in faecal incontinence in 9/10 patients.
  
  
  CONCLUSIONS
  Rapid transit in the proximal, ganglionated colon may be present in children with faecal incontinence following pull-through for HSCR, possibly secondary to adverse reactions to food. This study suggests that children with post-operative soiling may benefit from a transit study and hydrogen breath tests to diagnose adverse reactions to food caused by sugar malabsorption.
authors.affiliation: Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.
authors.forename: Lefteris
authors.initials: L
authors.lastname: Stathopoulos
authors.affiliation: Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.|Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia.
authors.forename: Sebastian K
authors.initials: SK
authors.lastname: King
authors.affiliation: Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Bridget R
authors.initials: BR
authors.lastname: Southwell
authors.affiliation: Surgical Research, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. john.hutson@rch.org.au.|Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. john.hutson@rch.org.au.|Department of Urology, The Royal Children's Hospital, Melbourne, VIC, Australia. john.hutson@rch.org.au.
authors.forename: John M
authors.initials: JM
authors.lastname: Hutson
mesh_terms: D000293:Adolescent; D001944:Breath Tests; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000503:physiopathology*; D005512:Food Hypersensitivity / Q000503:physiopathology*; D005632:Fructose / Q000378:metabolism; D005772:Gastrointestinal Transit / Q000502:physiology*; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007785:Lactose / Q000378:metabolism; D008286:Malabsorption Syndromes / Q000503:physiopathology*; D008297:Male; D011183:Postoperative Complications
chemical_list: D005632:Fructose; D006859:Hydrogen; D007785:Lactose
keywords: Allergy; Food; Hirschsprung disease; Rapid colonic transit